
Professor Aled Jones
Professor: Patient Safety & Healthcare Quality; Research Theme Lead - OSDO (Co-Lead)
- jonesa97@cardiff.ac.uk
- +44 (0)29 206 88570
- 12.06, Eastgate House, Newport Road, Cardiff, CF24 0AB
- Welsh speaking
- Available for postgraduate supervision
Overview
RESEARCH SUMMARY
My research focuses on two specific dimensions of healthcare quality, namely patient centeredness and patient safety. Two particular areas of patient safety are of interest, namely employee “speaking up” (also referred to as whistle-blowing/raising concerns) about poor patient care and other breaches to patient safety, and safe nurse staffing levels. As a researcher whose aim is to practically inform the work of healthcare practitioners, policy makers and academics, I was particuarly delighted to be nominated and subsequently awarded the 2018 Royal College of Nursing Wales Nurse of the Year Award for "Supporting Improvement through Research" (see here).
In 2019 I was appointed the Health Services Research Specialty lead for Health & Care Research Wales (see here for more information). In undertaking the role I hope to create opportunities for health services researchers within Wales to network and share successes and challenges of undertaking projects, capturing meaningful research impact and generating research income. I also aim to review and improve opportunities for health services researchers to inform and guide policy makers and decision makers in Wales and elsewhere in the UK.
“Speaking up” about safety concerns and poor care
I am interested in understanding more about how workplace cultures restrict or enhance the act of speaking up by employees. A further question of interest is what interventions can be designed and implemented to help employees to speak up and to respond to speaking up by colleagues. I mostly use qualitative research and sociological approaches and theories to better understand speaking up in the workplace. Information about my current research projects can be found under the "research" tab above.
Practical application of research findings to improve practices is currently underway at various NHS sites. I also advise the Welsh Government group on "Raising Concerns", NHS England culture working group and am a current member of the United Nations Expert Group informing the development of Whisteblower Protections in the Health sector.
Safe nurse staffing
There is a clear association between registered nursing staff levels and patient safety outcomes. However, important questions remain about the effective deployment of nurse staffing and associated resources. Research into nurse staffing for Welsh Government (see here) has been completed and I am a member of the NHS Wales Nurse Staffing Group, see here for further details of key note address at the 2017 Nurse Staffing Conference in Cardiff.
Patient Safety and Healthcare Quality - more generally I have also publish widely on patient safety communication and aspects of patient centred care in areas such as midwifery, primary care, mental health and children's care.
TEACHING SUMMARY - I teach on aspects of health policy, complex systems and the interface between policy/systems and the delivery of safer and improved quality of care to patients.
- HCT 203 Public Health, Health Policy and Health Economics (Masters module);
- NRT 073 Patient Safety & Clinical Risk (Masters module);
- HCT 118 Research methods (Masters module);
- NRT 150 Transforming Care through Leadership (Masters module);
in addition to a range of pre-registration nursing and midwifery Quality and Safety Teaching.
Biography
Publications
2021
- Jones, A.et al. 2021. Speaking up about bullying and harassment in healthcare: reflections following the introduction of an innovative “speak up” role in NHS England. In: Connecting Healthcare Worker Well-Being, Patient Safety and Organisational Change: The Triple Challenge. Aligning Perspectives on Health, Safety and Well-Being, pp. 145-161., (10.1007/978-3-030-60998-6_10)
- Jones, A.et al. 2021. Interventions promoting employee “speaking-up” within healthcare workplaces: a systematic narrative review of the international literature. Health Policy (10.1016/j.healthpol.2020.12.016)
2020
- Brown, P., Jones, A. and Davies, J. 2020. Shall I tell my mentor? Exploring the mentor-student relationship and its impact on students’ raising concerns on clinical placement. Journal of Clinical Nursing 29(17-18), pp. 3298-3310. (10.1111/jocn.15356)
- Horseman, Z.et al. 2020. Identifying the challenges and opportunities of the executive nurse director role in the UK: a scoping review. Nursing Management 27(5), article number: e1948. (10.7748/nm.2020.e1948)
- Adams, M.et al. 2020. How do “heroes” speak up? NHS staff raising concerns during covid-19. [Online]. blogs.bmj.com: BMJ Publishing Group. Available at: https://blogs.bmj.com/bmj/2020/08/11/how-do-heroes-speak-up-nhs-staff-raising-concerns-during-covid-19/
2019
- Jones, A., Aylward, R. and Jones, A. 2019. Enhanced supervision: new ways to promote safety and well-being in patients requiring one-to-one or cohort nursing. Nursing Management 26(3) (10.7748/nm.2019.e1827)
- Knight, J., Nigam, Y. and Jones, A. 2019. Effects of bedrest 6: bones, skin, self-concept and self-esteem.. Nursing Times 115(5), pp. 56 - 59.
