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ObjectivesThis study aimed to investigate the presence of perceived stressors, psychological safety and teamwork in healthcare professionals. As the timeframe for this study spanned the first wave of the COVID-19 pandemic, data were captured demonstrating the impact of the pandemic on these factors.DesignQualitative interview study.SettingAll staff working within the emergency and critical care departments of one National Health Service Trust in London, UK.ParticipantsForty-nine participants were recruited using a purposive sampling technique and interviewed when the first wave of the COVID-19 pandemic had subsided.Main outcome measuresEvaluation of changes in perceived stressors, psychological safety and teamwork in individuals working during the COVID-19 pandemic.ResultsThe thematic analysis relating to a participant’s lived experiences while working during COVID-19 led to the construction of five key themes, including ‘psychological effects’ and ‘changes in team dynamics’. Several psychological effects were described, including the presence of psychological distress and insights into the aetiology of moral injury. There was marked heterogeneity in participants’ response to COVID-19, particularly with respect to changes in team dynamics and the perception of a psychologically safe environment. Descriptions of improved team cohesiveness and camaraderie contrasted with stories of new barriers, notably due to the high workload and the impact of personal protective equipment. Building on these themes, a map of key changes arising due to the pandemic was developed, highlighting potential opportunities to provide targeted support.ConclusionsWorking on the front line of a pandemic can have significant implications for healthcare workers, putting them at risk of psychological distress and moral injury, as well as affecting team dynamics. There is striking heterogeneity in the manifestation of these challenges. Team leaders can use the themes and qualitative data from this study to help identify areas for management focus and individual and team support.

Healthcare teams are expected to deliver high quality and safe clinical care, a goal facilitated by an environment of psychological safety. We hypothesised that an individual’s personality would influence psychological safety, perceived stressors in the clinical environment and confer a suitability for different professional roles. Staff members were recruited from the Emergency or Critical Care Departments of one National Health Service Trust. Qualitative interviews explored participants’ experiences of personality, incorporating quantitative surveys to evaluate psychological safety and perceived stressors. The 16 Primary Factor Assessment provided a quantitative measure of personality. Participants demonstrated midrange scores for most personality traits, highlighting an ability to adapt to changing environments and requirements. There was a signal that different personality traits predominated between the two professional groups, and that certain traits were significantly associated with higher psychological safety and certain perceived stressors. Personality was described as having a strong influence on teamwork, the working environment and leadership ability. Our analysis highlights that personality can influence team dynamics and the suitability of individuals for certain clinical roles. Understanding the heterogeneity of personalities of team members and their likely responses to challenge may help leaders to support staff in times of challenge and improve team cohesiveness.

Background The Cost of Living Crisis (CoLC), a real term reduction in basic income, risks individuals being unable to afford essentials such as heat, food and clothing. The impact of the CoLC is disproportionate – with different population sub-groups more likely to be negatively affected. The objective of this survey was to evaluate the perceived impact of the CoLC on the life and health of participants across four European countries. Methods A survey housing two questions to investigate the relationship between the CoLC and its perceived impact on life and health was developed. Four European countries (U.K., Sweden, Italy and Germany) took part via the YouGov platform. Logistic regression models were created for each country and question to evaluate which population characteristics were associated with a negative reported impact of the CoLC. Results A total of 8,152 unique individuals responded between 17th March and 30th March 2023. Each country was equally represented. Those aged 36–64 were more likely to report a negative impact of the CoLC on their life and health than younger participants ( p  < 0.001, p  = 0.02 respectively). Across all countries, females were significantly more likely to report a negative impact on their life and health, however, when analysed according to country, in Sweden females were less likely to report a negative impact ( p  < 0.001). Those in lower income families or who reported poor health in the preceding 12 months were significantly more likely to report a negative impact of the CoLC on their life and health. There was no difference within the participant group on the reported impact of the CoLC based on location (rural vs. urban). Conclusions We demonstrate the disproportionate negative impact of the CoLC on both life and health in different population subgroups. Germany and Sweden appeared to be more resilient to the effects of the CoLC, particularly for certain population subgroups. It is important to understand the differing effects of a CoLC, and to learn from successful health and economic strategies in order to create targeted policy and create a population resilient to economic shocks.

