Impact for healthcare…the additional requirement

We are all familiar with the word impact. However, for those within the academic world this word continues to take on importance as the need to demonstrate relevance and transferability of research outputs grows. No longer do the neat definitions above suffice, now we are provided with comprehensive resources, leading to detailed “Pathways to Impact” to guide us on our way…

I’ve written before on my concerns/disappointment on the apparent gap between my two worlds – academia and healthcare. Exciting academic advances don’t appear to be making it to our “front-line”, on the average ward, on a Tuesday morning at 10.15am. According to literature there are multiple interventions that should be working to improve hand hygiene…behavioural models that can be applied…future work that is recommended….but follow-up is often lacking. Publication dates stretch back over 10, 15 years now. And on a Tuesday morning at 10.15am does that hand hygiene occur..?

The additional requirement…

Be brave!

I find it interesting, then, that in many conversations I have with healthcare professionals (of all grades) the word I hear much more frequently than impact is brave.  The fundamental need to be brave enough to implement something new, something that may ruffle some feathers, something that may affect the “targets”, but ultimately, something that evidence suggests should lead to improvement. This takes bravery. And for long-term change, it takes more than individual bravery, there needs to be a network of clear, effective support from managers brave enough to defend new ideas and processes.

Such bravery feeds impact right where it matters, making differences to staff and patients alike.  It engages staff, and it improves patient safety and experience. A good example of this can be seen through the model of Front Line Ownership, whereby a brave decision to allow staff to be creative problem solvers led to increased engagement, and direct impact on patient safety – barriers to hand hygiene were identified and solutions proposed and implemented.

So, within infection prevention, within healthcare, and within academia, we need to ensure that impact does not become (remain?) a tokenistic term used only for the purpose of securing funding or reputation. We need to constantly question what practical benefit our work can have at the front-line, and a fundamental lever to this appears to be bravery. Will the intended setting, be it the NHS, the private sector, industrial partners or beyond, be brave enough to make the changes your research is suggesting?

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Returning to blogging – What made the Summer List?

So it’s been almost 2 months since my last blog post….

I seem to start a lot of my posts with a comment on how long it has been since I last wrote, but apparently, when you’re writing up a thesis (or doing any kind of intensive project) it is expected that the odd MIA will occur, and I have been reassured that apologies are not necessary….  Still, I have to admit that I have felt rather frustrated at myself for lack of blogging – having had rather a lot to blog about!

That’s where Twitter is such a great tool, those 140 characters have helped me feel in sight of the loop, if not entirely in it over the course of the summer.

Well, what have I been up to?

The Summer List

Resorting to a list seems to be the only sensible course of action here, for everyone:

• Working on the thesis – a given, but happily progress has been rapid (give or take a few moments of horror) and I am well on course to submit by Christmas.

 

• I’ve been accepted to present my work on Study 3 at IPS 2013, the annual conference of the Infection Prevention Society.  I’m really excited about this, as the work on Inherent and Elective hand hygiene has proven really interesting to discuss with those from the field of infection prevention. The study represents the first (as I am aware) work of its kind within the NHS, so will be great to get some feedback now that the results are in. Just waiting on funding news before I can make final plans…

 

• Spent a great day with the wonderfully bubbly team over at UHCW who hosted hand hygiene heroes Julie Storr and Claire Kilpatrick for a day focussing on the WHO 5 Moments, looking at system and behavioural change.  Absolutely fascinating topics covered, and great to see the involvement of lots of healthcare professionals from a range of clinical settings, engaging in discussions and scenarios designed to help translate the 5 Moments into real-life Patient care. I certainly left the day with a greater level of clarity regarding the concept, and I am sure I wasn’t the only one.

 

• Outside hand hygiene I’ve also been spending time with the lovely Women in Science committee as we prepare for our symposium on the 26th September.  The event is entitled “WIS A Day With” and follows on from the successful event earlier this year, “WIS An Evening With”, which saw two highly regarded speakers share their experiences of a career in the field of science.  WIS A Day With features 4 speakers who will also share their career stories, along with sessions run by complimentary organisations looking to support career development. And, of course, there will be the popular wine and cheese event to finish.

• And as it’s Migraine Awareness Week it’s fair to say I’ve been doing a bit of that (right) too. I’ve posted about this once before, but I thought I’d mention it again briefly in this post after reading and discussing the condition a lot this week. Key words I noticed featuring heavily in discussions were ‘debilitating’, ‘underestimated’, ‘impact’ and, naturally, ‘pain’.  I’d also throw ‘unpredicatable’ and ‘exhausting’ into the mix, not to mention the effect on those around you.

 

• But on a brighter note, and what could be better – the Bake Off is back…!  That should take me nicely through until submission. Great timing from The Berry.