- Rauwolf, P. and Jones, A. 2019. Exploring the utility of internal whistleblowing in healthcare via agent-based models. BMJ Open 9, article number: e021705. (10.1136/bmjopen-2018-021705)
- Coffey, M.et al. 2019. Recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings: a cross national comparative mixed methods study. BMC Psychiatry 19, article number: 115. (10.1186/s12888-019-2094-7)
- Knight, J., Nigam, Y. and Jones, A. 2019. Effects of Bedrest 2 - Respiratory system, blood and mental Health. Nursing Times 115(1), pp. 44-47.
2018
- Hannigan, B.et al. 2018. Care coordination as imagined, care coordination as done: findings from a cross-national mental health systems study. International Journal of Integrated Care 18(3), article number: 12. (10.5334/ijic.3978)
- Jones, A.et al. 2018. Development of approaches and legislation to optimise nurse staffing levels. Nursing Standard 33(5), pp. 27-31. (10.7748/ns.2018.e11202)
- Jones, A.et al. 2018. Traditions of research in community mental health care planning and care coordination: a systematic meta-narrative review of the literature. PLoS ONE 13(6), article number: e0198427. (10.1371/journal.pone.0198427)
- Goodwin, L., Hunter, B. and Jones, A. 2018. The midwife-woman relationship in a South Wales community: experiences of midwives and migrant Pakistani women in early pregnancy. Health Expectations 21(1), pp. 347-357. (10.1111/hex.12629)
- Marie, M., Jones, A. and Hannigan, B. 2018. Social ecology of resilience and Sumud of Palestinians. Health 22(1), pp. 20-25. (10.1177/1363459316677624)
2017
- Simpson, A.et al. 2017. Cross-national mixed methods comparative case study of recovery-focused mental health care planning and coordination in acute inpatient mental health settings (COCAPP-A). Health Services and Delivery Research 5(26), pp. 1-234. (10.3310/hsdr05260)
- Brimble, M. and Jones, A. 2017. Using systems thinking in patient safety: a case study on medicines management. Nursing Management 24(4) (10.7748/nm.2017.e1621)
- Lewis, M., Jones, A. and Hunter, B. 2017. Women's experience of trust within the midwife-mother relationship. International Journal of Childbirth 7(1), pp. 40-52. (10.1891/2156-5287.7.1.40)
- Marie, M., Hannigan, B. and Jones, A. 2017. Challenges for nurses who work in community mental health centres in the West Bank, Palestine. International Journal of Mental Health Systems 11(3) (10.1186/s13033-016-0112-4)
- Marie, M., Hannigan, B. and Jones, A. 2017. Resilience of nurses who work in community mental health workplaces in Palestine. International Journal of Mental Health Nursing 26(4), pp. 344-354. (10.1111/inm.12229)
2016
- Kelly, D., Lankshear, A. and Jones, A. 2016. Stress and resilience in a post-Francis world - a qualitative study of executive nurse directors. Journal of Advanced Nursing 72(12), pp. 3160-3168. (10.1111/jan.13086)
- Ion, R., Jones, A. and Craven, R. 2016. Raising concerns and reporting poor care in practice. Nursing Standard 31(15), pp. 55-63. (10.7748/ns.2016.e10665)
- Jones, A., Lankshear, A. and Kelly, D. 2016. Giving voice to quality and safety matters at board level: a qualitative study of the experiences of executive nurses working in England and Wales. International Journal of Nursing Studies 59, pp. 169-176. (10.1016/j.ijnurstu.2016.04.007)
