Research

The safety climate of an organisation refers to its employees’ perceptions, attitudes and beliefs of the risks and safety associated with its work. In healthcare settings, a positive safety climate is associated with safe work practices, decreased medical errors, lower infection rates, and improved patient outcomes. Conversely, a negative safety climate has been identified as a contributory factor to adverse incidents and patient harm. The SAP-C study is a feasibility study employing a randomised controlled design that is running in 10 general practices in the Republic of Ireland and Northern Ireland. The aim of this study is to evaluate the feasibility and effects of an intervention intended to improve patient safety in primary care. Five general practices are participating in the intervention group and five practices are acting as control practices. The intervention being implemented is derived from the Scottish Patient Safety Programme in Primary Care, the first known comprehensive and coordinated attempt to improve patient safety in primary care settings in any country.

The nine-month intervention will measure the safety climate at each intervention practice over three time-points. Each practice receiving the intervention will receive feedback on their safety score in the clinical environment. A specialised trigger tool intended to facilitate the detection of unidentified patient harm will be used as part of patient chart audits. Control group practices will complete the measure of safety climate pre- and post- intervention but will not receive any feedback or engage in any other activities as part of the study.

It is anticipated that the study will provide useful data regarding the prevalence of undetected patient harm in Irish primary care, the safety climate of Irish general practices, and will contribute to an improved standard of care delivered by general practitioners. The initial results suggest that safety climate in Irish primary care settings is quite positive. A discrepancy in the reports of “managerial” (i.e. senior GPs) and “non-managerial” (i.e. assistant GPs, locum GPs, administrative staff) staff was noted however suggesting that managerial staff may overestimate the safety of their practices and that engagement with all practice staff members concerning safety is necessary.

The Safety Climate in Primary Care (SAP-C) Study is a Health Research Board funded project.

Status: This programme of research is ongoing. If you would like more information or would like to get involved please contact: sinead.lydon@nuigalway.ie

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Precision Teaching for Procedural Skills Training

Precision teaching is an instructional methodology that aims to develop accuracy and speedy responding in a target behaviour, known as behavioural fluency. Behaviours that are trained to fluency are maintained over time, can be performed for long durations, are not impacted by distraction, and generalise to other contexts. Precision teaching has been widely used in other domains to develop expertise in particular skills. Our research team has begun to apply, and evaluate, precision teaching within medical education as a mode of procedural skills training. This research employs simulation technology in combination with precision teaching and peer tutoring strategies to help students become fluent in important procedural skills before they perform them in the clinical setting. Recently, our research team carried out a study where medical students received a precision teaching intervention to improve their venepuncture procedural skills. Students who received this training programme outperformed a control group of untrained peers and a control group of practising hospital doctors. Their improved performance persisted two months after training end, was evident in the hospital setting, and wasn’t impacted by distraction.

At present, our research team is collaborating with the paediatric department at University Hospital Galway on a project evaluating the utility of precision teaching to develop paediatric lumbar puncture skills among senior house officers.

Status: This programme of research is ongoing. If you would like more information or would like to get involved please contact: sinead.lydon@nuigalway.ie

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Masters in Healthcare Simulation and Patient Safety student projects

As part of the Masters in Healthcare Simulation and Patient Safety the students write a 5,000 word research thesis. These projects are on a variety of topics related to simulation and/or patient safety. Recent projects include:

• Comparing the quality of chest compressions standing and seated in a simulated ambulance
• Examining the  time to chest compressions in terms with adaptions to the protocol when using a mechanical chest compression device
• Task analyses of anaesthetic procedures in order to make recommendations for improving patient safety.
• The development of  a Spanish language de-briefing tool.
• Assessment of the effectiveness precision teaching for a basic clinical skill.
• Education/training needs of student nurses for distributing medication and prescribing.
• Blueprinting an undergraduate medical school curriculum to look at where simulation could be introduced.

