Social Model Vs. Biological Model – Week 4

The fourth week at HTS was a nostalgic one to say the least. I would just like to take moment to appreciate I have actually been working at the hospital for a whole month. Time has gone by so quickly! There was a fire drill which made me reminisce on my times at school, where I used to be thrilled at the chance to miss a maths lesson for a time to get outside and chat carefree with friends, more recently however, I found the fire drill to be more harmful than good as it was more time consuming than productive. As the clinical psychologists and I walked briskly to exit the building with the pale coloured walls which seemed to go on infinitively, I thought about  what my supervisor, David, had told me in my first week. Whilst marching through the wide corridors of the historical hospital, it made me think back about how far science and medicine  has progressed. Where before the hallways were made built wide purposely to haul hundreds of mental health patients, now the hallway was empty, as now, scientists have psychologists have uncovered that we need to take a more person-centred approach when dealing with dementia patients, which is evident in the evaluation forms which I have been reading. HTS  can take pride that they are emotionally attached to each of their clients and do their best offer them care and meet their needs on a personal level. This is important as many patients with dementia, which often worsens to greater stages, are left alone, isolated and dis-attached from society, even their family members leave them, due to stigma surrounding mental health.

From an interactionist perspective, it could be said that this is because once members of society no longer fit a role which benefits society, they are consequently marginalised. Today I read a case when the client was as young as 44 years old, and found it sad that this same stigma meant that the client had become distant from their loved ones. On a brighter note however, I have recorded around 320 cases now and hopefully can finish inputting data so I can start the data analysis process. David also gave me another book which details further what person-centred care is all about and why dementia is a significant feature of the twentieth century, which is also known as the Medicalization of Old Age by some in the sociological world.  More to come next week!

Melissa

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KSS AHSN Newsletter – 31 July 2014

Collaboratives – key change agents?

Many of you will be familiar with our Enhancing Quality and Recovery (EQR) programmes. They provide clinical teams with an effective methodology for service improvement based on a collaborative approach. The evidence suggests they’ve been very successful across Kent, Surrey and Sussex at embedding and spreading best practice which leads to better results for patients.

With that in mind, I’d like to draw your attention to the latest publication from the Health Foundation, Improvement collaboratives in health care. It’s an evidence scan which compiles research about whether quality improvement collaboratives are effective. There’s increasing interest in the health and social care sectors about the potential for collaboratives to be powerful change agents so it’s a very timely document. It looks at the effectiveness of collaboratives in improving healthcare and the impact of other factors.

How collaboratives work

team-process

Learn, change, repeat

Although there are a number of different models, collaboratives usually involve teams from across an organisation or a number of organisations working together to achieve agreed outcomes. Sharing learning is integral to the process of spreading best practice and sustaining improvements. In KSS, our EQR collaboratives focus on pathways such as heart failure, acute kidney injury, pneumonia, fractured neck of femur, and dementia. It’s also the approach behind the new Patient Safety Collaborative which is due to launch in the autumn.

We are fortunate that the EQR methodology is well established in KSS and able to demonstrate sustained improvements across a number of pathways. The Health Foundation concludes that “collaboratives may have some potential to support improvements in the quality of health care but, like most initiatives, they are not a ‘silver bullet’ and cannot be relied upon in isolation to spread broad change”. The report also highlights the likely characteristics of successful collaborative include:

  • well facilitated programme management
  • the value assigned by the organisation and teams to the collaborative methodology
  • the length of data collection
  • perceived support from junior doctors
  • inter-professional collaboration
  • organisational readiness

They will resonate I’m sure with colleagues who have been involved with EQR. It’s encouraging to see key components of the KSS EQR programmes on a list generated by participants in the Health Foundation’s research. Our role is to create the environment in which collaboration can flourish; it’s the clinical teams, committed to a collaborative approach, sharing data and learning, who translate the methodology into better outcomes for patients. The report notes that sustainability can be an issue for improvement – whether delivered through a collaborative approach or not – and this is something built into the EQR approach. Annually agreed targets and ongoing data measurement ensure momentum for continuous improvement and reduce variations in the quality of care across KSS.

If you’d like to know more about EQR, please get in touch with Kay Mackay, our Director of Improvement, via kay.mackay1@nhs.net

Kind regards,
Guy Boersma
Managing Director, KSS AHSN

KSS AHSN Commercial Director job vacancy

KSS AHSN is at an exciting stage in our development, as we look to grow our team to include a Commercial Director.

Our Commercial Director will drive forward our ambitions and help to shape our business model, using stakeholder and market input to ensure we develop compelling membership and service offerings that are commercially sustainable and focus on positive patient outcomes.