- Simpson, A.et al. 2016. Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study. BMC Psychiatry 16, article number: 147. (10.1186/s12888-016-0858-x)
- Marie, M., Hannigan, B. and Jones, A. 2016. Mental health needs and services in the West Bank, Palestine. International Journal of Mental Health Systems 10(1), article number: 23. (10.1186/s13033-016-0056-8)
- Simpson, A.et al. 2016. Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP). Health Services and Delivery Research 4(5), pp. 1-190. (10.3310/hsdr04050)
- Jones, A. 2016. The role of employee whistleblowing and raising concerns in an organizational learning culture - elusive and laudable? Comment on “cultures of silence and cultures of voice: the role of whistleblowing in healthcare organisations”. International Journal of Health Policy and Management 5(1), pp. 67-69. (10.15171/ijhpm.2015.182)
2015
- Williams, H.et al. 2015. Harms from discharge to primary care: mixed methods analysis of incident reports. British Journal of General Practice (BJGP) 65(641), pp. e829-e837. (10.3399/bjgp15X687877)
- Jones, A.et al. 2015. Realising their potential? Exploring interprofessional perceptions and potential of the advanced practitioner role: a qualitative analysis. BMJ Open 5(12), article number: e009740. (10.1136/bmjopen-2015-009740)
- Biddyr, S. and Jones, A. 2015. Preventing sight loss in older people. A qualitative study exploring barriers to the uptake of regular sight tests of older people living in socially deprived communities in South Wales. Public Health 129(2), pp. 110-116. (10.1016/j.puhe.2014.10.013)
- Jones, A.et al. 2015. Research into nurse staffing levels in Wales. Project Report. [Online]. Cardiff: Welsh Government. Available at: http://gov.wales/statistics-and-research/research-into-nurse-staffing-levels-wales/?lang=en
- Simpson, A.et al. 2015. Study protocol: cross-national comparative case study of recovery-focused mental health care planning and coordination (COCAPP). BMC Psychiatry 15, article number: 145. (10.1186/s12888-015-0538-2)
2014
- Jones, A. and Kelly, D. 2014. Whistle-blowing and workplace culture in older peoples' care: qualitative insights from the healthcare and social care workforce. Sociology of Health and Illness 36(7), pp. 986-1002. (10.1111/1467-9566.12137)
- Rapport, F.et al. 2014. Consultation workshops with patients and professionals: developing a template of patient-centred professionalism in community nursing. Journal of Research in Nursing 19(2), pp. 146-160. (10.1177/1744987113490416)
- Jones, A. and Carson-Stevens, A. 2014. Patient stories in improvement. In: Panesar, S. S. et al. eds. Patient Safety and Healthcare Improvement at a Glance. Chichester, UK: Wiley, pp. 90-92.
- Jones, A., Benbow, J. and Gidman, R. 2014. Provision of training and support for newly qualified nurses. Nursing Standard 28(19), pp. 44-50. (10.7748/ns2014.01.28.19.44.e8191)
- Jones, A. and Kelly, D. 2014. Deafening silence? Time to reconsider whether organisations are silent or deaf when things go wrong. BMJ Quality & Safety 23, pp. 709-713. (10.1136/bmjqs-2013-002718)
2013
- Jones, A., Carson-Stevens, A. P. and Williams, A. J. 2013. Integrating quality improvement into pre-registration education. Nursing Standard 27(29), pp. 44-48.
