About
475
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Introduction
Additional affiliations
November 2015 - November 2020
July 2011 - December 2015
Position
- Professor of Health Policy
September 1998 - June 2012
Education
January 1980 - May 1982
January 1974 - May 1976
September 1967 - June 1972
Publications
Publications (475)
Background
Addressing increasing patient demand and improving ED patient flow is a key ambition for NHS England. Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evidence shows no overall improvement in addressing d...
Background
Emergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models.
Objectives
To evaluate the effectiveness, safety, patient experience and system implications...
Objective
To develop mid-range programme theory from perceptions and experiences of out-of-hours community palliative care, accounting for human factors design issues that might be influencing system performance for achieving desirable outcomes through quality improvement.
Setting
Community providers and users of out-of-hours palliative care.
Par...
Contexte. La pandémie de COVID-19 a imposé une réorganisation rapide des services de santé. Les patients sont exposés à des risques importants de dommages associés aux soins. L’interruption totale des services de soins pendant la pandémie a contribué à accroître ces risques. Objectif. Le type et la nature des incidents liés à la sécurité des patien...
Background
Increasing demand on emergency healthcare systems has prompted introduction of new healthcare service models including the provision of GP services in or alongside emergency departments. In England this led to a policy proposal and £100million (US$130million) of funding for all emergency departments to have co-located GP services. Howeve...
Objective
Existing quality of care frameworks insufficiently integrate the perspectives of physicians, nurses and patients. We collected narrative accounts from these three groups to explore if their perspectives might add new content to these existing definitions.
Methods
Ninety-seven descriptions of “good” and “poor” care episodes were collected...
Objective
Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics.
Design
Retrospective mixed methods methodology: (1) an a prior...
Background: The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. Objectives: We explored the type and nature of patient safety incide...
Background:
Increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments (EDs), but with a lack of evidence for patient safety outcomes.
Aim:
We aimed to explore how care processes work and how patient safety incidents associated with GPs wor...
Introduction
There is a paucity of knowledge and understanding of medical error in opioid substitution treatment programmes.
Objectives
To characterise patient safety incidents involving opioid-substitution treatment with methadone or buprenorphine in community-based care to identify the sources and nature of harm, describe and interpret themes an...
Fundamental characteristics of healthcare, including approaches to priority-setting, culture, traditions of professional practice, leadership styles, and accountability mechanisms mean that many deep-seated causes of unsafe care have proved intractable to transformation. The wisdom and experience of patients and families that have suffered harm is...
Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning syste...
Learning from patient safety incident reports is a vital part of improving healthcare. However, the volume of reports and their largely free-text nature poses a major analytic challenge. The objective of this study was to test the capability of autonomous classifying of free text within patient safety incident reports to determine incident type and...
Background & aims:
Opioid substitution treatment is used in many countries as an effective harm minimization strategy. There is a need for more information about patient safety incidents and resulting harm relating to this treatment. We aimed to characterise patient safety incidents involving opioid-substitution treatment with methadone or bupreno...
Purpose
Patient safety failures are recognised as a global threat to public health, yet remain a leading cause of death internationally. Vulnerable children are inversely more in need of high-quality primary health and social-care but little is known about the quality of care received. Using national patient safety data, this study aimed to charact...
With this paper, we initiate the Supplement on Deepening our Understanding of Quality in Australia (DUQuA). DUQuA is an at-scale, cross-sectional research programme examining the quality activities in 32 large hospitals across Australia. It is based on, with suitable modifications and extensions, the Deepening our Understanding of Quality improveme...
Background
Colorectal cancer incidence in the UK and other high-income countries has been increasing rapidly among young adults. This is the first analysis of colorectal cancer incidence trends by sub-site and socioeconomic deprivation in young adults in a European country.
Methods
We examined age-specific national trends in colorectal cancer inci...
Background:
Diagnostic error occurs more frequently in the emergency department than in regular in-patient hospital care. We sought to characterise the nature of reported diagnostic error in hospital emergency departments in England and Wales from 2013 to 2015 and to identify the priority areas for intervention to reduce their occurrence.
Methods...
The World Health Organization Global Patient Safety Challenge, Medication Without Harm, aims to reduce serious, avoidable medication-related harm by 50% in 5 years, globally. Three areas have been identified for early priority action. This technical report addresses Medication Safety in Transitions of Care; why it is a priority, what has been done...
Objectives
Worldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of fun...
Background
Technological advances and societal expectations are transforming professional-patient relationships, while interpersonal therapeutic interactions remain essential to palliative care.1,2,3 Harm can be experienced as an ‘unfolding series of negative events…inextricably linked with feeling unsafe’.⁴ Negotiating safe care that remains sensi...
Objectives: Medication errors continue to contribute substantially to global morbidity and mortality. In the context of the recent launch of the World Health Organization’s (WHO) Third Global Patient Safety Challenge: Medication Without Harm, we sought to establish agreement on research priorities for medication safety.
Methods: We undertook a con...
Background
Patients receiving palliative care are often at increased risk of unsafe care with the out-of-hours setting presenting particular challenges. The identification of improved ways of delivering palliative care outside working hours is a priority area for policymakers.