IntroductionBarcode medication administration (BCMA) systems are increasingly being implemented in hospital settings, with the aim of decreasing medication administration errors. However, the majority of the literature demonstrating the value of BCMA in supporting patient safety is from the USA. Furthermore, little is known about the underlying mechanisms that support its use. This study aims to explore the impact of BCMA on patient safety including medication admisntration errors and nursing time spent providing direct patient care, in terms of what works, for whom, under what circumstances, and how.Methods and analysisWe will use a mixed-methods realist evaluation. The study will be conducted in four phases, at two London NHS teaching trusts and one South West Region NHS Trust using different electronic health record systems. Phase 1 will involve documentary analysis and a narrative review to develop an initial programme theory for how BCMA is expected to work. Phase 2 will use interviews with key informants to refine this programme theory. The programme theory will then be tested in phase 3 using mixed methods: (1) observation of nurses’ medication administration; (2) analysis of alert data from the BCMA systems to understand the alerts’ clinical significance and utility and (3) interviews with nurses and hospital inpatients to explore their views. These data will be triangulated to refine and finalise the programme theory in phase 4, together with recommendations for practice.Ethics and disseminationThe Study Coordination Centre has obtained approval (24/SC/0326) from the Oxford B NHS Research Ethics Committee and the Health Research Authority. The study’s findings will be presented at scientific meetings and published in peer-reviewed journals. Additionally, summaries of the findings will be produced, targeted at relevant groups such as healthcare professionals, policy-makers and study participants.

Background There is significant health inequity in the United Kingdom (U.K.), with different populations facing challenges accessing health services, which can impact health outcomes. At one London National Health Service (NHS) Trust, data showed that patients from deprived areas and minority ethnic groups had a higher likelihood of missing their first outpatient appointment. This study’s objectives were to understand barriers to specific patient populations attending first outpatient appointments, explore systemic factors and assess appointment awareness. Methods Five high-volume specialties identified as having inequitable access based on ethnicity and deprivation were selected as the study setting. Mixed methods were employed to understand barriers to outpatient attendance, including qualitative semi-structured interviews with patients and staff, observations of staff workflows and interrogation of quantitative data on appointment communication. To identify barriers, semi-structured interviews were conducted with patients who missed their appointment and were from a minority ethnic group or deprived area. Staff interviews and observations were carried out to further understand attendance barriers. Patient interview data were analysed using inductive thematic analysis to create a thematic framework and triangulated with staff data. Subthemes were mapped onto a behavioural science framework highlighting behaviours that could be targeted. Quantitative data from patient interviews were analysed to assess appointment awareness and communication. Results Twenty-six patients and 11 staff were interviewed, with four staff observed. Seven themes were identified as barriers – communication factors, communication methods, healthcare system, system errors, transport, appointment, and personal factors. Knowledge about appointments was an important identified behaviour, supported by eight out of 26 patients answering that they were unaware of their missed appointment. Environmental context and resources were other strongly represented behavioural factors, highlighting systemic barriers that prevent attendance. Conclusion This study showed the barriers preventing patients from minority ethnic groups or living in deprived areas from attending their outpatient appointment. These barriers included communication factors, communication methods, healthcare the system, system errors, transport, appointment, and personal factors. Healthcare services should acknowledge this and work with public members from these communities to co-design solutions supporting attendance. Our work provides a basis for future intervention design, informed by behavioural science and community involvement.

Compliance with hand hygiene is an effective way of reducing the incidence of healthcare acquired infections (HCAI). At one London National Health Service (NHS) Trust, improving hand hygiene compliance (HHC) was a patient safety priority in response to non-compliance and ongoing occurrences of HCAI. The objective of this study was to co-design a behavioural science informed intervention to improve HHC. To obtain a baseline level of HHC and understand associated behaviours, 18 hours of observation were undertaken on three inpatient wards. These focused upon Moment 1 and 5 of the World Health Organisation’s moments for hand hygiene. The intervention was co-designed with clinical staff and took the form of “visual primes”. Three different stickers designed to create a motivational “nudge” were placed at key points where HHC had been observed to fail. Following implementation, a further 18 hours of observation took place. A Chi-squared statistical analysis compared proportions of HHC pre- and post-intervention. Our intervention led to an 11% increase in HHC across the three study wards for both Moments ( X 2 (1, N = 1,285) = 13.711, p = <0.001) in the six weeks following the intervention. The intervention had a more marked effect on Moment 1, (with an increase of 15%, X 2 (1, N = 667) = 17.091, p = <0.001 when compared to the change in compliance with Moment 5 (11%, X 2 (1, N = 652) = 7.449, p = 0.06). This study demonstrated that utilising behavioural science in the co-design and placement of visual motivational nudges can significantly improve compliance with hand hygiene practices. We highlight the benefit of co-design when designing interventions–both in terms of engagement with and efficacy of the intervention.