- Chan, E. A., Jones, A. and Wong, K. 2013. The relationships between communication, care and time are intertwined: a narrative inquiry exploring the impact of time on registered nurses' work. Journal of Advanced Nursing 69(9), pp. 2020-2029. (10.1111/jan.12064)
- Ward, H., Jones, A. and Carson-Stevens, A. P. 2013. IHI Open School's quality improvement initiative [Letter]. BMJ 346, article number: f1371. (10.1136/bmj.f1371)
- Carson-Stevens, A. P.et al. 2013. Q-Tip: "What can I do to improve your care today?" -One question closer to patient-centered care. American Journal of Medical Quality 28(2), pp. 174-174. (10.1177/1062860612470782)
- Kelly, D. M. and Jones, A. 2013. When care is needed: The role of whistleblowing in promoting best standards from an individual and organizational perspective. Quality in Ageing and Older Adults 14(3), pp. 180-191. (10.1108/QAOA-05-2013-0010)
- Ward, H. O.et al. 2013. How asking patients a simple question enhances care at the bedside: medical students as agents of quality improvement. The Permanente Journal 17(4), pp. 27-31. (10.7812/TPP/13-028)
2012
- Chan, E. A.et al. 2012. Nurses' perception of time availability in patient communication in Hong Kong. Journal of Clinical Nursing 21(7-8), pp. 1168-1177. (10.1111/j.1365-2702.2011.03841.x)
- Hutchings, H.et al. 2012. Obtaining consensus about patient-centred professionalism in community nursing: nominal group work activity with professionals and the public. Journal of Advanced Nursing (10.1111/j.1365-2648.2011.05938.x)
2011
- Jones, A. 2011. Respect for colleagues is respect for patients [Opinion]. Nursing Management 18(5), pp. 12.
- Jones, A. and Jones, D. 2011. Improving teamwork, trust and safety: an ethnographic study of an interprofessional initiative. Journal of Interprofessional Care 25(3), pp. 175-181. (10.3109/13561820.2010.520248)
- McLaughlin, K. and Jones, A. 2011. "It's all changed:" carers' experiences of caring for adults who have Down’s syndrome and dementia. British Journal of Learning Disabilities 39(1), pp. 57-63. (10.1111/j.1468-3156.2010.00618.x)
2010
- Rapport, F. L.et al. 2010. Narrating uncertainties about treatment of mental health conditions. Social Psychiatry and Psychiatric Epidemiology 45(3), pp. 371-379. (10.1007/s00127-009-0072-y)
2009
- Jones, A. 2009. Creating history: documents and patient participation in nurse-patient interview. Sociology of Health & Illness 31(6), pp. 907-923. (10.1111/j.1467-9566.2009.01190.x)
- Nigam, Y., Knight, J. and Jones, A. 2009. Effects of bedrest 3: musculoskeletal and immune systems, skin and self perception. Nursing Times 105(23), pp. 16-20.
- Jones, A. 2009. Creating history: documents and patient participation in nurse-patient interviews. In: Pilnick, A., Hindmarsh, J. and Gill, V. T. eds. Communication in Healthcare Settings: Policy, Participation and New Technologies. Sociology of Health and Illness Monograph Series Chichester: Wiley-Blackwell, pp. 117-132., (10.1002/9781444324020.ch8)
- Knight, J., Nigam, Y. and Jones, A. 2009. Effects of bedrest 1: cardiovascular, respiratory and haematological systems. Nursing Times 105(21), pp. 16-20.
- Knight, J., Nigam, Y. and Jones, A. 2009. Effects of bedrest 2: gastrointestinal, endocrine, renal, reproductive and nervous system. Nursing Times 105(22), pp. 24-27.
