Yes / There have been concerns about the quality and safety of NHS hospital services since the turn of the millennium. This study investigated the progress that acute NHS hospital trusts have made in developing and using technology infrastructures to enable them to monitor quality and safety following the publication in 2013 of the second Francis report on the scandal at Mid Staffordshire NHS Foundation Trust (The Mid Staffordshire NHS Foundation Trust Public Inquiry. Chaired by Sir Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. HC 898. London: The Stationery Office; 2013). Methods: A telephone survey of 15 acute NHS trusts in the Yorkshire and the Humber region, and a review of board papers of all acute NHS trusts in England for January 2015, were undertaken. The telephone survey was used to identify trusts for a larger field study, which was undertaken in four acute NHS trusts between April 2015 and September 2016. The methods included the direct observation of the use of whiteboards and other technologies on two wards in each trust, an observation of board quality committees, semistructured interviews and an analysis of the quality and safety data in board papers. Published sources about national and local agencies were reviewed to identify the trust quality and safety data that these agencies accessed and used. An interview programme was also undertaken with those organisations. The Biography of Artefacts approach was used to analyse the data. Findings: The data and technology infrastructures within trusts had developed over many years. The overall design had been substantially determined by national agencies, and was geared to data processing: capturing and validating data for submission to national agencies. Trust boards had taken advantage of these data and used them to provide assurance about quality and safety. Less positively, the infrastructures were fragmented, with different technologies used to handle different quality and safety data. Real-time management systems on wards, including electronic whiteboards and mobile devices, were used and valued by nurses and other staff. The systems support the proactive management of clinical risks. These developments have occurred within a broad context, with trusts focusing on improving the quality and safety of services and publishing far more data on their performance than they did just 3 years earlier. Trust-level data suggest that quality and safety improved at all four trusts between 2013 and 2016. Our findings indicate that the technology infrastructures contributed to these improvements. There remains considerable scope to rationalise those infrastructures. / National Institute for Health Research Health Services and Delivery Research programme.

The UK's NHS is the largest employer in Europe with approximately 1.3 million staff. Around 83% of the journeys associated with the NHS are made by private car. In this context, every healthcare authority was required to produce a travel plan by December 2010, including an emphasis on promoting walking and cycling as a means of accessing hospitals. Evidence shows that although the take-up of travel plans is increasing across the NHS, the impact of travel plans in promoting walking as a travel option is relatively low among hospital staff. A scoping study has been conducted aiming to bridge the gap between research and practice by capturing the views of the NHS representatives on hospital travel plans by a nationwide survey and review of hospital travel plans. The survey findings show that despite having a high potential to promote walking as a key travel option among the hospital staff, the measures to promote walking were cited as the least effective. A Spearman's ρ correlation coefficient test was performed to evaluate the correlation between travel plan measures to promote walking and restrictive measures to reduce the use of cars. The results show that the effectiveness of measures to reduce the use of cars is positively correlated with the effectiveness of measures to promote walking. The effectiveness of travel plan measures to secure the targeted outcome is attributed to the methods used to address the determinants for changing travel behaviour whilst designing travel plan measures and the successful adoption of innovative strategies in the given context. A theoretical framework has been developed based on the Theory of Planned Behaviour and five key research hypotheses have been proposed to demonstrate the key determinants for changing travel behaviour. The analysis was based on a nationwide survey among the NHS hospital staff in England in 2013. There were 863 completed responses, out of which 459 responses were from hospital staff, who solely relied on car journeys for commuting purposes. Structural equation modelling was performed to investigate the effects of socio-economic, psychological and situational factors in determining intention to change travel behaviour among the car users only. The model estimation results show that the effects of cognitive attitude towards walking and objective mobility were significant on determining intention to change travel behaviour. The respondents exhibited a habitual nature of travel behaviour, which is characterised by longer commuting distance and journey time than the national UK average. The practical implications of the study were addressed by providing recommendations that need to be considered whilst designing travel plan measures. The recommendations were based on the concept of Model for Planned Promotion. This study provides a basis for further conceptualisation of travel behaviour change and identifies several areas that need further investigation in relation to designing interventions to promote walking in the context of healthcare.

Yes / This paper reports on a regionally based UK study uncovering what has worked well in learning from adverse incidents in hospitals. The purpose of this paper is to review the incident investigation methodology used in identifying strengths or weaknesses and explore the use of a database as a tool to embed learning. Documentary examination was conducted of all adverse incidents reported between 1 June 2011 and 30 June 2012 by three UK National Health Service hospitals. One root cause analysis report per adverse incident for each individual hospital was sent to an advisory group for a review. Using terms of reference supplied, the advisory group feedback was analysed using an inductive thematic approach. The emergent themes led to the generation of questions which informed seven in-depth semi-structured interviews. “Time” and “work pressures” were identified as barriers to using adverse incident investigations as tools for quality enhancement. Methodologically, a weakness in approach was that no criteria influenced the techniques which were used in investigating adverse incidents. Regarding the sharing of learning, the use of a database as a tool to embed learning across the region was not supported. Softer intelligence from adverse incident investigations could be usefully shared between hospitals through a regional forum. The use of a database as a tool to facilitate the sharing of learning from adverse incidents across the health economy is not supported.