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Putting pen to paper, finger to key....

Putting pen to paper, finger to key….

The past month has been all about the writing…although that includes a lot of reading, re-reading, editing, re-writing and, perhaps oddly, drawing too.  However, progress is undoubtedly being made, and I now have some really thick stacks of paper which have a very strong resemblance to ‘chapters’; you don’t even need to look at them in too much of a funny way or anything!

I have been concentrating on writing up my empirical studies which formed the mixed methods case study I am using as the basis for my PhD research.  This case study has been carried out at a large NHS hospital, with great support from Healthcare Professionals participating in and facilitating the research.  Participants from all identified areas of the audit process were included in interviews and observations, to explore the research question:

What is the importance of Domain Knowledge and Human Behaviour for successful Quality Audit Processes and (associated) Technology Development?

Study Summaries

Research Question and 3 studies

Research Question and 3 studies

  • Study 1 addressed the current state of measurement for Hand Hygiene within the case study site, producing a map of the process helping to identify key burdens from the perceptions of those involved in generating and receiving the data. Feedback was highlighted as a key factor requiring further attention, current weaknesses leading to the conclusion from participants that audit output was seen as “meaningless data“.
  • Study 2 investigated the potential of current technologies developed/promoted to aid Hand Hygiene auditing, questioning their ‘Fit-For-Purpose’ using the WHO 5 Moments as benchmark, and discussing examples of such innovations with current Healthcare Professionals.  Whilst some technologies were found to be able to detect Hand Hygiene activity at WHO Moments 1, 4 and 5, no technologies could detect such activity at Moments 2 and 3.  This fact, alongside issues of anonymity, feelings of “Big Brother” and accuracy led to concerns for the Healthcare Professionals as to the usability of technologies – however they were interested in their potential to provide meaningful data about their performance, especially at Moments 1, 4 and 5, which they recognised from their training.
  • Study 3 applied an existing Hand Hygiene behavioural theory – Inherent and Elective Hand Hygiene – to a NHS setting, piloting a new method for both identifying activities classified as “Inherent” or “Elective”, then comparing whether Hand Hygiene in either classification was greater.  This led on from Study 2, where Healthcare Professionals noted that they felt technology to ‘prompt’ Hand Hygiene at activities related to Moments 2 and 3 (e.g. taking a blood sample, removing a urinary catheter) would be unnecessary as they would “always wash their hands if there were bodily fluids involved”.  The study found that, at the setting studied, Hand hygiene was indeed significantly more likely at Inherent activities than Elective activities.

Now I get the very exciting opportunity to take the details of two of these studies (1 and 2) and share them with some of the leading experts within the field of Infection Prevention, as I have been fortunate enough to get a place at ICPIC 2013 in Geneva.  I hope to Tweet as much as possible, and if time allows I will write a quick blog whilst I am out there; if not then I am sure I will have plenty to say about it all once I am back. Even reading (and highlighting!!) the conference programme this afternoon has caused my excitement levels to rise dramatically….

ICPIC

(NB: Will be back to the dissertation writing July 2nd….promise!)

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When I last blogged, way back in mid-April I was in need of a holiday, and was experiencing a mixed bag of events, although on the whole things were turning more positive, with enjoyable times being had with both Women In Science (#WISAnEveningWith) and the #GetStoolSmart campaign at UHCW.

So what has happened since?

Well, I managed to get away on the eagerly anticipated holiday! As with all such things, it seems a very long time ago now, but it was a wonderful break, and a great opportunity to spend some time outdoors (in all elements…!).  This isn’t a “Postcard From…” blog, but honourable mentions must go to (Dyfi Osprey Project, Welsh Cakes, MOMA Wales, Cadair Idris, and A Nets Catch).  Whilst I cannot say that I switched off from work completely (probably never possible for anyone), it was certainly much more pleasurable to be going through my presentations (Doctoral/IPS)  in my head whilst faced with scenery like this…

Doctoral Work – Getting it “Out There”

I hit the ground running when I got back from holiday, with the WMG Doctoral Conference (Healthcare) on the 29th April, a positive chance to not only share my PhD progress with peers and WMG, but also to catch up with what other Doctoral students have been up to in the last 12 months. A PhD can be an isolating experience, especially when (like me) you are researching something “different” so spend most of your time working independently – so events like this are a welcome chance to gain feedback both professionally and personally. Fortunately the presentation seemed to be well received, and discussions over lunch were all positive, with great use of the word ‘rigour’…always a good thing to hear about your work when you’ve reached the ‘only writing up now’ stage I think…!

The 9th May saw a second opportunity to share my work, this time as an Invited Speaker at the IPS Ambulance Forum and Audit and Surveillance Forum Conference (“Every Bug Counts!)” in Birmingham.  This was my first IPS meeting (outside of presenting my Poster at IPS 2012 last year), and I was absolutely blown away by the welcoming, supportive and truly friendly atmosphere; could not have been a more positive experience. Speaking after the ‘event’ that is Martin Kiernan, and with IPS President (not to mention Hand Hygiene legend!) Julie Storr mere meters away I think the word nervous barely covers it, but the excitement of being able to talk about my work, and knowing I was (in a way) representing the brilliant participants at my case study site helped me focus. And I think I got away with it…

Finally, I also found out I’ve been accepted to present my Poster summarising Studies 1 and 2 at ICPIC 2013 in Geneva at the end of June. Excited?  I believe I may have jumped a bit when I read the email. Fortunately I wasn’t in public…  Anyhow, bearing in mind the sheer scale of ICPIC 2013 with the speaker list looking like it has been copied right from my thesis reference section, I think a small amount of bouncing is allowed.

