Rob Bethune

Yeovil District Hospital NHS Foundation Trust, Йеовиль, England, United Kingdom

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Publications (18)

  • Rob Bethune · Mark Dahill · Katherine Finucane · [...] · Patricia Woodhead
    [Show abstract] [Hide abstract] ABSTRACT: Introduction Despite an increasing and widespread understanding of the importance of quality improvement in healthcare, medical students and junior doctors receive variable training in improvement methods. The South West Foundation Doctor quality improvement programme attempted to equip junior doctors with the skills to develop and improve healthcare services.
    Article · Jul 2016 · Clinical Risk
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    R Bethune · N Francis
    Full-text available · Article · Aug 2015 · Techniques in Coloproctology
  • Mark Dahill · Rob Bethune · Andrew Carson-Stevens · [...] · Clare VanHamel
    [Show abstract] [Hide abstract] ABSTRACT: In the current environment of culture change and financial pressure on the National Health Service, quality improvement initiatives are heralded as new vehicles for workplace evolution. Foundation Year One doctors encounter many of the problems impinging on quality, and their enthusiasm and number make them an indispensable resource and critical mass for improvement. In response to the increasing importance of quality improvement training, and as part of an ongoing project to embed quality improvement education in the Severn Deanery region, this paper describes the evolution of a questionnaire tool to assess the attitudes and beliefs of a cohort of new Foundation Year One doctors. An electronic survey was developed and validated to address each aim of quality care. The survey was sent by email to every Foundation Year One doctor in the Severn Deanery. New Foundation Year One doctors’ attitudes are overwhelmingly positive towards quality improvement and patient safety; however, universally, they do not feel valued and listened to. In addition, they do not feel that their previous medical education has fully equipped them to improve the quality and safety of the care they deliver to their patients. Foundation Year One doctors represent a large, intelligent and enthusiastic workforce and in an environment where quality is now accepted as paramount, harnessing their potential through better quality improvement training could prove advantageous to all National Health Service stakeholders.
    Article · May 2015 · Clinical Risk
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    [Show abstract] [Hide abstract] ABSTRACT: The risks to patients at August handover time are well known, yet there is no national consensus on the best way to deliver induction programmes for Foundation Year One (F1). The aim of this study was to design, deliver and assess a targeted structured induction programme for new F1 doctors. The induction training programme was designed using educational models of topic analysis informed by results of a survey of F1s and medical students, and the F1 curriculum. Data regarding serious untoward incidents and self-reported preparedness were collected between 2008 and 2010, and rates were compared between those receiving optional (2008) and compulsory (2009 and 2010) training. By delivering targeted education and spending time with the outgoing F1 doctors, 97 % of our new doctors felt adequately prepared for practice. The incidence of self-reported mistakes made by F1s in the first 4 months of their practice fell by 45 % and serious untoward incidents also decreased. Targeted structured induction training addresses final-year medical students' concerns about their preparedness for practice as junior doctors, and improves patient safety. This study supports the General Medical Council recommendation that targeted structured induction training should be mandatory for all new doctors.
    Full-text available · Article · Apr 2015
  • Rob Bethune · Nader Francis
    [Show abstract] [Hide abstract] ABSTRACT: This chapter describes the impact of human factors (non-technical skills) on minimally access surgery (MAS). Errors related to human factors affect up to 20 % of surgical patients, with a small proportion of these errors resulting in death. MAS is particularity challenging and the increased physical and cognitive strain can increase the number of errors impacting on patients. The various domains of human factors will be described using real life examples. These are: communication, teamwork, decision-making, situational awareness and coping with stress and fatigue. The aviation industry has developed effective methods to reduce human error and these will be discussed before detailing the attempts to replicate this training in surgery.
    Chapter · Jan 2015
  • Alan George Mackenzie Jardine · Tristan Page · Rob Bethune · [...] · Joanne Lee