For full details on the role and how to apply for the position, please download the candidate appointment briefing document here.

Health Innovation Challenge Fund

The Health Innovation Challenge Fund invites applicants to apply for funding in any of the areas of special interest listed below. Please read the eligibility criteria thoroughly before applying.

Each £10m funding round will review and assess proposals from all themes. All applications are judged purely on merit. There are no funding quotas for individual themes.

For further information and details, please click here.

Opportunity to Get Involved in the Systems Leadership, Local Vision Programme

The Local Government Authority led, Systems Leadership Steering Group is looking for applications for the second round of Systems Leadership – Local Vision projects across the country. The projects bring people together from across the NHS, public health, local government, social care and other services, in order to create new ways of working on ‘wicked’ issues and achieve measurable improvements in health, care and wellbeing.

Read more here

Horizon 2020 – Launch of 2015 Calls

The revised versions of the Horizon 2020 work programmes have been adopted and uploaded onto the Horizon 2020 website. The revised version of the Health, Demographic Change and Wellbeing work programme can be accessed here.

The call for the 2015 topics opened on 30 July 2014. You can see the calls for proposals online, on the Horizon 2020 calls for proposals portal.

Nutrition and Hydration Week 16 – 22 March 2015: A Global Challenge

2015 will see the 4th Nutrition and Hydration Week.

For further information about plans for 2015 and activities this year please click here.

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Week 2: Getting into the Routine

I have now finished my second week of working at the William Harvey hospital. Although I found myself moaning about working full-time (although I guess who doesn’t?!), the week actually went really quickly. I’ve now settled into the office routine and am finding my time spent here both enjoyable and interesting – things I definitely want out of a job.

I’ve been continuing work on the SUTO project, checking patients’ scans and entering their relevant information into spreadsheets. I’ve included an example below of how the results from such CT perfusion scans can look. Although some of this work is quite repetitive, being exposed to such information so often is definitely helping me to immerse myself in stroke medicine and begin recognising patient treatment patterns. It has also showed me the reality of some people’s functioning following a stroke (something I hadn’t fully realised) and how even though the risk of haemorrhage following thrombolysis is small, it does still happen to people. I  know that there’s still a lot more that I can  learn from this placement however, with some neurology reports mentioning areas of the brain completely unknown to me!  To help with this I’ve been writing down key words or terms that I don’t fully understand each day and am gradually looking them up to gain a firmer understanding of their use.

I’ve also found that I’m now a lot more confident with finding specific patient information, having a clearer idea of what the different patient databases and files show. For example, when analysing whether someone has a stroke risk factor of high cholesterol you could check both their case file for evidence of hyperlipidemia management, as well as their general admission tests to compare their total cholesterol levels with reference norms. I have also now learnt how to calculate patients’ Modified Rankin Scale (mRS) levels using patient notes made by departments such as occupational therapy. These indicate a person’s assessed level of disability and how able they are to carry out their usual activities. Having never heard of this scale before starting here, for me it’s a good indication that I’m making progress in the right direction.

At the end of the week we were also briefly introduced to another of our projects – ‘Obstructive Sleep Apnoea (OSA) in the Rapid Neurovascular Clinic’. We began by looking at the client letters of patients that had entered the clinic to identify both the symptoms of  their TIA (Transient Ischaemic Attack), how long the event had lasted and what risk factors they had.  This is the first stage of this project and luckily it shares some similarities with the one we’re already working on, making things a bit easier. It can sometimes be harder than I expected to draw this information out though. For example, when identifying whether someone has a stroke risk factor of hypertension, each of their medical prescriptions may first require checking to see whether they are taking medication to manage such. We’re due to compare our inital findings for consistency next week.

Overall I feel like I’m being really productive each day, which is a nice change from spending days at a time on the same essay paragraphs at university. Although it seems like there’s still a long way to go before finishing, when looking at the amount of work that still needs doing it definitely feels needed! I’m really happy that I decided to apply for this placement and am looking forward to the upcoming week.

MRI & CT Scan

Image retrieved from: http://www.taafonline.org/ba_detection.html

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Week 2 – Getting into the swing of it

When I left you last it was the start of my second week and since then I’ve learnt a lot! So last week we really started getting into the proper work. Monday was spent doing the tedious task of looking through all the people that have had a stroke in the last 3 years (almost 4,000 people)  in the East Kent Hospitals University Foundation Trust (EKHUFT) and determining if it was an unknown time of onset. We’ve been doing a little bit of this everyday since and hopefully it’ll be finished by the end of this week! Even though it’s been taking us a long time to get through, it is really interesting as we get to look at CT scan images. It is amazing how well machines can see inside the human body and how detailed the images are. Also on Monday, Emily started requesting patient files and we weren’t quite prepared when on Tuesday these files started to pour into the office. Since we still don’t have our ID cards, we can’t actually return these files after we’ve entered them into the database so they’ve just been building up in the office. We’ll have quite a stack to take back when we eventually can!

