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Teaching

I lead the Masters Module in Health Policy and Health Economics (NRT177) which runs January to April and do sessional lectures on advanced practice modules such as documentation and clinical assessment; team working and complex systems; patient safety and risk; research methods. In addition I supervise Masters students’ dissertations.

I also lead the Professional Doctorate Module “Critical Perspectives on Patient Safety and Quality), next running January 2018.

I teach patient safety and quality improvement as well as research methods on a range of courses from undergraduate to doctoral level. I am a faculty member of NHS Wales 1000 Lives Improvement and of the UK & Ireland IHI Open School. As faculty member I advise on how best to design, deliver and support education programmes to improve healthcare

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.

https://youtu.be/hRYdKkZDoyM

More information available at the following website:

www.cardiffandvaleuhb.wales.nhs.uk/freedom-to-speak-up

Patient Safety & Healthcare Quality current project: 

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

Related ongoing project and areas of interest:

• Development of a “Speak up” Survey (led by David Schwappach, Swiss Patient Safety Foundation)
• Speaking up about poor care: the role of students, educators and HEIs (with Robin Ion and Richard Craven)

Research collaborators:

• Daniel Kelly, Tricia Brown, Davina Allen (Cardiff University)
• Jill Maben (University of Surrey)
• Mary Adams (King’s College London)
• Russel Mannion (University of Birmingham)
• David Schwappach (Swiss Patient Safety Foundation)
• Robin Ion, Richard Craven (Abertay University)

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).

Current research students

Tricia Brown PhD studentship - The mentor-student dynamic in raising concerns in clinical practice. A grounded theory study.

Judith Benbow PhD studentship - The resilience of front-line registered nurses working in Wales.

Rene Mifsud PhD studentship - Exploring professional practice of Occupational Therapists in Malta.

Iain Harbison Professional Doctorate studentship - An exploration of the strategies and experiences of senior clinicians and the implementation and management of Emergency Department waiting time targets.

Ian Willliams Professional Doctorate studentship - How do children aged six to eleven years old living in Wales experience their quality of life following a moderate head injury?

Marianne Maraj Professional Doctorate studentship - Exploring well-being in hybrid managers in an NHS Trust

Current supervision

Judith Benbow

Research student

Marianne Hamer

Research student

Patricia Brown

Research student

Ian Williams

Research student

Rene Mifsud

Research student

Iain Harbison

Research student