2007
- Jones, A. 2007. Admitting hospital patients: a qualitative study of an everyday nursing task. Nursing Inquiry 14(3), pp. 212-223. (10.1111/j.1440-1800.2007.00370.x)
- Bugge, C. and Jones, A. 2007. Methods for studying patient participation.. In: Collins, S. et al. eds. Patient Participation in Health Care Consultations: Qualitative Perspectives. Open University Press, pp. 22-40.
- Jones, A. 2007. Putting practice into teaching: an exploratory study of nursing undergraduates’ interpersonal skills and the effects of using empirical data as a teaching and learning resource. Journal of Clinical Nursing 16(12), pp. 2297-2307. (10.1111/j.1365-2702.2007.01948.x)
- Jones, A. and Collins, S. 2007. Nursing assessments and other tasks: influences on participation in interactions between patients and nurses.. In: Collins, S. et al. eds. Patient Participation in Health Care Consultations: Qualitative Perspectives. Buckingham: Open University Press, pp. 143-163.
2006
- Jones, A. and Bugge, C. 2006. Improving understanding and rigour through triangulation: an exemplar based on patient participation in interaction. Journal of Advanced Nursing 55(5), pp. 612-621. (10.1111/j.1365-2648.2006.03953.x)
2003
- Jones, A. 2003. Nurses talking to patients: exploring conversation analysis as a means of researching nurse–patient communication. International Journal of Nursing Studies 40(6), pp. 609-618. (10.1016/S0020-7489(03)00037-3)
2001
- Jones, A. 2001. Time to think :temporal perspectives in nursing research and practice. Journal of Advanced Nursing 33(2), pp. 150-158. (10.1111/j.1365-2648.2001.01647.x)
Teaching
Teaching
I teach on aspects of health policy, complex systems and the interface between policy/systems and the delivery of safer and improved quality of care to patients.
- HCT 203 Public Health, Health Policy and Health Economics (Masters module);
- NRT 073 Patient Safety & Clinical Risk (Masters module);
- HCT 118 Research methods (Masters module);
- NRT 150 Transforming Care through Leadership (Masters module);
in addition to a range of pre-registration nursing and midwifery Quality and Safety Teaching.
RESEARCH TOPICS
Employees “speaking up”, raising concerns and whistleblowing
Employees who “speak-up” or “raise concerns” about problems with healthcare services are often referred to as “whistleblowers”. Although whistleblowing makes an important contribution to patient safety in the NHS, whistleblowers have not always been treated well, often suffering professional and person reprisals from colleagues and the public for their efforts. The Francis Report in 2013 into serious patient care failures at Stafford Hospital is one of many inquiries into poor practice in the NHS which describe how whistleblowers were often ignored and mistreated by colleagues to the detriment of safe patient care.
Our research has explored the influence of workplace culture on employee speaking up. We want to better understand how the conditions and circumstances within organisations can encourage or deter staff from speaking up. Related to this, we also want to better understand the organisational response to concerns when raised –why is it that so many organisations respond so badly when employees speak up, even though organisations encourage this behaviour?
We have used qualitative social science approaches to better understand some of these questions. Our studies have been undertaken with staff from a range of professions and at different levels within the organisational hierarchy, from students and junior workers to executive level nurses.
Current research project: Evaluation of the implementation of Freedom to Speak Up Guardians in NHS England (funded by the NIHR HS&DR programme 16/116/25)
‘Freedom to Speak Up Guardians’ are a new role in NHS England introduced in 2016 designed to help staff to ‘speak-up’ about workplace concerns. In the NHS, the urgent need for a change in workplace cultures in relation to openness and learning from employee concerns have resulted in a raft of policies and measures seeking to provide legal, structural and social foundations for culture change. Among the policy initiatives is the ‘Freedom to Speak Up Review’ (Francis, 2015) and its formation of the Freedom to Speak Up Guardian (FTSUG) role and the ‘National Guardian’s Office’ as a means of normalising the raising of concerns.
