Susan J Burnett | Imperial College London (original) (raw)
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Papers by Susan J Burnett
International Journal for Quality in Health Care, Jun 12, 2019
Research Square (Research Square), Aug 13, 2020
The purpose of this article is to discuss the idea that governments should not take policy measur... more The purpose of this article is to discuss the idea that governments should not take policy measures for the development and growth of National Health System (NHS) without taking into account their financial sustainability.
Health Services and Delivery Research, 2018
Background Since 2007, Imperial College London has generated monthly mortality alerts, based on s... more Background Since 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied. Objectives To improve understanding of mortality alerts and evaluate their impact as an intervention to reduce mortality. Design Mixed methods. Setting English NHS acute hospital trusts. Participants Eleven trusts were included in the case study. The survey involved 78 alerting trusts. Main outcome measures Relative risk of mortality and perceived efficacy of the alerting system. Data sources Hospital Episodes Statistics, published indicators on quality and safety, Care Quality Commission (CQC) reports, interviews and documentary evidence from case studies, and a national evaluative survey. Methods Descriptive analysis of alerts; association with other measures of quality; associated change in mortalit...
Background When there is a gap in professionals’ adherence to safe practices during cancer treatm... more Background When there is a gap in professionals’ adherence to safe practices during cancer treatment, the consequences can be serious. Identifying these gaps in order to enable improvements in patient safety can be a challenge. This study aimed to assess if cancer patients and their relatives can be given the skills to audit four safe practices reliably, and to explore whether they are willing to play this new role.Methods We recruited 136 participants in 2018, from the oncology and haematology day hospital of a tertiary hospital in Spain.The study comprised two parts: an interventional educational program and a cross-sectional design to collect data on the participants’ skills and perceptions about their willingness to be auditors.Results 63 participants (46.3%) were classified as good auditors after the training. A logistic regression model identified age, educational level, previous experience of an adverse event and perception of hospital safety as predictor variables. Additiona...
BMC Health Services Research, 2011
A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QU... more A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol
Background: In Britain over 39,000 reports were received by the National Patient Safety Agency re... more Background: In Britain over 39,000 reports were received by the National Patient Safety Agency relating to failures in documentation in 2007 and the UK Health Services Journal estimated in 2008 that over a million hospital outpatient visits each year might take place without the full record available. Despite these high numbers, the impact of missing clinical information has not been investigated for hospital outpatients in the UK. Studies in primary care in the USA have found 13.6 % of patient consultations have missing clinical information, with this adversely affecting care in about half of cases, and in Australia 1.8 % of medical errors were found to be due to the unavailability of clinical information. Our objectives were to assess the frequency, nature and potential impact on patient care of missing clinical information in NHS hospital outpatients and to assess the principal causes. This is the first study to present such figures for the UK and the first to look at how clinici...
Journal of health services research & policy, Jan 17, 2015
Given the impact of the global economic crisis, delivering better health care with limited financ... more Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. The development of hospital leaders' skills in translating external requirements into implementation plans wit...
Purpose. Being able to compare hospitals in terms of quality and safety between countries is impo... more Purpose. Being able to compare hospitals in terms of quality and safety between countries is important for a number of reasons. For example, the 2011 European Union directive on patients' rights to cross-border health care places a requirement on all member states to provide patients with comparable information on health-care quality, so that they can make an informed choice. Here, we report on the feasibility of using common process and outcome indicators to compare hospitals for quality and safety in five countries (England, Portugal, The Netherlands, Sweden and Norway). Main Challenges Identified. The cross-country comparison identified the following seven challenges with respect to comparing the quality of hospitals across Europe: different indicators are collected in each country; different definitions of the same indicators are used; different mandatory versus voluntary data collection requirements are in place; different types of organizations oversee data collection; di...
BMC Health Services Research
Background When there is a gap in professionals’ adherence to safe practices during cancer treatm... more Background When there is a gap in professionals’ adherence to safe practices during cancer treatment, the consequences can be serious. Identifying these gaps in order to enable improvements in patient safety can be a challenge. This study aimed to assess if cancer patients and their relatives can be given the skills to audit reliably four safe practices, and to explore whether they are willing to play this new role. Methods We recruited 136 participants in 2018, from the oncology and haematology day hospital of a tertiary hospital in Spain. Patient identification, hand hygiene, blood or chemotherapy identification, and side effects related to transfusion and chemotherapy, were the safe practices selected for evaluation. The study comprised two parts: an interventional educational program and a cross-sectional design to collect data and assess to what degree participants are able and willing to be auditors depending on their characteristics using multivariate logistic regression mode...