If you would like more information please contact: paul.oconnor@nuigalway.ie

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The Intern Junior Mentoring Programme (iJuMP)

Previous research indicates that new medical graduates do not feel prepared for the clinical working environment. Mentoring programmes have been suggested as a promising strategy for increasing preparedness for internship and improving medical students’ and doctors’ professionalism and clinical skills. This study conducted a research evaluation of the Intern Junior Mentoring Programme (IJuMP), a peer teaching programme that was developed and run at NUI Galway during the 2015-2016 academic year and which saw interns teaching and mentoring final year medical students. IJuMP was partially funded by the HSE and is the first programme of its kind in Ireland. This mixed methods research study aimed to describe the programme and to evaluate the perceptions of the programme among the three key stakeholder groups (i.e. final year medical students who received the teaching, interns who delivered the teaching, and senior doctors or medical school faculty with a knowledge of the programme). Early data suggests that the iJuMP may be a valuable addition to the final year medical curriculum. All three stakeholder groups indicated that the programme had substantial benefits for both students and intern teachers.

Status: This project has now concluded and the resulting paper will be published shortly. 

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The Stethocope App

Effective decision making is essential to the successful management of patients and good medical practice. However, research indicates that junior doctors are not confident in their ability to make important medical decisions. One of the key supports for decision making by doctors is the use of checklists and protocols which can help guide doctors in making the correct decisions for their patients. However, these checklists and protocols can often be difficult to access when needed. The Stethocope App is an ongoing project focused on developing decision-making supports for junior doctors to aid them in making clinical decisions in acute patient care.

The app project aims to:

• Identify the acute scenarios that an intern commonly find difficult to manage.
• Design, develop and pilot a user-friendly app that will present checklists and flow sheets for acute care scenarios that are user-friendly. The checklists will be supported by links to educational content.

Status: This programme of research is ongoing. If you would like more information or would like to get involved please contact Dara.Byrne@nuigalway.ie

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 Clinical Learning Environment during Internship

This mixed methods research study aims to develop and evaluate a protocol to assess the clinical learning and safety environment of junior doctor training posts. The assessment protocol will subsequently be applied to evaluate junior doctor training posts in the West-North-West Intern Training Network. This research is important given that the increasingly frequent decision that many junior doctors make to leave Ireland and practice elsewhere has been linked to poor experiences in the clinical learning environment in the Republic of Ireland. The assessment protocol developed will help to identify poor or unsafe intern training posts and will aid the development of improvement strategies which will alter these posts to improve patient safety, intern learning and protect future interns.

Status: This project is ongoing. If you would like more information or would like to get involved please contact: sinead.lydon@nuigalway.ie

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 The Induction Portal Project

The Hospital Induction Portal is an information and learning website designed and developed by a multidisciplinary hospital team for junior doctors in the West-North-West Intern Training Network, to improve their orientation and help prepare them for the clinical working environment. The portal provides interns with information regarding living and working in intern post regions, hospital staff supports, occupational health information, national clinical guidelines and recommendations for best practice.

Following a pilot phase at University Hospital Galway, the portal has been made available to other junior doctor networks.

Status: This project is ongoing. If you would like more information or would like to get involved please contact Dara.Byrne@nuigalway.ie

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Unlocking the Potential of Healthcare Complaints to Improve Hospital Care (UP-CIC)

 Most assessments of quality of care in Irish healthcare services are focused on healthcare workers’ opinions, statistics (e.g., how many patients got infections), or investigating large errors. However, these assessments fail to consider patients’ unique insights into quality of care and support improvement in services. For example, patients have knowledge about interactions with healthcare workers, whether care was patient-centred, and whether a patient's dignity was respected. Patients often write complaints about care with the aim of helping the service improve care for future patients. Sometimes these complaints may be about small issues, but they can also be about major problems.

More than 12,000 complaints are written annually about Irish healthcare organisations. While these complaints receive individual responses, there is no focus on analysing these complaints together and using this data to learn about the key issues in specific services and the healthcare system. This means that patients’ desire, and ability, to contribute to identifying problems are limited.

Researchers at the London School of Economics have developed the Healthcare Complaints Analysis Tool (HCAT) that guides the systematic analysis of the cause and severity of complaints. The proposed research will utilise the HCAT to analyse complaints received about Irish healthcare organisations.

This project will tell us what patients complain about, how serious their complaints are, and will allow for the identification of hotspots and blindspots in quality and safety in the Irish healthcare system. The data collected will be analysed and discussed by relevant stakeholders (patients, healthcare workers, policy makers) that will work together to decide how the feedback patients provide, and identified hotspots and blindspots, in healthcare complaints can be most effectively used to make changes that will improve patient care.