 

To celebrate the work with Women In Science, and just because it is rather special in itself, I shall finish this update with this rather glorious picture from Lego:

First female scientist figure by Lego

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‘Potentially’ interesting

Haven’t written a post for a while, as it has been somewhat difficult to think of what to write….half of me is very excited about the direction my research is potentially taking, whilst the other half is so hung up on the ‘potentially’ aspect, that I find myself getting tied up in knots and fighting waves of panic…..  And no one wants to read a blog post about that (but they might want to look at a picture….)

SO, a brief update as to all things research, to help me clear the mind, and reassure those who are asking that work is still continuing.

• Study 3 – the revised version – is currently in the recruitment stage.  This will be investigating Inherent and Elective Hand Hygiene in an NHS setting, and will be on a pilot scale, hopefully giving me the grounds for future Post-Doc development, exploring themes of training and technology/process development all centred around the WHO 5 Moments.
• Studies 1 and 2 – the data collected from these studies are being analysed, using thematic coding (for interviews) with a mixture of both inductive and deductive analysis.  A process map, based on how Auditing works within the Case Study site has been produced, showing areas of perceived ‘confusion’, and it is here that analysis is being concentrated – is there a potential role for technology to help reduce this confusion?
• I am now looking forwards to the time after my PhD (only 8 months left) and have had some great conversations about the potential to extend the PhD work, to develop the emergent themes. A number of NHS sites have potentially shown an interest in collaborating, which is excellent, and I believe we have in place some excellent (relatively short-term) study designs that could help us explore issues surrounding the understanding and use of the WHO 5 Moments further.  My main decisions to make are how to fund (applying for an independent Fellowship…?) and where to base myself (Academic Institution…?).  These are big decisions to make, and always harder at a time when trying to finish a PhD. A recognised and shared worry I’m sure.

What else is happening?

• I had an amazing conversation with Claire Kilpatrick and Jules Storr at IFIC 2012.  I cannot say too much about it (because I’ll sound far too over-excited), but suffice to say their encouragement and support about my work was immeasurable. Well timed and simply perfect.  As a researcher working without a ‘team’ (I am the only member of my department working on Infection Prevention) it is often a disappointment not to be able to become passionate about the work with other people; this conversation certainly gave me a strong shot of that passion!  Cannot thank them enough.
• Have also been asked to share my work at my host NHS site’s ICT study day (November 14th), which I’m really looking forward to.  I’ve been given free range to talk on anything related to the work we’ve been doing, and I’m really eager to share what we’ve been upto – especially as the ICT often (it seems) get a bit of a ‘bad press’ within hospital circles, by nature having to appear mainly at times of crises, and often being seen to be ‘telling people off’. Will be great to share the story of how the work on Hand Hygiene is preventative, looking to stop these crises happening, and how the new work (Study 3) is trying to explore an angle the audience may not have heard about before.  We can but see….
• In off topic news, I’ve also been testing out the NHS as a Patient, as I’m sporting a knee injury post-marathon. This has left me unable to run, and may be in someway linked to my ‘PhD blues’ state.  Fingers crossed I will be able to get some more answers tomorrow at the next check.  The only good thing is I get to play one of my favourtie games, where I see the Doctor’s face when I tell them what I do for a living……cue instant fear, and sudden Hand washing….!

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A Buckaroo Moment….?

Source: http://www.despair.com

With reflection it is fair to say that after such a glorious weekend the days that followed were always likely to seem challenging, however by any stretch of the imagination I don’t think I could have envisaged just how difficult they were to become.  By Thursday afternoon the word ‘meltdown’ was being liberally spouted from my mouth…!  

In short, I have hit a problem with the Ph.D. project.  All research has moments like this, and when I use my logical brain I can easily sit and discuss how such issues offer advantages as well as challenges, and be thankful that the study has a purposely flexible design, to cope with such eventualities. It is just when I am tired, or when I reach what I feel is a saturation point of contingency planning, I feel sometimes I would just prefer things to be straight-forward. For once.  Please. 

 To put the issue into context, my project design involves running 3 separate studies in parallel, to enable maximum efficiency when working with limited resources, most notably the time of the Healthcare Professionals involved. Thus 1 interview provides data for up to 3 study aims, without the need for additional interview sessions with the same participant.  This has worked well, and has allowed Studies 1 and 2 to progress at planned speed throughout June and July.  However, Study 3 has a segment which is reliant on findings from the interview phase, to allow for data analysis during September, and it is here that the ‘problem/challenge/crisis/meltdown’ has occurred.  The findings from the interviews has proven to be much more complex (a positive on one side) when analysed than previously thought, which prohibits the required data analysis in the form first planned.  

