Innovation and Quality Improvement Current Awareness Bulletin August 2020

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The Henry Fords of healthcare: lessons the West can learn from the East This publication examines the lessons Western nations could learn from some developing countries in fostering innovation and entrepreneurship in health care. Health systems in Western countries are 'plagued by inefficiency and productivity growth': so by adopting a new approach they could cut costs, increase quality and reduce waiting times. Technology and innovation for long-term health conditions – King’s Fund It has become received wisdom that the NHS struggles to adopt digital innovation, with many government reports and research papers highlighting barriers to the spread of technology. Yet during the Covid-19 pandemic, many NHS providers have moved services online at astonishing pace.

This paper, commissioned by the Academic Health Science Network, looks at four digital innovations in health services from the UK and the Nordic countries: the TeleCare North programme, which provides remote treatment for people with chronic obstructive pulmonary disease (COPD); the Patients Know Best portal and electronic health record; remote diabetes monitoring for children at Helsinki University Hospital; and the Huoleti app that connects patients with a support network.

The case studies illustrate the potential of digital technology to transform care, particularly through empowering patients, supporting stronger therapeutic relationships and effective teamworking across professional boundaries, and creating networks and communities to support patients.

The paper also calls on health care providers to assess the impact on staff and patients of the rapid transition to online services driven by the Covid-19 pandemic. Has the impact of the changes been fully assessed? And, in light of these case studies, is there scope to be more ambitious in redesigning services?

Resilient health and care: learning the lessons of Covid-19 in the English NHS This analysis of the state of the health and care system in England in the run-up to the Covid-19 pandemic finds that underinvestment in social and community care left four in five hospitals with ‘dangerously low’ levels of spare beds as the crisis hit. The report calls for a long-term approach for the health and care service in England, to build resilience for any future crisis and to ensure the system isn’t always ‘running hot’ during normal times.

Title: Government unveils roadmap for making UK a "science superpower" Citation: BMJ : British Medical Journal (Online); Jul 2020; vol. 370 Author(s): Torjesen, Ingrid Abstract: 1 Before covid-19 the science community had warned of the damage that Brexit would do to the UK’s science base in terms of lost research funding and collaborative opportunities, as well as difficulties in recruiting top scientists.2 Robert Lechler, president of the Academy of Medical Sciences, said that the roadmap provided welcome recognition of the critical role that research and innovation played in the UK’s future and the global recovery from covid-19. Ambition Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry, said, "The ambition for Britain to be a science superpower is

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exactly the direction we need to take as we leave the EU and emerge from the pandemic. A UK R&D Place Strategy to maximise local growth and societal benefit from R&D around the UK as part of the government’s "levelling up" agenda will be published later this year, the plan says, and an Innovation Expert Group will be established to review how the government supports research through all stages of development. 1 Department for Business, Energy & Industrial Strategy.

Title: Examining innovation in hospital units: a complex adaptive systems approach. Citation:: BMC health services research; Jun 2020; vol. 20 (no. 1); p. 554 Author(s): Glover, Wiljeana Jackson; Nissinboim, Noa; Naveh, Eitan Background: We are in an innovation age for healthcare delivery. Some note that the complexity of healthcare delivery may make innovation in this setting more difficult and may require more adaptive solutions. The aim of this study is to examine the relationship between unit complexity and innovation, using a complex adaptive systems approach in a hospital setting. Methods: We conducted a quantitative study of 31 hospital units within one hospital and use complex adaptive systems (CAS) theory to examine how two CAS factors, autonomy and performance orientation, moderate the relationship between unit complexity and innovation. Results: We find that unit complexity is associated with higher innovation performance when autonomy is low rather than high. We also find that unit complexity is associated with higher innovation performance when performance orientation is high rather than low. Our findings make three distinct contributions: we quantify the influence of complexity on innovation success in the health care sector, we examine the impact of autonomy on innovation in health care, and we are the first to examine performance orientation on innovation in health care. Conclusions: This study tackles the long debate about the influence of complexity on healthcare delivery, particularly innovation. Instead of being subject to the influence of complexity with no means of making progress or gaining control, hospitals looking to implement innovation programs should provide guidance to teams and departments regarding the type of innovation sought and provide support in terms of time and management commitment. Hospitals should also find ways to promote and make successful pilot implementations of such innovations visible in the organization. A close connection between the targeted innovation and the overall success and performance of the hospital unit is ideal.