    [Show abstract] [Hide abstract] ABSTRACT: While it is widely recognised that communication and handover are a fundamental component in providing safe clinical care for hospital patients (1,2.3). The Royal College of Physicians found that the majority of hospital doctors are dissatisfied with the standard of their handovers (4). These findings were mirrored by the junior staff at the Royal United Hospital, who felt that the weekend handover was inadequate, and detrimental to patient safety. A group of eight junior doctors at the Royal United Hospital, Bath utilised The Model For Improvement to systematically analyse and improve various aspects of the weekend handover system. Handover sheets from a subset of wards were assessed to observe direct effects of staged interventions over a nine month period, allowing small-scale testing prior to widespread implementation of a standardised intranet-based weekend handover. The effects of interventions were evaluated using a predesigned scoring system and data was collected continuously throughout the project. Over a nine month period the quality of handovers improved significantly from 76% to 93% (p <0.01): a success which was supported by a 100% improvement in formal feedback collected from hospital doctors and highlighted by the desire of senior staff and directors to implement the system throughout the trust. Using The Model For Improvement a group of junior doctors were able to introduce and develop a standardised weekend handover system that met their requirements. A structured, efficient and auditable system has been successfully produced which improves the quality and safety of patient care.
    Article · Oct 2014 · BMJ Quality Improvement Reports
  • Rob Bethune · Kate Campbell · Alex Rose · [...] · Sean Whitaker
    [Show abstract] [Hide abstract] ABSTRACT: Poor weekend handover has been implicated as one of the causes of observed higher mortality rates at weekends in UK hospitals. In a large teaching hospital we, a group of junior doctors, set about improving the quality and effectiveness of weekend handover. We used the Model for Improvement to implement a weekend handover sticker through an iterative process using multiple Plan/Do/Study/Act (PDSA) cycles. Over the 16 week study period the number of completed weekend tasks increased by 30% and the number of patients with a documented weekend handover increased by nearly 50%. Junior doctors are well positioned to notice the quality and safety shortcomings within hospitals, and by using effective improvement methods they can improve these systems at little or no cost.
    Article · Oct 2014 · BMJ Quality Improvement Reports
  • Rob Bethune · Rob Longman
    [Show abstract] [Hide abstract] ABSTRACT: We read with interest the recent editorial ‘Why do we do the same things so differently’[1]. We agree with the points raised and wanted to add a few further.As the article states, for a wide variety of surgical conditions and situations there is no clear evidence to do one particular surgical technique over another.This article is protected by copyright. All rights reserved.
    Article · May 2014 · Colorectal Disease
  • Rob Bethune · Natalie S Blencowe
    [Show abstract] [Hide abstract] ABSTRACT: Preoperative briefings and the 'time out' component of the WHO surgical safety checklist offer unique opportunities to improve the technical and non-technical skills of surgical trainees. The addition of a training briefing--a succinct adjunct to these processes--offers a novel method by which training opportunities can be maximised and learning needs better understood by theatre staff. However, more training is needed for staff in the use of briefings and checklists to achieve the best possible benefit for trainees and patients.
    Article · Mar 2014 · Journal of perioperative practice
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    Alan George Mackenzie Jardine · Tristan Page · Rob Bethune · [...] · Joanne Lee
    File available · Dataset · Jan 2014
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    Alan George Mackenzie Jardine · Tristan Page · Rob Bethune · [...] · Joanne Lee
    File available · Dataset · Jan 2014
  • Rob M Bethune
    Article · Jun 2013 · Journal of the Royal Society of Medicine
  • Rob Bethune · Eleanor Soo · Patricia Woodhead · [...] · Joanne Watson