This project is funded by a Health Research Board Applied Parternship award.

If you would like more information please contact: paul.oconnor@nuigalway.ie

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Healthcare ‘Fit’ for persons with Autism: Development and Evaluation of an intervention to Improve Healthcare Visits for people with Autism (H-FIT)

Rationale

People with autism are more likely to experience a range of physical and mental health problems compared to the general population.  However, poorer health is not an inevitable consequence of being on the autism spectrum; instead, it reflects a healthcare disparity, whereby individuals with autism have more difficulties accessing appropriate healthcare than the general population.

Aims and objectives

The aim of this study is to examine the healthcare experiences of persons with autism and to develop an intervention to improve the quality of care this population receives. 

Specifically, this project will:

1. Engage with individuals with autism, and their caregivers, to explore a) their experiences with primary and secondary healthcare, b) barriers and facilitators to healthcare access and c) their perceived healthcare needs.
2. Examine the experiences of healthcare professionals, from primary and secondary healthcare services, of caring for individuals with autism, and their perceived educational needs.
3. Assess the effectiveness of an intervention aimed at improving the quality of care received by persons with autism.

This PhD project is funded by the Irish Research Council.

If you would like more information please contact: chloe.walsh@nuigalway.ie

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Unlocking the Potential of Healthcare Complaints to Improve Patient Care in Community Healthcare Organisations 

Almost 10,000 complaints are written annually about Irish healthcare. While these complaints receive individual responses, there is no attempt to analyse them together or use this data to learn about the key issues in specific services. Arguably, this is particularly true for community healthcare organisations (CHOs), including primary care, social care, and mental health services. This project aims to adapt a tool (developed for hospital complaints) to analyse complaints relating to CHOs. From this analysis, it is hoped to identify ways to improve patient safety and quality of care. The PhD will involve four main studies; a) a systematic review to synthesise research on complaints in community healthcare; b) adapting the HCAT for use in CHOs; c) using the adapted tool to classify the type and severity of complaints received about CHOs; and d) identifying areas for improvement with a stakeholder Delphi group. This project is funded by a NUI Galway Hardiman PhD Scholarship.

If you would like more information please contact: emily.odowd@nuigalway.ie

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 The National Burnout Survey

Burnout is a significant problem in the medical profession, impacting negatively on both doctors and the patients that they care for.  Previous research indicates that burnout is present among junior doctors and may be related to medical errors. The aim of this research study is to assess the prevalence of burnout among junior doctors in Ireland, to examine if burnout levels change across the first year of clinical practice, and to evaluate if there is a relationship between burnout levels and medical error. This data will contribute to our understanding of doctor wellbeing and inform interventions to improve resilience among medical professionals and to reduce burnout.

Status: This project has now concluded and the resulting paper will be published shortly.

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Resilience among medical professionals: What is it, how do we measure it, and how do we fix it?

A growing body of literature now suggests that resilience may be the difference between medical professionals who experience burnout and those who do not. In a recent study by our research team, it was found that more than one-fifth (20.7%) of all medical interns presented with burnout just a few months into their intern year. While there is an increasing interest in resilience within the medical profession, the research literature on defining resilience, measuring resilience and strategies for improving resilience is limited. This is important given that the medical profession differs significantly from other occupations in terms of work context, responsibility and consequences of mistake. This project aims to fill this gap in the research literature and to create a foundation of knowledge that will inform the development of interventions to promote resilience among doctors.

The project has three key aims:

1)     To conduct a systematic review of the literature on resilience among medical professionals. This literature review will provide guidance on defining and understanding resilience, measuring resilience, and intervening to improve resilience.

2)     To develop, pilot, and validate an instrument suitable for assessing resilience among medical professionals using the guidance of the systematic review and qualitative research.

3)     To evaluate the effects and feasibility of a small number of interventions to promote resilience among interns at GUH.

Status: This programme of research is ongoing. If you would like more information or would like to get involved please contact: susan.fox@nuigalway.ie

‌Resilience Programme - Grand Rounds

Dr. Eoghan Clifford, Lecture Civil Engineering NUI Galway. Double Paralympic medal winner

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Dr. Paddy Barrett 'The Doctor Paradox' - Cardiologist - Scripps Translational Science Institute, San Diego, California.  Host of the internationally acclaimed podcast series ‘The Doctor Paradox’

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