International Journal of Health Policy and Management
Background: Hospital boards have statutory responsibility for upholding the quality of care in th... more Background: Hospital boards have statutory responsibility for upholding the quality of care in their organisations. International research on quality in hospitals resulted in a research-based guide to help senior hospital leaders develop and implement quality improvement (QI) strategies, the QUASER Guide. Previous research has established a link between board practices and quality of care; however, to our knowledge, no board-level intervention has been evaluated in relation to its costs and consequences. The aim of this research was to evaluate these impacts when the QUASER Guide was implemented in an organisational development intervention (iQUASER). Methods: We conducted a ‘before and after’ cost-consequences analysis (CCA), as part of a mixed methods evaluation. The analysis combined qualitative data collected from 66 interviews, 60 hours of board meeting observations and documents from 15 healthcare organisations, of which 6 took part on iQUASER, and included direct and opportun...
Review of Business and Legal Sciences
The purpose of this article is to discuss the idea that governments should not take policy measur... more The purpose of this article is to discuss the idea that governments should not take policy measures for the development and growth of National Health System (NHS) without taking into account their financial sustainability.
BMJ quality & safety, Jan 8, 2017
Health systems worldwide are increasingly holding boards of healthcare organisations accountable ... more Health systems worldwide are increasingly holding boards of healthcare organisations accountable for the quality of care that they provide. Previous empirical research has found associations between certain board practices and higher quality patient care; however, little is known about how boards govern for quality improvement (QI). We conducted fieldwork over a 30-month period in 15 healthcare provider organisations in England as part of a wider evaluation of a board-level organisational development intervention. Our data comprised board member interviews (n=65), board meeting observations (60 hours) and documents (30 sets of board meeting papers, 15 board minutes and 15 Quality Accounts). We analysed the data using a framework developed from existing evidence of links between board practices and quality of care. We mapped the variation in how boards enacted governance of QI and constructed a measure of QI governance maturity. We then compared organisations to identify the characte...
International Journal for Quality in Health Care, Jun 12, 2019
Research Square (Research Square), Aug 13, 2020
The purpose of this article is to discuss the idea that governments should not take policy measur... more The purpose of this article is to discuss the idea that governments should not take policy measures for the development and growth of National Health System (NHS) without taking into account their financial sustainability.
Health Services and Delivery Research, 2018
Background Since 2007, Imperial College London has generated monthly mortality alerts, based on s... more Background Since 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied. Objectives To improve understanding of mortality alerts and evaluate their impact as an intervention to reduce mortality. Design Mixed methods. Setting English NHS acute hospital trusts. Participants Eleven trusts were included in the case study. The survey involved 78 alerting trusts. Main outcome measures Relative risk of mortality and perceived efficacy of the alerting system. Data sources Hospital Episodes Statistics, published indicators on quality and safety, Care Quality Commission (CQC) reports, interviews and documentary evidence from case studies, and a national evaluative survey. Methods Descriptive analysis of alerts; association with other measures of quality; associated change in mortalit...
Background When there is a gap in professionals’ adherence to safe practices during cancer treatm... more Background When there is a gap in professionals’ adherence to safe practices during cancer treatment, the consequences can be serious. Identifying these gaps in order to enable improvements in patient safety can be a challenge. This study aimed to assess if cancer patients and their relatives can be given the skills to audit four safe practices reliably, and to explore whether they are willing to play this new role.Methods We recruited 136 participants in 2018, from the oncology and haematology day hospital of a tertiary hospital in Spain.The study comprised two parts: an interventional educational program and a cross-sectional design to collect data on the participants’ skills and perceptions about their willingness to be auditors.Results 63 participants (46.3%) were classified as good auditors after the training. A logistic regression model identified age, educational level, previous experience of an adverse event and perception of hospital safety as predictor variables. Additiona...
