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  • i

    Final Report

    Evaluation of the

    Huddling Up for Safer Healthcare

    (HUSH)

    Scaling Up Project

    Authors

    Kate Crosswaite – Evaluation Research Fellow, University of Bradford

    Muhammad Faisal – Senior Research Fellow, University of Bradford

    Joyce Craig - Associate Project Director, York Health Economics Consortium

    Claire Marsh - Senior Research Fellow, Improvement Academy

    Eileen McDonach – Honorary Research Fellow, University of Bradford

    Mohammed A Mohammed – Professor of Healthcare Quality, University of Bradford

    30 April 2018

  • ii

    70% of ward staff in five hospitals successfully embedded Patient Safety Huddles

    “I understand if a patient is at risk, more now than ever before because I don’t have to

    seek out information because any issues are highlighted by the huddle.”

    Healthcare Assistant

    “[Team] members work more co-operatively when caring for patients and are able to

    help each other more effectively.”

    Staff Nurse

    “I think it’s more learning culture, it’s introduced a learning culture and an interest in

    the changes and interest in improvement and that’s what we’re aiming to be as a

    trust. More of an improvement based culture, a learning culture. Like you say, it’s

    knock down those defensive barriers.”

    Coach

    “My support at the beginning was based on the results of the wards that had already started

    them, the enthusiastic leadership, and because I couldn’t really see that they could

    do any harm. But now if I went to another Trust and they weren’t doing safety

    huddles I would be keen to get them introduced.”

    NHS Leader

  • iii

    Acknowledgements

    The authors of this report are grateful to the following individuals for their on-going support

    to the evaluation team, sometimes in quite challenging circumstances.

    List if names (alphabetical) –

    Name Affiliation Professor Gerry Armitage University of Bradford (UoB)

    Dr Judith Dyson University of Hull

    Dr Jason Etchegaray University of Texas, USA

    Dr Sean Leamon The Health Foundation

    Professor Graham Martin University of Leicester

    Vicky Padgett The Improvement Academy

    We would also like to acknowledge the contribution of the following to the evaluation:

     All those who participated in the patient representative workshops

     Project leaders, coaches and senior NHS stakeholders who took part in the evaluation

     Staff at The Improvement Academy who supported the project

     NHS staff and others who attended the Evaluation Dress Rehearsals

     Jane Montague (UoB) and Laura Lamming (UoB) for their support and insights

     Michael Rooney and Craig Pattison for their assistance with the data collation

  • iv

    Table of Contents

    Table of Contents ................................................................................................................................... iv

    List of Abbreviations (alphabetical) ...................................................................................................... vii

    Executive Summary .............................................................................................................................. viii

    Introduction ..................................................................................................................................... viii

    Evaluation Approach ........................................................................................................................ viii

    Findings .............................................................................................................................................. ix

    Implementation and Fidelity of PSHs ............................................................................................. ix

    Team working and patient safety climate ..................................................................................... ix

    Harm reduction ............................................................................................................................... x

    Return on Investment ..................................................................................................................... x

    Lessons from scaling up ................................................................................................................. xi

    Conclusions ........................................................................................................................................ xi

    1 Introduction .................................................................................................................................... 1

    1.1 Overview ................................................................................................................................. 1

    1.2 Patient Safety Huddles: a brief literature review .................................................................. 3

    1.2.1 Characteristics of Patient Safety Huddles ....................................................................... 3

    1.2.2 Impact of Patient Safety Huddles ................................................................................... 5

    1.3 Huddling Up for Safer Healthcare ........................................................................................... 5

    1.4 Scaling up Patient Safety Huddles........................................................................................... 6

    1.5 Organisational Context for the HUSH project ......................................................................... 8

    2 Evaluation aims, themes and questions ....................................................................................... 10

    3 Evaluation Methodology ............................................................................................................... 11

    3.1 Overview of the evaluation approach .................................................................................. 11

    3.2 Developmental Evaluation .................................................................................................... 11

    3.3 Estimating the Return on Investment ................................................................................... 12

    3.4 Patient and Public Involvement ............................................................................................ 13

    3.5 Unfeasibility of randomisation and controlled comparisons................................................ 13

    3.6 Unit of analysis ...................................................................................................................... 13

    3.7 The measurement framework .............................................................................................. 14

    3.8 Implementation and Fidelity of PSH ..................................................................................... 16

    3.8.1 Stages of Implementation Checklist ............................................................................. 16

    3.8.2 The Ward Level Report ................................................................................................. 17

    3.8.3 Structured observations of PSHs by the Evaluation Fellow .......................................... 17

    3.9 Measurement of Outcomes and Effectiveness ..................................................................... 17

    3.9.1 Teamwork and Safety Climate Survey .......................................................................... 17

    3.9.2 Routinely collected patient harms ................................................................................ 18

    3.10 Capturing feedback on PSHs and the scaling up process...................................................... 19

    3.10.1 Barriers and Facilitators to Patient Safety Huddles ...................................................... 19

    3.10.2 Feedback from stakeholders ......................................................................................... 19

    3.10.3 The Evaluation Survey: Feedback from frontline teams ............................................... 20

  • v

    3.10.4 Patient and Public Involvement .................................................................................... 20

    3.11 The deeper dive sub-sample of wards .................................................................................. 21

    3.12 Ethics and approvals ............................................................................................................. 21

    4 Results ........................................................................................................................................... 22

    4.1 Number of wards in the evaluation ...................................................................................... 22

    4.2 Data completeness ............................................................................................................... 23

    4.3 Key challenges in collecting data .......................................................................................... 24

    4.4 Implementation and Fidelity ...........................................................................................

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