A lot of last week was spent looking through these files. There’s so much information in each one (they can range from 2cm think to about 10cm thick, and some patients have more than one!) that it’s quite tricky and time consuming to extract the exact details we need to fill in the database. Over the course of the week I learnt where to look for things in each file which made going through each one a bit faster, as at the start each entry was taking a few hours to complete. By the end of the week I managed to fill in 18 entries. The number would have been more, but by Thursday we were starting to run out of files again, and we couldn’t get anymore as we’d already filled up a whole shelf with ones waiting to be returned!

Since there are two of us in the same department, I’m lucky that I’m actually going to be able to work on two projects, my own and Emily’s, Transient Ischaemic Attack and Obstructive Sleep Apnoea (TIA and OSA). So far we’ve only really been working on my project so it was really good on Friday when we were given a taste of what the other project  will be like. We were given a spreadsheet and some clinic letters and asked to enter as much data from the leters (e.g. symptoms, treatment, patient risk factors) into the spreadsheet. The problem was that whilst some of the letters were really detailed and had everything, others weren’t quite as helpful. It was a bit scary how many gaps there were in the spreadsheet, but hopefully we’ll be able to fill them in later on in the project.

This week hopefully our ID cards will be sorted and we’ll be able to pick up and return files, and I’m looking forward to doing a bit more work on the TIA and OSA study. See you next week!

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Defining Dementia – Week 3

My third week working at HTS was busy, busy, busy! I have done over 200 entries of feedback forms and I’ve learnt even more about dementia. Firstly, I have learnt there are many types and levels of dementia, there is not only Alzheimer dementia but there is also Vascular dementia, Fronto-temporal dementia and many more. Secondly, I have learnt there are not one set of symptoms of dementia, every single person diagnoised has a different story, or difference experience to tell. I have learnt to prevent yourself from having dementia when older, you must regularly exercise your brain, keep your body fit and healthy and generally care for your wellbeing, which to me connotes that there is more to dementia than just the biology, but the social world perhaps dictates who is more likely to suffer from dementia and why. For example, from the data so far, more women seem to suffer from dementia than men. This can be due to the way women are socialised and treated in society.

Well that’s it for this week, stay tuned for more!

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KSS AHSN Newsletter – 24 July 2014

In this week’s edition:

 

Horizon scanning: where next for innovation?

In June, Simon Stevens, NHS England Chief Executive, reminded delegates at the NHS Confederation in Liverpool about why innovation, in whatever form it takes, is so important: it’s the ageing and growing population, contemporary lifestyles and more expansive and expensive treatments that put the “I” in Quality, Innovation, Productivity and Prevention (QIPP).

More recently, I was invited to speak at the Sussex Innovation Collaborative which took place a couple of weeks ago. I was really struck by the diversity of the innovation that’s taking place for local patients, and the passion of colleagues to make sure our communities are getting the very best care, services and treatment. Their ambitions are underpinned by a determination to innovate wherever needed and overcome whatever barriers lie between them and even better patient care. It’s passion we share here at KSS AHSN and see in colleagues right across Kent, Surrey and Sussex.

Part of the Sussex event was a panel session. One delegate asked “what innovations will make the biggest difference in 2014?” An interesting question and it generated a range of responses. One thing that does strike me as crucial to making significant difference is not just about the innovation itself, but what we do with it. Using our networks, meetings and learning events well is paramount. The answer to the question may well be that the innovation making the biggest difference will be the one we all, as a region-wide network, succeed in sharing through to widespread adoption. Until we’re doing that on a regular and systematic basis, many innovations will fail to realise their potential and their benefits simply won’t reach as many patients.

2025

Surveying an even broader horizon, the Academy of Medical Sciences recently published the report from its FORUM’s annual lecture, ‘Horizon scanning: looking ahead to 2025’. The report summarises the presentations and ensuing debate on topics including: changes in the healthcare landscape and enhanced collaboration between sectors, new modes of developing drugs and devices, flexibility of the regulatory framework, opportunities offered by the use of data, the importance of addressing health behaviours, and the centrality of patients and the public.

