Organising care at the NHS front line: who is responsible?

Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice: 

The report concludes that clinical teams and managers need to have time and resources to improve patient care. This ought to include access to the evidence-base that libraries can provide, and time to read and apply it.

Libraries also have a key role in providing resources at the point of care, but as one of the essayists points out, even getting access to a computer on a ward is not easy, and passwords act as another barrier. Libraries need to ensure their resources are accessible as seamlessly as possible, and this could mean integrating them into the electronic patient record, or using IP or referrer URL authentication rather than relying solely on OpenAthens.

Source: King’s Fund

Link to main document

Publication format: Webpage of key points, with link to full PDF

Date of publication: May 2017

Summary of driver:

This report contains a number of essays looking at how acute care is currently provided, the pressures on it, and how it could be improved. It is intended to serve as a starting point for an ongoing appreciative inquiry into improving care processes in hospitals.

Key features of driver:

  • Acutely-ill patients make up a high proportion of the NHS’ inpatient work – this is usually unplanned and complex with ailments being difficult to diagnose. There are increasing numbers of these patients with increasingly complex needs
  • Information about these patients’ medical histories and test results isn’t always easily available
  • Consultants have problems communicating with GPs, other consultants and other hospitals
  • Using agency staff to fill vacancies has affected team-working and continuity of care
  • Changes in doctors’ training have affected continuity of care and led to a more fragmented and unsatisfactory experience for junior doctors
  • Hospitals’ solutions include: joining up different IT systems, using board rounds alongside ward rounds, improving handovers, understanding how patients experience care
  • Some Trusts have tried quality-improvement programmes but progress has been slow
  • Some Trusts have tried to standardise care on hospital wards including: specifying the composition of teams, interdisciplinary collaboration, early treatment of the deteriorating patient
  • The main responsibility for delivering safe and high-quality care rests with clinical teams
  • BUT Trust leaders should support them with the training, resources and time to improve care
  • Leaders should value and trust staff, giving them the ‘headroom’ to improve care and act on patients’ feedback.
  • Managers should make it easy for staff to speak up about problems affecting the safety and quality of care
  • Leaders at all levels should focus on the operational aspects of how work is done in hospitals
  • Action is urgently needed to improve the working lives of junior doctors
  • Regulators should provide the resources to modernise buildings, equipment and IT and to train and develop staff
  • Regulators should replace management consultants with a commitment to quality improvement led by trust leaders with a track record of delivering change
  • Professional societies should support quality-improvement work
  • The Government has a responsibility to provide enough money to keep up with rising patient demands

Primary audience: Hospital Trust management teams, clinical leaders, regulators and professional bodies

Date last updated: August 2017

Due for review: August 2017

Group member responsible: JC

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