Hand Hygiene – Impressive NHS Activity

Some amazing ideas!

Some amazing ideas!

Also since I last blogged I also had a wonderful invite from the team at UHCW to come and judge their exciting Hand Hygiene poster competition, which involved both local primary school children and in-patients, all tasked with getting the vital “Hand Hygiene” message over.  These posters were displayed in the main entrance area of the hospital for over a week, generating much interest from Public and Staff alike, showing the worth of such apparently simple innovations.  Even some of the parents of the children came to see the handiwork of their offspring, and you could see the pride clearly – and also, interestingly, comments like “Oh yes, they’ve been on and on about when we should be washing our hands at home now…”. 

Baked Goodness for all!

Baked Goodness for all!

Not just your standard poster competition then…!The judging panel found picking winners in each of the age categories nearly impossible, because each child seemed to have managed to put their own unique spin on the challenge, some going with the ‘Big and Bold’ strategy, others using ‘Devil in the Detail’, whilst others were just amazingly beautiful and colourful.  Naturally, we needed cake to help us with our discussions, and fortunately the IPCT office is a haven for such baked goodness….

In the end the winners reflect a real mixture, and the overall winner will be on display at UHCW soon – contact UHCW IPCT for more information.

Global Hand Hygiene Day – My Challenge

In preparation for May 5th – Global Hand Hygiene DayProfessor Didier Pittet Tweeted a call asking what everyone would personally be doing to mark the event…which made me think about what I could do, specifically, on that date.  I decided, as my main activity in the sphere on Hand Hygiene at the moment is research, to set myself the target of trying to submit my first academic paper to a journal for review on May 5th.  I chose the Journal of Infection Prevention (JIP), as it is the Journal of the Infection Prevention Society (IPS) who I have found an invaluable source of inspiration, information and support, and I felt that my research may be best suited to their audience at this stage.  Having contacted the Editor (the wonderful Dr Neil Wigglesworth, who I’d met briefly at IFIC 2012) and received a virtually immediate response to confirm that the topic would be fitting for JIP, I knuckled down and (with my co-author!!) managed to get this paper to a format suitable for submission…thus it found itself winging its way off to the reviewers on the 5th May precisely.   Time will tell as to what feedback is returned, but we’re just looking forward to hearing what ‘outside eyes’ think of the topic, so we can take it from there. Don’t worry, I’ll keep you posted…

General PhD Progress

From a writing-up point of view progress is still being made; albeit a ‘non-linear, backwards/forwards, apparently quite normal’ PhD type way. I think it is best illustrated by the medium of cakes consumed recently, each representing either a breakthrough or breakdown in writing progress….

Fuel for IPS Talk run through...

Fuel for IPS Talk run through…

The PG Hub turned 1!

The PG Hub turned 1!

Celebrating breakthrough in Study 1 writing

Celebrating breakthrough in Study 1 writing

Dark times...not always bad...

Dark times…not always bad…

Part of the PG Hub "Dissertation Station" season

Part of the PG Hub “Dissertation Station” season

Cake selection for Happy Monday!

Cake selection for Happy Monday!

And the eagle-eyed amongst you, if you haven’t been distracted by all that cake, may have spotted actual pages of thesis hidden in amongst those snap shots. Proof that amongst all those sugar hits, words are emerging….there’s even talk of “sense” and “logic”… But let’s not get too carried away yet…

Back to writing for today now – revisiting my Literature Review section at the moment to add-in a section on Effective Hand Hygiene, covering Soap and Water, ABHR, Technique and, of course, the 5 Moments

WHO 5 Moments for Hand Hygiene

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This week has been a true representation of how varied a PhD experience can be, especially one like mine which has a number of different threads  being (carefully…) woven together.  The brief overview of my schedule below should give some insight into how all the topics within my research are currently being explored in parallel, turning me into something akin to a plate-spinner….plates

Monday: (Snow Day) Chapter writing for Thesis on the topic of Hand Hygiene Compliance; Factors Affecting Compliance (especially Intensity  of Patient Care, Ward Context and Patient Type) and Issues of Measurement of Hand Hygiene Compliance (which links with the work for my Study 1, which explores how Hand Hygiene is Audited at an NHS Acute Trust).

Tuesday: (Rescheduled from in-situ study day), instead Paper writing on the topic of Electronic Monitoring Technologies and Hand Hygiene, discussing  their Fit-For-Purpose rating according to established guidelines. This links in with the work for my Study 2, which explores the potential for Technology within the Audit Process at an NHS Acute Trust. Also had good Twitterchat and received support (and Thesis!) from great source of knowledge in Infection Prevention – Microbiology expert Jon Otter.