    [Show abstract] [Hide abstract] ABSTRACT: The structure of postgraduate medical training rightly puts enormous emphasis on gathering clinical experience and constantly updating knowledge of relevant medical research to use in practice. At most, this can be contrasted with the slight emphasis on clinical leadership and acquiring the skills to effect change and improve the quality of care. Doctors play central roles in orchestrating the clinical management of patients across multiple settings within the healthcare system. They also routinely encounter the many problems within the systems that they work, affecting their own practices as well as those of other healthcare professionals. They thus represent a tremendous resource for identifying solutions to these problems and playing leadership roles in implementing them. However, physician training programs focus almost entirely on the knowledge and skills to manage clinical problems, with almost no training in skills related to healthcare management or effective quality improvement. In this article, we describe one attempt to improve this situation. In four hospitals in the Severn Deanery in the Southwest of England, first-year doctors carry out a structured and supported quality improvement project of their choice throughout their first year of training. To date, 30 such projects have been or are being run. This has significant benefits for both the trusts they are working for as well as for their own professional development. We describe the successes, difficulties and future of this programme.
    Article · May 2013 · BMJ quality & safety
  • Rob Bethune · Richard Canter · Paul Abrams
    [Show abstract] [Hide abstract] ABSTRACT: Introduction Little is known about the patient safety culture within surgical departments in UK hospitals. What has been done to date is to survey only permanent senior staff opinion of the safety culture in their institution. This study surveyed both consultant and trainee views on perceived patient safety and compared the results between these two groups. Material and methods The previously validated Team Work and Safety Climate Questionnaire was configured in Survey Monkey format and sent to all surgical trainees and consultant surgeons in the South West Strategic Health Authority. Two reminders were sent to achieve as high a return rate as possible. Results Two hundred and ninety-six replies were received. Forty-four percent of trainees and 30% of consultants responded to the survey. Consultants consistently rated a higher safety culture than surgical trainees. Only 2.9% of trainees believe their patient safety concerns would be acted upon by hospital management. There is notable variation in perceived patient safety culture between hospitals. Conclusion This study has suggested that the patient safety culture in hospitals, within a Strategic Health Authority, is variable and sub-optimal when viewed by surgical trainees and their consultants. This study also provides some evidence that the perception of patient safety in an organization varies according to clinical experience. As trainees deliver a great deal of clinical care, surveys of safety culture should include this group. As perceived patient safety culture is correlated to clinical outcomes, validated safety surveys might form part of the assessment of a hospital's performance, along with outcome and patient satisfaction.
    Article · Mar 2012 · Clinical Risk
  • Rob Bethune
    Article · Nov 2011 · BMJ (online)
  • [Show abstract] [Hide abstract] ABSTRACT: : This study was carried out to evaluate the introduction of preoperative safety briefings on operating theater start times. In addition, we assessed staff attitudes toward the safety briefings. Lack of time, motivation, and a negative perception in staff are often cited as barriers to the implementation of safety briefings. : The preoperative safety briefing consisted of a 5- to 10-minute meeting between anesthetic staff, surgeons, and nursing staff to discuss the operating list before the commencement of surgery. Using the hospital database, the operating theater start times were obtained for 2 months before and after the introduction of the safety briefings. A questionnaire using a 5-point Likert scale was distributed to the operating room theater staff to evaluate attitudes toward the safety briefing. : There was no statistical difference in operating theater start time after the introduction of the safety briefing. The questionnaire responses from 37 theater staff demonstrated positive attitudes toward the safety briefings including agreeing strongly with factors affecting patient safety and communication. This included 97% replying that the safety briefing highlighted potential patient problems, whereas 89% believed it improved communication. : The safety briefings were popular among staff and did not delay the operating theater start time.
    Article · Sep 2011 · Journal of Patient Safety
  • Rob Bethune · Alice Roueché · Toby Hilman
    Article · Mar 2011 · BMJ (online)
  • Rob Bethune · Alice Roueche · Toby Hilman
    [Show abstract] [Hide abstract] ABSTRACT: Pronovost and colleagues and the linked evaluations of the Safer Patient Initiative (SPI) comment on the successes and failures of the patient safety and quality improvement movement in the UK.1 2 3Crucially, the initiatives were not targeted at …
    Article · Jan 2011 · BMJ Clinical Research

Publication Stats

40 Citations


  • 2015
    • Yeovil District Hospital NHS Foundation Trust
      Йеовиль, England, United Kingdom
  • 2014
    • University Hospitals Bristol NHS Foundation Trust
      Bristol, England, United Kingdom