2025-FORUM

The multi-sector FORUM panel  included:

  •  Sir Gordon Duff FRSE FMedSci, Chairman, Medicines and Healthcare products Regulatory Agency (MHRA);
  •  Professor Sir Malcolm Grant CBE, Chair, NHS England;
  •  Professor Dame Nancy Rothwell FRS FMedSci, President and Vice-Chancellor, University of Manchester; and
  •  Professor Patrick Vallance FMedSci, President, Pharmaceuticals R&D, GSK.

Their insight into the changing landscape and how that will drive the future of healthcare makes fascinating reading. And what might be even more fascinating would be to know what you think – please drop us a note with your vision of what you see on the innovation horizon in less than 200 words and we’ll publish the results here!

September 25 – primary care

One of the exciting events on our horizon is the King’s Fund conference “Realising the potential of primary care” on 25 September. The programme includes presenters from our patch, as well as ChenMed – I know many of you would like to know more about their approach to care of the elderly. If you’re interested in attending and saving money, please let us know and we’ll arrange a group booking. Please email janet.moore10@nhs.net if you’d like to be part of it. We’re also hosting a dinner discussion afterwards; again please let Janet know if you’d like to join us.

Kind regards,
Guy Boersma
Managing Director, KSS AHSN

The 2014 NHS Leadership Recognition Awards – nominations are now open!

The NHS Leadership Recognition Awards celebrate leaders at all levels and across all professions who have ultimately improved people’s health, the public’s experience of the NHS and those leaders who we are truly proud to work alongside.

Nominations are now open. For further information and details, please click here.

Funding Opportunity for Innovations to Improve Healthcare

The Health Foundation is looking for projects that aim to improve health care delivery and/or the way people manage their own health care as part of its new Innovating for Improvement programme.

Successful bidders will receive up to £75,000 of funding, over 15 months, to support the implementation and evaluation of their health care innovation project. Please read the Call for applications on the Health Foundation website and for further information, visit: www.health.org.uk/innovatingimprovement

The deadline for applications is 12 noon, 5 August 2014.

Opportunity to Get Involved in the Systems Leadership, Local Vision Programme

The Local Government Authority led, Systems Leadership Steering Group is looking for applications for the second round of Systems Leadership – Local Vision projects across the country. The projects bring people together from across the NHS, public health, local government, social care and other services, in order to create new ways of working on ‘wicked’ issues and achieve measurable improvements in health, care and wellbeing.

Read more here

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Week One: Starting Off

My first week at William Harvey has been full of getting to grips with exactly what it is I’m going to be doing and trying to remember what the variety of terms being used by clinicians actually mean. I started off in the library, recognizable by the piles of stroke journals and medical statistics textbooks that I’d gathered up around me to read throughout the day. This really helped me to get a good grounding in what the topics I was working with actually meant and involved (plasminogen activators and subarachnoid haemorrhages anyone?!), as well as what previous research had been carried out into these areas. This gave me a much clearer idea about the reasoning behind my research projects and what gaps in the literature still exist, whilst providing me with some personal relief that I now had at least a small understanding of the upcoming work. I was also able to refresh my knowledge about how to choose and carry out statistical analyses, particularly inferential tests, something that will hopefully be of use later on!

On Thursday I was able to attend a morning MDT meeting to listen to neurologists and radiologists discussing recent patient brain scans and angiograms. I found it amazing how detailed and clear the scans were, with the clinicians able to zoom right in on patients’ individual vessels to check for clots. They were also kind enough to describe how to interpret the various scans, explaining how haemorrhages or ischaemic strokes may show up differently depending on the type of scan used. It made it clear how much experience clinicians must need to be able to interpret these, as well as how important MDT meetings are for sharing ideas about how to move forward. We were then taken through what our daily work for the project: ‘Strokes of Unknown Time of Onset (SUTO) and Image Based Selection of Reperfusion Therapy’ would involve, with a steep learning curve involving multiple spread sheets and piles of case notes. Although at first it seemed very overwhelming, after having a practice at extracting and entering the data that we will need for analysis, the reasons behind doing everything began to come together. We are first analysing whether patients clearly had either a SUTO or underwent CT brain perfusion imaging following their stroke. These are scans which are used to identify patients’ mismatch of cerebral blood flow and mean tissue transit times. These scans are relevant for our project as their indication of whether patients with a SUTO have brain tissue at risk due to a lack of oxygen can be used to guide provision of a treatment called thrombolysis (a reperfusion therapy which breaks down fibrin within clots). For these identified patients with either a SUTO or CT perfusion scan,  we are then using various client letters and patient notes to find out factors such as whether thrombolysis was given to them, what stroke risk factors the patient had, how they scored on various assessments and how long it took for them to be treated. Overall, we are hoping that this will show us how effective thrombolysis is when used for patients that have a SUTO, as currently it is only recommended for strokes with an onset time of < 4.5 hours. I’m sure it will take a while longer before I’m confident with all of this!