Wednesday: Very interesting meeting with Engineering company to hear all about Hand Hygiene system which can provide data to Healthcare Professionals about their Hand Hygiene compliance against scientifically sound ‘benchmarks’ (expected compliance rates) based on WHO 5 Moments. So much potential to explore….  Also an opportunity for exciting, motivating and woefully short catch-up with Claire Kilpatrick,  already working on outputs from that session!

Thursday: (Today) Back to collecting data in-situ for Study 3, looking at the effect of Human Behaviour on Hand Hygiene, and then back to writing the Thesis Chapter draft…

Tomorrow I shall be collecting more data, and then next week I am attending a networking event at my University, aiming to bring together Health Research from all departments and schools. Health @ Warwick3should be an interesting and vibrant day, and I am looking forward to sharing my “Why Do You Wash You Hands” poster from IFIC, to give a flavour of the work I have been doing over the past 3 or so years.  I’ll probably Tweet from the day, so if you’re there/interested, make sure you keep an eye out for @CHD05!

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Yesterday, 10th January, I passed a big landmark in my research, when I finished the final stage of the interview transcriptions for Study 1 and 2.  It feels great!

This process has involved a number of stages, initial recordings of the first wave of interviews, which were then transcribed verbatim to form a Coding Schedule, and then further cycles of new interviews being recorded and transcribed, new themes being discovered, further interviews, further transcriptions, and then revisiting the earlier scripts to re-code based on new emergent themes.  Yesterday I added the final 2 interviews to the ‘pool’, and so can now begin the final full sweep of analysis, using both the initial Deductive and then emergent Inductive Coding Schedules which have been developed as the research has evolved – and I have to say it is very exciting… 

Having personally conducted and transcribed all 18 Interview sessions (including 3 group interview sessions), I feel like I ‘know’ the data well, however it will be good to see it as a whole, to see which themes emerge as ‘strong’ across more Participants, and which appear to come from individuals, and of course, to see if there is a difference based on which area the Participants come from.

I start Study 3 next week, which is partially based on the existing major themes to have emerged from the earlier analysis of this data, so it will be very useful to have it so fresh in my mind when I am back on the wards come Tuesday….

Will keep you posted – and full results will be available by June 2013 – submission time!!!

Getting there...!

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Finally uploading the link to my IFIC Poster  – things have been a bit hectic since my last post, and whilst things are still very much ‘potentially interesting’ they are also very much intense!  Here I’ve split the week up into 3 chunks, the Successes, the Highs and the Lows (not too gloomy though!)….and then finish on my lingering issue of Where Next…..

Successes

This week I completed the final interview sessions for Study 1/2 – whilst it is tempting to continue collecting data along these themes, as it is enjoyable meeting new members of staff and discussing Hand Hygiene experiences and views on what could be done differently, the key (or one of them!) to successful qualitative research lies in knowing when to stop.  The legendary ‘Saturation Point’, whereby no new themes emerge from the data, is hard to categorically locate – there is always the fear that the next interview may provide something different…but you have to use your instinct, and also respect the time and resources available.

So after 6 months of data collection, using a mixture of deductive and inductive analysis, I am now confident that I can defend the process used to explore the phenomenon, and also the decision to stop at this stage.  Whilst every individual has unique experiences to share, due to differences in perceptions, memories and the very nature of life opportunities, the general themes now emerging are beginning to converge.  Thus I used the final group interview session to clarify issues I was still partially unclear on, and also to confirm some general themes that had emerged so far.  I now look forward to analysing the whole data set using the coding matrix established previously, and seeing the themes that fully emerge….

Highs

 This week I also had fun with a supplementary activity – comparing the emergent themes from my research with those which were raised during a live TwitterChat hosted by @WeNurses (see here for article). It was really interesting and encouraging to see so many other Healthcare Professionals raise the same themes as we have found at our case study site – issues such as the impact of Role Models, Habitual Hand Hygiene and the Challenges of Compliance.  It shows that the research is both relevant, and necessary!

Lows – but not all negative

This week I also said a sad goodbye to my Academic Supervisor, who has left WMG and Warwick to take up a new post as Leadership
Chair in eHealth Research at the Leeds Institute of Health Sciences (University of Leeds).  I have so much to thank Jeremy for, as even though I have only worked with him for 18 months, he has been instrumental in moulding my research into the project it is today, and helping me build both my skills and confidence as an early career researcher.  He has also shown a genuine interest in the topic area, despite it not being directly linked to any current research he is involved in, and thus it has taken additional time and resource for him to work on my PhD project – a fact he has never once complained about.  I cannot thank him enough for all his help and encouragement, and am delighted that we will be keeping in close contact as we both face our new future challenges.

It’s not all sad though – at our last meeting I was able to share with Jeremy my ideas for future research, and things looked good – I am very enthusiastic about his feedback and own enthusiasm.  The ‘Where Next’ question looms larger by the day then – questions such as ‘Is anyone else researching Hand Hygiene?‘, ‘Where?’, ‘In what context?‘…..

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