Aim
To explore the nature and causes of unsafe care delivered to patien...
The Independent Monitoring Board tracks and comments on progress with polio eradication. This is its 16th report.
Introduction
Advance Care Planning (ACP) is an important component of patient centred end-of-life care (Houben et al. 2014; Brinkman-Stoppelenburg et al. 2014). However there is little evidence available on the safety of the process and its impact on quality of care.
Aim
To characterise the nature of patient safety incidents arising around the ACP...
Background
Patients receiving palliative care are vulnerable to patient safety incidents but little is known about the extent of harm caused or the origins of unsafe care in this population.
Aim
To quantify and qualitatively analyse serious incident reports in order to understand the causes and impact of unsafe care in a population receiving palli...
Background:
Patients receiving palliative care are vulnerable to patient safety incidents but little is known about the extent of harm caused or the origins of unsafe care in this population.
Aim:
To quantify and qualitatively analyse serious incident reports in order to understand the causes and impact of unsafe care in a population receiving p...
Primary care lags behind secondary care in the reporting of, and learning from, incidents that put patient safety at risk. In primary care, there is no universally agreed approach to classifying the severity of harm arising from such patient-safety incidents. This lack of an agreed approach limits learning that could lead to the prevention of injur...
Importance
The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions.
Objective
To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings.
Design, Setting, and Participants
Multistage stratified sample with medical reco...
Background Patients receiving OOH palliative care are at increased risk of unsafe care (Mazzocato & Stiefe, l 1997; Dietz et al. 2010). The identification of improved ways of delivering palliative care outside working hours is a priority area for policy makers. (Best et al. 2015) To allow service redesign to provide safer care for patients, a means...
Who could disagree with the seemingly common-sense reasoning that: “We must learn from the things that go wrong.”? Despite major investments to improve patient safety, relatively few evaluations demonstrate convincing reductions in risk, harm, serious error or death. This disappointing trajectory of improvement from learning from errors or Safety-I...
Background:
Opioids are a widely prescribed class of drug with potentially harmful short-term and long-term side effects. There are concerns about the amounts of these drugs being prescribed in England given that they are increasingly considered ineffective in the context of long-term non-cancer pain, which is one of the major reasons for their pr...
Objectives
To describe serious incidents occurring in the management of patient remains after their death.
Design
Incidents occurring after patient deaths were analysed using content analysis to determine what happened, why it happened and the outcome.
Setting
The Strategic Executive Information System database of serious incidents requiring inve...
The independent board monitors progress in implementation of the polio transition programme.
Priorities for infection prevention and control
Sub-optimal care for patients in the out of hours primary care setting at the end of life: a mixed methods study
Background Patients receiving palliative care are often at increased risk of unsafe care, (Mazzocato and Stiefel 1997; Dietz et al. 2014) and the identification of improved ways of delivering palliative care outside working hours is a priority area. (Best et al. 2015)
Aim To explore the nature and causes of unsafe care delivered to patients receiv...
Purpose:
A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident repor...
Objectives
The improvement of safety in healthcare worldwide depends in part on the knowledge, skills and attitudes of staff providing care. Greater patient safety content in health professional education and training programmes has been advocated internationally. While WHO Patient Safety Curriculum Guides (for Medical Schools and Multi-Professiona...
Background
older adults are frequent users of primary healthcare services, but are at increased risk of healthcare-related harm in this setting.
Objectives
to describe the factors associated with actual or potential harm to patients aged 65 years and older, treated in primary care, to identify action to produce safer care.
Design and Setting
a cr...
The use of simulation-based training has established itself in healthcare but its implementation has been varied and mostly limited to technical and non-technical skills training. This article discusses the possibilities of the use of simulation as part of an overarching approach to improving patient safety, and represents the views of the Simnovat...
Background The UK has the highest prevalence of illicit drug use in developed countries. Opioid replacement therapy (ORT) aims to reduce illicit opioid use, but inadequate monitoring of treatment can lead to serious preventable adverse drug reactions. We undertook a mixed-methods observational study of unsafe care received by adult patients receivi...
Background
The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in th...
The law's intervention in patient safety can be haphazard and inconsistent
“Jail time for a medical error.” This was the headline of Bob Wachter’s patient safety blog about the Ohio pharmacist Eric Cropp.1 When Cropp’s professional colleagues saw him clad in an orange jumpsuit in a prison visiting room, they knew it could have been them. A pharma...
Background and aims:
Chronic pain is a potentially disabling condition affecting one in three people through impaired physical function and quality of life. While the psychosocial impact of chronic pain is already well established, little is known about the potential biological consequences. Chronic pain may be associated with an increased prevale...
Background
There is an emerging interest in the inadvertent harm caused to patients by the provision of primary health-care services. To date (up to 2015), there has been limited research interest and few policy directives focused on patient safety in primary care. In 2003, a major investment was made in the National Reporting and Learning System t...
Advances offer a healthier future for all, but putting them into practice will not be easy.
As a unified field of scholarship, patient safety dates to the late 20th century. It has its origins in several developmental strands: observational studies demonstrating that the level of avoidable adverse outcomes of care in hospitals was higher than previously realized; the pressure to do something about the high cost of medical litigation; the...