BMC Health Services Research, 2011
A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QU... more A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol
Background: In Britain over 39,000 reports were received by the National Patient Safety Agency re... more Background: In Britain over 39,000 reports were received by the National Patient Safety Agency relating to failures in documentation in 2007 and the UK Health Services Journal estimated in 2008 that over a million hospital outpatient visits each year might take place without the full record available. Despite these high numbers, the impact of missing clinical information has not been investigated for hospital outpatients in the UK. Studies in primary care in the USA have found 13.6 % of patient consultations have missing clinical information, with this adversely affecting care in about half of cases, and in Australia 1.8 % of medical errors were found to be due to the unavailability of clinical information. Our objectives were to assess the frequency, nature and potential impact on patient care of missing clinical information in NHS hospital outpatients and to assess the principal causes. This is the first study to present such figures for the UK and the first to look at how clinici...
Journal of health services research & policy, Jan 17, 2015
Given the impact of the global economic crisis, delivering better health care with limited financ... more Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. The development of hospital leaders' skills in translating external requirements into implementation plans wit...
Purpose. Being able to compare hospitals in terms of quality and safety between countries is impo... more Purpose. Being able to compare hospitals in terms of quality and safety between countries is important for a number of reasons. For example, the 2011 European Union directive on patients' rights to cross-border health care places a requirement on all member states to provide patients with comparable information on health-care quality, so that they can make an informed choice. Here, we report on the feasibility of using common process and outcome indicators to compare hospitals for quality and safety in five countries (England, Portugal, The Netherlands, Sweden and Norway). Main Challenges Identified. The cross-country comparison identified the following seven challenges with respect to comparing the quality of hospitals across Europe: different indicators are collected in each country; different definitions of the same indicators are used; different mandatory versus voluntary data collection requirements are in place; different types of organizations oversee data collection; di...
BMC Health Services Research
Background When there is a gap in professionals’ adherence to safe practices during cancer treatm... more Background When there is a gap in professionals’ adherence to safe practices during cancer treatment, the consequences can be serious. Identifying these gaps in order to enable improvements in patient safety can be a challenge. This study aimed to assess if cancer patients and their relatives can be given the skills to audit reliably four safe practices, and to explore whether they are willing to play this new role. Methods We recruited 136 participants in 2018, from the oncology and haematology day hospital of a tertiary hospital in Spain. Patient identification, hand hygiene, blood or chemotherapy identification, and side effects related to transfusion and chemotherapy, were the safe practices selected for evaluation. The study comprised two parts: an interventional educational program and a cross-sectional design to collect data and assess to what degree participants are able and willing to be auditors depending on their characteristics using multivariate logistic regression mode...
International Journal of Health Policy and Management
Background: Hospital boards have statutory responsibility for upholding the quality of care in th... more Background: Hospital boards have statutory responsibility for upholding the quality of care in their organisations. International research on quality in hospitals resulted in a research-based guide to help senior hospital leaders develop and implement quality improvement (QI) strategies, the QUASER Guide. Previous research has established a link between board practices and quality of care; however, to our knowledge, no board-level intervention has been evaluated in relation to its costs and consequences. The aim of this research was to evaluate these impacts when the QUASER Guide was implemented in an organisational development intervention (iQUASER). Methods: We conducted a ‘before and after’ cost-consequences analysis (CCA), as part of a mixed methods evaluation. The analysis combined qualitative data collected from 66 interviews, 60 hours of board meeting observations and documents from 15 healthcare organisations, of which 6 took part on iQUASER, and included direct and opportun...
Review of Business and Legal Sciences
The purpose of this article is to discuss the idea that governments should not take policy measur... more The purpose of this article is to discuss the idea that governments should not take policy measures for the development and growth of National Health System (NHS) without taking into account their financial sustainability.
BMJ quality & safety, Jan 8, 2017
Health systems worldwide are increasingly holding boards of healthcare organisations accountable ... more Health systems worldwide are increasingly holding boards of healthcare organisations accountable for the quality of care that they provide. Previous empirical research has found associations between certain board practices and higher quality patient care; however, little is known about how boards govern for quality improvement (QI). We conducted fieldwork over a 30-month period in 15 healthcare provider organisations in England as part of a wider evaluation of a board-level organisational development intervention. Our data comprised board member interviews (n=65), board meeting observations (60 hours) and documents (30 sets of board meeting papers, 15 board minutes and 15 Quality Accounts). We analysed the data using a framework developed from existing evidence of links between board practices and quality of care. We mapped the variation in how boards enacted governance of QI and constructed a measure of QI governance maturity. We then compared organisations to identify the characte...