Emergency medicine: what keeps me, what might lose me?

EDs are currently under intense pressure due to increased patient demand. There are major issues with retention of senior personnel, making the specialty a less attractive choice for junior doctors | Emergency Medicine Journal

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This study aims to explore what attracted EM consultants to their career and keeps them there. It is hoped this can inform recruitment strategies to increase the popularity of EM to medical students and junior doctors, many of whom have very limited EM exposure.

Methods: Semistructured interviews were conducted with 10 consultants from Welsh EDs using a narrative approach.

Results: Three main themes emerged that influenced the career choice of the consultants interviewed: (1) early exposure to positive EM role models; (2) non-hierarchical team structure; (3) suitability of EM for flexible working. The main reason for consultants leaving was the pressure of work impacting on patient care.

Conclusion: The study findings suggest that EM consultants in post are positive about their careers despite the high volume of consultant attrition. This study reinforces the need for dedicated undergraduate EM placements to stimulate interest and encourage medical student EM aspirations. Consultants identified that improving the physical working environment, including organisation, would increase their effectiveness and the attractiveness of EM as a long-term career.

Full reference: James, F. & Gerrard, F. (2017) Emergency medicine: what keeps me, what might lose me? A narrative study of consultant views in Wales. Emergency Medicine Journal. 34:436-440

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Over half of sessional GPs suffer work-related stress

At least half of sessional GPs suffer from work-related stress, according to a new survey by the BMA | OnMedica

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The BMA reported that work-related stress has led more than one in ten sessional GPs to take time off work in the past year.

The BMA also found that a staggering 70% of locums would consider leaving the profession if a locum cap was introduced in general practice. It warned against anything – such as measures that harm locum pay – that could lead to an ‘exodus’ of locum and salaried doctors, who it said play a key part in solving the NHS’s current problems.

The BMA wanted to understand the issues that sessional GPs face, to ensure that its discussions with government accurately address their needs. So its sessional GP subcommittee conducted a UK-wide survey of salaried and locum GPs from 1st March to 6th April 2017.

Implementing shared decision making in the NHS

Shared decision making requires a shift in attitudes at all levels but can become part of routine practice with the right support, say Natalie Joseph-Williams and colleagues | BMJ

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Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support. In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods

The learning from MAGIC derives from a variety of sources, including facilitated shared learning events, clinic and consultation observations, interviews with clinicians and patients, patient and public involvement panels, focus groups, and questionnaires. We assessed progress using “plan do study act” data collection tools,monthly project team meetings (including researchers, clinical teams, healthcare organisations, and patient representatives), and an independent evaluation report of phase 1. Here, we draw on our learning from the three year programme and subsequent experience to summarise the key challenges of implementing shared decision making and to offer some practical solutions

Read the full article here

Tackling culture change to transform mental health services

Mandip Kaur for the King’s Fund Blog | 16th March 2017

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Traditionally, mental health services are delivered by Children and Adolescent Mental Health Services (CAMHS) up until the age of 16 or 18 – or when a young person leaves school or college – at which point they’re expected to transition to adult mental health services. It’s long been recognised that this is a poor boundary for service transition, often having a further detrimental effect on mental health.

Forward Thinking Birmingham delivers mental health services for children and young people aged up to 25, combining the expertise of Birmingham Children’s Hospital, Worcester Health and Care Trust, Beacon UK, The Children’s Society and The Priory Group. The partnership’s vision is that Birmingham should be the first city where mental health problems are not a barrier to young people achieving their dreams. The transformational changes to the service were driven by the need to address disjointed and fragmented care provision, complicated service models, long waiting lists and rising demand. The service operates a ‘no wrong door’ policy and aims to provide joined-up care, focusing on individual needs, with improved access and choice for young people.

Read the full blog post here

Organisational characteristics, teamwork & service delivery in lung cancer diagnostic assessment programmes

Honein-AbouHaidar, G.N. et al. (2017) BMJ Open. 7:e013965.

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Objectives: Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs.

Conclusions: This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes.

Read the full article here

New report from the national guardian for freedom to speak up

Dr Henrietta Hughes, national guardian for speaking up freely and safely in the NHS has published a new report, which outlines the progress made since her appointment in October 2016 | NHS Employers

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Image source: CQC

Over the last 100 days, Dr Hughes has set up the national office and established a national network of Freedom to Speak Up guardians. Key points include:

  • 201 NHS trusts now have an FTSU guardian in place
  • twelve trusts are in the process of making an appointment of an FTSU guardian
  • 21 trusts have yet to appoint to the role
  • online resources and training available for guardians (including eight training sessions being led by the National Guardian’s Office (NGO)
  • guardians are encouraged to join regional networks to share progress and provide neighbouring support
  • the NGO plans to issue good practice guidance.
Read the full report here

Study on Hospital Administrators’ Beliefs and Attitudes toward the Practice of Evidence-Based Management

Guo, R. et al. (2016) Hospital Topics. 94(3-4) pp. 62-66

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The authors’ purpose was to explore hospital administrators’ beliefs and attitudes toward the practice of evidence-based management (EBMgt) and to identify the needs for EBMgt training programs. A cross-sectional, nonexperimental design was utilized. Survey data were analyzed using descriptive statistics and Spearman’s correlation. The results showed that hospital administrators had positive attitudes toward the practice of EBMgt. There was a significant correlation between attitudes and percentage of healthcare management decisions made using an evidence-based practice approach (p < .01). The study findings suggest EBMgt educational training programs would likely help hospital administrators adopt evidence-based practice in management decision-making.

Read the full abstract here