ePoster
Implementation of the Francis Report recommendation 158-asking University of Bristol Medical Undergraduates in psychiatry about quality of care and patient safety

Authors

  1. Dr Karl Scheeres e-mail: karlscheeres@nhs.net Twitter: @karlscheeres
  2. Dr Nicola Taylor
  3. Dr Dheeraj Rai
  4. Dr Geoffrey Van der Linden

Theme

8JJ Patient safety

INSTITUTION

Avon & Wiltshire Mental Health Partnership NHS Trust
University of Bristol

Take-home Messages

Medical students are a valuable resource in monitoring and highlighting patient safety concerns and the quality of care.

Background

The 2013 Francis report1 into unacceptably poor standards of care in a UK hospital highlighted a number of recommendations to prevent recurrence. They recognised that medical students were not asked their views about patient safety or quality of care.   Recommendation 158 advised that, “…providers actively seek feedback from students and tutors on compliance by placement providers with minimum standards of patient safety and quality of care.”

Summary of Work

The University of Bristol provides undergraduate psychiatry education in partnership with three National Health Service (NHS) trusts in South West England.  We developed two specific questions relating to patient safety and quality of care that we asked all students following their psychiatry placement (in addition to our usual feedback questions).  This was carried out using an electronic questionnaire administered to students on the last day of their attachment.

The two questions that we asked were:

1. The recent Francis Report has highlighted our professional duty to report instances of unsafe practice. During your Psychiatry placement/block, please tell us about any instances that you think compromised patient safety. Each report will be considered. We may contact you if we think we need further details of your experience, to ensure good patient care (free text feedback box)

2. Think about your placement in psychiatry. How likely would you be to recommend that ward or team to family or friends should they need similar care or treatment? (Five item Likert scale: 1. Very Likely  2. Likely 3. Neither Likely nor Unlikely 4. Unlikely  5.Very Unlikely)

Summary of Results

We achieved a 98% response rate with 225 of 230 students completing the questionnaire.

Question 1.  Patient Safety

There were 11 genuine concerns from medical students (5% of students).  Of these concerns, six related to the students own safety, and 5 related to issues of patient safety or concerns about professionalism.  The results are summarised here:

Question 2 - Quality of Care using 'Friends and Family' test

The vast majority of students rated the care provided to our patients as good, when asked to think about whether they would recommend our services to friends or family who had the same needs as patients.  However, when this data was broken down into individual sites (psychiatry teaching took place in eight separate geographical locations), there were clear differences seen. The question was used to calculate a metric used widely in the UK called the 'Friends and family score'2. This is a score ranging from +100 (best) to -100 (worst) calculated by subtracting the percentage who answered ('neither likely nor unlikely + 'unlikely' + 'very unlikely') from the percentage who answered 'very likely'. The scores varied from +33 to -12.  These results were fed back to the medical directors in the trusts, and are summarised here: 

Conclusion

Involving medical students in reporting standards of care and patient safety concerns was illuminating; concerns were often specific and direct.  This data is an invaluable source of information for medical directors, that can be triangulated with other data about patient safety and quality, to better understand areas requiring improvement.   

Several students appeared to have mis-read the patient safety question and instead felt it was asking about their own safety.  This might suggest that they are not used to being asked their opinion about patient safety;  exactly what the Francis report highlighted.   The process encourages reflection on their role in identifying patient safety concerns at an early stage in training, and hopefully will contribute to a greater awareness of patient safety issues as they progress.

Acknowledgement

We would like to thank Dr Hayley Richards, Medical Director at Avon & Wiltshire Mental Health Partnership Trust who originally brought our attention to this recommendation of the Francis report.  We would also like to thank Dr Steve Arnott, Director of Medical Education for his help with implementation of this project.  Mr David Jackson, Mrs Kay Russell and Mrs June Johnstone all helped administer the electronic questionnaire at the University of Bristol Medical School, for which we thank them.

References

1. The Mid-Staffordshire foundation inquiry (2013).  Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery office.

2. Department of Health (2013).   The NHS Friends and Family Test, Publication Guidance.  Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214941/Friends-and-Family-Test-Publication-Guidance-v2-FOR-PUBLIC_E2_80_A6.pdf (accessed 18th August 2014).

Take-home Messages
Background
Summary of Work
Summary of Results
Conclusion
Acknowledgement
References
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