By the end of the week I was feeling a lot better about what was involved with the SUTO project and was able to independently fill my day with getting things done. Looking through all of the different brain scans by myself was also really interesting and I was able to read through neurologists’ reports to greater understand what I was looking at. I don’t yet have my own computer login or ID card which means I’m restricted with some of my work and need to ask people to help me with gaining access but luckily this hasn’t been a problem so far. Hopefully next week will continue to run so smoothly and I’ll get approval to begin working on the other project too!

William Harvey Hospital, Ashford

Image retrieved from: http://www.kentonline.co.uk/ashford/news/william-harvey-hospital-food-spa-a56947/

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MSc in Applied Health Research

CHSS are pleased to to announce a new course – Applied Health Research (MSc). Starting in September 2015 the MSc in Applied Health Research is designed to be studied over one year full-time or two years part-time. There are three compulsory modules, plus four optional modules. To be awarded a MSc in Applied Health Research students will be required to obtain 180 M level credits including the dissertation module which comprises 60 credits, with the programme being divided into 2 stages.

For more information about this course or any other courses please go to the KentHealth website, or view the flyer for this course.

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Week 1 – Lots of things to learn!

So it’s the start of my second week here at the William Harvey and I think that I might be starting to get an idea of what I’m supposed to be doing!

Last week was quite busy and working 9 to 4 most days was a big change from my post exams normal daily routine of doing nothing. I spent Monday and Tuesday in the library doing research on strokes and some of the statistical techiniques that I’ll need to know later on in my placement. On Wednesday I was still reading in the library but the other student, Emily, who is doing a placement in the same office as me started, so it was nice to have someone else to chat to. Whilst doing all that reading was very helpful, I was really glad that on Thursday I got to get out of the library and see a few different things. I was in early on Thursday (8am!) so that I could attend a meeting in Radiology, where a radiographer and the stroke consultants met to discuss the stroke patients over the previous week to review their scans. It was amazing to see the scans, even if I didn’t really understand that much of what was actually being discused! Straight after the meeting we met last years placement student who showed us some of the ropes. Me and Emily both had lots of questions for him, and he took us through some of the computer programmes we’ll be using and showed us how to fill in entries on the SUTO (Stroke of Unknown Time of Onset) database. I made lots of notes which came in really useful on Friday, our first proper day in the HCOOP (Health Care of the Older Person) office where we’ll be working during the 8 weeks. I was surprised at how fast the day went and even though I was glad it was Friday, that was mostly just because I wanted a bit of a lie in over the weekend!

It’s Monday morning now and I’m really excited to get into my second week. I haven’t got my proper NHS ID card yet which is a bit annoying, so I’m having to be extra nice to the girls in the office, who have been super helpful, so that they’ll log into the computer for me. Hopefully this will all be sorted by the end of the week though and I’ll be able to start going downstairs and picking up patient records myself. I’ve got a lot to learn still but it’s really good to being doing something different from studying for my degree and it’s great to experience one career area that I could potentially go into once I’ve graduated. See you again next week!IMG_20140722_240125628

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2nd Annual International Weight Stigma Conference

Weight Stigma is pervasive in society and has implications for healthcare, education, employment and everyday quality of life. Despite rising levels of anti-fat prejudice in all areas of daily life, discrimination on the basis of weight is generally not covered by anti-discrimination legislation. Moreover, intersectionality has emerged as a critical lens for recognising the overlap of various forms of exclusion and discrimination. Although still often treated as mutually exclusive, the intersections of race, gender, class, sexual identity, age, ability, religion, and nationality represent complex identities that must be factored into how we approach weight stigma. The more we can do to understand weight stigma, the more we can undo in terms of the negative consequences that result from it.

The Weight Stigma Conference brings together scholars and practitioners from a range of disciplines (e.g., psychology, medicine, public health, allied health professions, education, sports and exercise science, social sciences, media studies, business, public policy, law) to consider research, policy, rhetoric, and practice around the issue of weight stigma.

We aim to address a number of issues, such as weight stigma across social identities, weight stigma among health professionals, public policy implications, and interventions to reduce weight stigma.

This year’s exciting line-up of speakers span the US and Europe and include Drs. Deb Burgard, Robert Carels, Sarah Riley, Lee Monaghan, Emma Rich, and Noorjte van Amsterdam.

For further details see the event web page.

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