This dawning realisation, checked, re-checked and worked-through-on-the-white-board-and-triple-checked led to a last-minute cancellation of an interview (which I hated doing), and a brainstorming session with a very lovely fellow researcher, and we have now carved out a future plan….  Despair to excitement in the space on one afternoon, 4 colours of white-board marker, 6 cups of tea, and a walk along a canal to feed the ducks. 

I am now off for a break for a couple of weeks – very much needed – and am feeling a lot more confident about moving forwards when I come back.  I need to get back to my host NHS site, talk over the new plans with my key support links there, and with the best of luck things will be able to go ahead as I hope.  If not, I fear we may really see the donkey flip…………

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Working with the NHS, always for everyone

Having a truly wonderful weekend of patriotic pride now that London 2012 is finally here – cannot praise all those involved in the opening ceremony highly enough – simply sublime!  I was delighted with the NHS tribute, the inclusion of real Healthcare Professionals, and the interweaving of our children’s literature heritage through the GOSH ties with JM Barrie.  Pure pride.  I struggle to think of any other country whom, when really pushed, would put their healthcare system so close to their hearts and literally make a song and dance about it.  I only hope that such affection is upheld and carried forward once all the glitz has passed and the reality of budget planning is once again the main topic of conversation…

On a research note the past week has been a busy one working with my NHS Acute Trust host, who themselves could not be more helpful.  As I enter my final year of PhD research my focus turns to the future, and I am more certain than ever that this research, on Hand Hygiene, Auditing and the development of suitable processes/technology, is an area that can and arguably should, be developed.  My major challenge will now be to find suitable funding for a Fellowship position – a difficult objective, but one I am more determined to achieve knowing the passion of those within the team I have been working at my NHS host site.  Together I feel certain we can make things happen!

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Patient Empowerment

One of the early themes that I started to explore as part of my research was that of Patient Empowerment with regard to attempts to increase compliance to required Hand Hygiene standards.  This is something which has been recommended by empirical work (e.g. McGuckin et al, 1999) and the World Health Organisation (WHO),  and incorporated into strategies within the UK – for example the National Patient Safety Agency (NPSA) “Cleanyourhands” Campaign (2004).

However, as acknowledged by the WHO (2009) document – further work needs to be done on establishing effective ways to involve patients in the Hand Hygiene process. For example, data collected by the National Audit Office in 2009 found that only 36% of acute trusts involved in the “Cleanyourhands” Campaign believed Patient Empowerment had been achieved by the methods employed (i.e. ‘It’s Ok to Ask’ message).

To investigate this issue personally I designed a Poster entitled “Encouraging Debate: Patient Empowerment” for the Warwick Postgraduate Poster fair in 2010 – this gave me a great opportunity to talk to both other research students and staff, plus a wider audience, about the issues surrounding the involvement of patients in Hand Hygiene.  These included viewpoints about the ethical concerns regarding their role in ensuring medical staff performed their tasks to a ‘correct’ standard, how patients are supposed to understand what this ‘correct’ standard is, what pressure this ‘role’ may cause or alleviate in the patient – and also whether the Public should be involved in Hand Hygiene research, when they may not be aware of problems obtaining compliance in the first place.

A copy of this poster will be uploaded shortly – and whilst the main focus of the research has now moved away from this area I feel it is still a vital field that should be discussed, as each individual has the potential to one day be a patient – the question being, would you challenge a Healthcare Worker over their Hand Hygiene behaviour?

Cited References:

• McGuckin M et al. (1999). Patient education model for increasing handwashing compliance. American Journal of Infection Control. V, 27, pp. 309-314.
• National Audit Office (2009). Reducing Healthcare Associated Infections in Hospitals in England report by the Comptroller and Auditor General. HC 560 Session 2008-2009.
• National Patient Safety Agency (2004). “Cleanyourhands Campaign” data available online at: http://www.npsa.nhs.uk/cleanyourhands/
• World Health Organisation. (2009). WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care is Safer Care. Geneva: WHO Press.

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Welcome to ExploringHandHygiene

With a clue in the title, this blog is set to follow a multitude of themes in and around the umbrella topic of “Hand Hygiene”.

Whilst the main Doctoral Research being carried out has a specific focus on the Monitoring and Measurement of Hand Hygiene Compliance within NHS Acute Settings, this blog is to be a space dedicated to exploring the topic on a much wider scale – looking at Hand Hygiene in general terms, interventions and research outside of the NHS/UK field, and generally discussing an issue that has relevance to every individual in every walk of like. 

Comments, direct contact and all feedback welcome – the aim is to get people talking about Hand Hygiene….and practicing it….!

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