The Review describes the FTSUG role as: ‘a key component in keeping watch over the way concerns are handled, providing support to those who need it, and ensuring the patient safety issue is always addressed. The climate that can be generated by these measures will be one in which injustice to whistleblowers should become very rare indeed, but is redressed when it does occur’ (p.198).
For further information about this project please see the project website by following this link
Research impact: Freedom to speak up safely with Cardiff and Vale University Health Board (funded by ESRC/Cardiff University Impact Acceleration Award).
In the summer of 2016 Cardiff and Vale University Health Board launched their Freedom to Speak Up Safely (F2SUS) initiative. The initiative is designed to support employees to raise and respond to concerns about any issue that deflects from the organisation’s aim to deliver consistently excellent care. Our research and expertise in this area of practice contributed directly to the design and implementation of the F2SUS initiative
Please see the following links for further information.
More information available at the following website:
www.cardiffandvaleuhb.wales.nhs.uk/freedom-to-speak-up
Other Patient Safety & Healthcare Quality current projects:
Understanding how to facilitate continence for people with dementia in acute hospital settings: raising awareness and improving care (funded by the NIHR HS&DR programme 15/136/67) led by Dr Katie Featherstone
Enhancing the opportunities for people living with dementia to keep control over their most private of functions can enhance independence, rehabilitation, and reduce the length of inpatient stays (Morris, 2005). Incontinence is also highly discrediting (Brittain & Shaw, 2007; Kelly, 2009) and combined with dementia it increases stigma and produces a powerful attack on social status (Herskovits & Mitteness, 1994; Bamford et al, 2012). Yet there is a disparity between policy recommendations to improve care for people living with dementia within the acute hospital and their implementation. Despite the growing population of people living with dementia and the importance of continence care (DuBeau, et al, 2009), little is known about the appropriate management, organisation and interactional strategies for people living with dementia in acute hospital wards (Royal College of Physicians, 2012). In response, this ethnography will provide a detailed examination of the organizational and interactional factors that influence the management of continence care and add to understandings of the impact of these practices on notions of personhood and dignity for people living with dementia and those who care for their most basic bodily needs. Quality of care does not only encompass effectiveness, but humanity and equity. This study brings rigour to all of these aspects of acute hospital care. An initial systematic narrative review (Popay et al, 2006) will identify successful strategies used in other care settings that could inform innovations. Data collection (observation, ethnographic and in-depth interviews) will be in wards that exemplify the challenges for wards of caring for a large number of people living with dementia within 3 acute hospitals (1x MAU and 1x general medical, total: 6 wards).
For further details please see here
Quality-Assured Follow up of quiEscent Neovascular agE-relaTed maculaR dEgeneration by non-medical practitioners: a randomised controlled trial The FENETRE study funded by the HTA (17/85/05) led by Dr Konstantinos Balaskas, Moorfields Eye Hospital
In this large, multi-site prospective study funded by the NIHR, we will look at how care for patients with stable AMD can be devolved to community optometry practices. We will explore the role of digital technologies and artificial intelligence decision support to facilitate the process of monitoring patients with stable AMD closer to home, reducing the pressures on busy hospital-based eye clinics. Cardiff University are leading on the mixed-methods qualitative process evaluation phase of this trial, focussing on the workforce adaptations related to the intervention. Further information available here and here
Supervision
I am interested in supervising PhD students who would like to explore patient safety and quality improvement in health and social care contexts. Applications are particularly welcomed that focus on
- Raising concerns/speaking-up/whistleblowing by staff about failures in care - for example, what are the barriers and facilitators to effective "speaking up" by staff? What interventions/initiatives can be developed to promote speaking up culture in the workplace?
- Workplace culture and patient safety - for example, how does workplace culture affect healthcare workers understanding of patient safety and their safety practices?
- Optimal deployment of staffing levels - for example, projects that consider nurse staffing levels and the effects on patient outcomes (e.g. safety outcomes) and staff outcomes (e.g. retention of staff, staff well-being).