Title: Managing Organizational Constraints in Innovation Teams: A Qualitative Study Across Four Health Systems. Citation: Medical care research and review : MCRR; Jun 2020 ; p. 1077558720925993 Author(s): Atkinson, Mariam Krikorian; Singer, Sara J Abstract: Though increasingly useful for developing complex healthcare innovations, interdisciplinary teams are prone to resistance and other organizational challenges. However, how teams are affected by and manage external constraints over the lifecycle of their innovation project is not well understood. We used a multimethod qualitative approach consisting of over 3 years of participant observation data to analyze how four interdisciplinary teams across different health systems experienced and managed constraints as they pursued process innovations. Specifically, we derived the constraint

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management process, which demonstrates how teams address constraints at different stages of innovation by applying various tactics. Our findings point to several practical implications concerning innovation processes in healthcare: (a) how conditions in the organizational context, or constraints, can impede team progress at different stages of innovation; and (2) the collective efforts, or tactics, teams use to manage or work around these constraints to further progress on their innovations.

Title: Implementation of an Innovative, Multiunit, Postevent Debriefing Program in a Children's Hospital. Citation: Pediatric emergency care; Jul 2020; vol. 36 (no. 7); p. 345-346 Author(s): Zinns, Lauren E; Welch-Horan, Thomas B; Moore, Thomas A; Ades, Anne; Wolfe, Heather A; Mullan, Paul C Background: Postevent debriefing has been associated with improved resuscitation outcomes and is recommended by the American Heart Association and the American Academy of Pediatrics to improve clinical performance. Objective: Despite the benefits of postevent debriefing, published debriefing programs have focused on single areas within a hospital. We are unaware of any hospital-wide debriefing programs implemented in a pediatric setting. Methods: We established a multidisciplinary, interprofessional debriefing collaborative at the Children's Hospital of Philadelphia to implement postevent debriefings in multiple areas of the hospital. The collaborative created a standardized debriefing form to capture data about the postevent debriefings. Results: From July 23, 2015 to December 31, 2017, the emergency department performed 153 debriefings (18%) for 850 resuscitations. The neonatal intensive care unit conducted 10 debriefings (9%) for 107 resuscitations, and the pediatric intensive care unit performed 5 debriefings (7%) for 73 resuscitations. Conclusions: Several departments at the Children's Hospital of Philadelphia have incorporated hot and cold debriefings into their clinical practice as part of their continuous quality improvement programs. By disseminating the tools and lessons learned from the implementation process, the collaborative hopes that other institutions will benefit from their lessons learned to successfully create their own debriefing programs. Widespread adoption of debriefing programs will enable a more scientific approach to studying the outcomes of debriefing.

Title: Can guidelines inhibit innovation and critical thinking? Citation: Bone marrow transplantation; Jul 2020; vol. 55 (no. 7); p. 1217-1219 Author(s): McCann, Shaun R

Title: Patient Falls Prevention: Assessing the Use of an Innovative Color-Coded Flag System in an Outpatient Oncology Infusion Center. Citation: Clinical journal of oncology nursing; Aug 2020; vol. 24 (no. 4); p. 448-450 Author(s): Shah, Megha

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Abstract: The National Database of Nursing Quality Indicators (NDNQI, 2020) defines a patient fall as an unplanned descent to the floor with or without injury. A fall occurs in 30%-50% of hospitalized patients with cancer in the United States (Jatoi, 2017). According to the Joint Commission (2015), the average cost of each fall with injury in the United States was about $14,000 to the healthcare system, averaging about $50 billion annually (Kartiko et al., 2020). Fall-related injuries to patients can result in additional treatment, hospital admissions, prolonged hospital stays, delays in cancer treatment, immobility, pain, emotional distress, caregiver fatigue, and depression (Joint Commission, 2015). Patients with cancer are highly susceptible to falls because of the neurologic deficits caused by chemotherapy treatments, medications given to prevent side effects, allergic reactions to the chemotherapy medications, increasing age, cognitive status, disease site, and cancer- and treatment-related fatigue (Jatoi, 2017). The high financial costs to patients and healthcare providers, as well as the physical and mental impact on patients, led to this pilot project.

Title: A Guide to Empowering Frontline Nurses and Healthcare Clinicians Through Evidence-Based Innovation Leadership During COVID-19 and Beyond. Citation: Worldviews on evidence-based nursing; Jul 2020 Author(s): Raderstorf, Tim; Barr, Taura L; Ackerman, Michael; Melnyk, Bernadette Mazurek Sources Used: A number of different databases and websites are used in the creation of this bulletin. Disclaimer: The results of your literature search are based on the request that you made, and consist of a list of references, some with abstracts. Royal United Hospital Bath Healthcare Library will endeavour to use the best, most appropriate and most recent sources available to it, but accepts no liability for the information retrieved, which is subject to the content and accuracy of databases, and the limitations of the search process. The library assumes no liability for the interpretation or application of these results, which are not intended to provide advice or recommendations on patient care.