ObjectivesThis study aimed to quantify the presence of psychological safety (defined as an environment ‘safe for interpersonal risk taking’) in critical care staff, exploring the ways in which this manifested.DesignQualitative interview study incorporating a short quantitative survey.SettingThree intensive care units within one National Health Service Trust in London.ParticipantsThirty participants were recruited from all levels of seniority and roles within the multidisciplinary team. A purposive sampling technique was used, with recruitment ceasing at the point of thematic saturation.InterventionsSemistructured interviews explored attitudes towards psychological safety and contained a quantitative assessment measuring the climate of psychological safety present.ResultsTwenty-eight participants agreed that it was easy to ask for help, with 20 agreeing it is safe to take a risk on the team, demonstrating a strong perception of psychological safety in this group.Our thematic analysis highlighted areas where the context influenced an individual’s psychological safety including personality, culture and leadership. Possible negative consequences of psychological safety included distraction and fatigue for the team leader. We demonstrated that speaking up can be influenced by motivations other than patient safety, such as undermining or self-promotion.ConclusionsOur data demonstrate reassuring levels of psychological safety within the participants studied. This allowed us to explore in depth the participant experience of working within a psychologically safe environment. We add to the current literature by uniquely demonstrating there can be negative consequences to a psychologically safe environment in the healthcare setting. We expand on the influence of context on psychological safety by developing a model, allowing leaders to identify which elements of context can be modified in order to promote speaking up. Team leaders can use these data to help foster a culture of openness, innovation and error prevention while minimising the risk of negative implications

Background Hospital managers are responsible for the delivery of organisational strategy, development of clinical services and maintaining quality standards. There is limited research on hospital managers, in particular how stress manifests and impacts managers and the presence of individual resilience. Managers must work closely with clinical colleagues, however these relationships can be hindered by the perception of stereotyping and differing priorities. This study aimed to explore the working environment of hospital managers, focusing upon the unique stresses faced, psychological safety and the presence of resilience. Methods This study utilised mixed methodology using an embedded approach. Participants were purposively recruited from all levels of hospital management within one National Health Service Trust in London, United Kingdom. An exploration of managers experiences was undertaken using semi-structured qualitative interviews. Psychological safety and individual resilience were additionally assessed using validated surveys. Qualitative data were analysed iteratively using inductive thematic analysis, and triangulated with quantitative data. Kruskal-Wallis statistical analysis was performed to evaluate differences in resilience and psychological safety according to seniority and background experience. Results Twenty-two managers were recruited and interviewed, with 20 returning completed surveys. Key findings from the thematic analysis included the importance of good working relationships with clinical colleagues, the persistence of some stereotyping, and feeling unsupported in times of challenge. Stresses described included the bureaucracy involved when delivering change, conflict with colleagues and target driven expectations. Participants described their own psychological safety as lower than desired, supported by quantitative data; but recognised its importance and strived to create it within their own teams. Sixteen participants had ‘normal’ scores for resilience, with senior managers more likely to have higher scores than those more junior ( p =0.011). Conclusion Positive working relationships, high psychological safety and individual resilience are important for organisational safety and individual wellbeing. Our data illustrate unique stressors faced by hospital managers, provide detail on sometimes challenging working relationships, and demonstrate scope to improve both the psychological safety and resilience of those in managerial positions. A map for senior healthcare leaders was constructed, facilitating the identification of modifiable areas within their organisation to promote good working relationships and improve the working environment of hospital managers.

Introduction Barcode medication administration (BCMA) technology helps ensure correct medications are administered by nursing staff through scanning of patient and medication barcodes. In many hospitals scanning rates are low, limiting the potential safety benefits. We aimed to explore the barriers and facilitators to BCMA use in a London hospital. Methods In this mixed methods study we used local quantitative data on BCMA scanning rates to identify clinically similar wards (in terms of patient acuity and workload) with different scanning rates for qualitative exploration. Interviews designed to elicit barriers to using BCMA technology were conducted with nursing staff, supported by observations of medication administration. Qualitative data were analysed inductively and a thematic framework constructed housing key themes, subsequently categorised into barriers and facilitators. To explore patient perspectives of BCMA scanning, a purposive sample of patients were also interviewed. These patient data were analysed deductively according to the thematic framework. Themes were mapped to behavioural science frameworks to further understand the behaviours involved. Results BCMA was operational on 15 wards, with only six having medication scan rates of more than 10% of scannable doses. Of three wards selected for qualitative investigation, the lowest scan rate was 6.7%. Twenty-seven nurses and 15 patients were interviewed. Eleven key themes were identified, encompassing both barriers and facilitators to BCMA use. Barriers included poor trolley ergonomics and perceived time inefficiency. Facilitators included a streamlined process and thorough training. All nurses described BCMA as positive for patient safety. Patients described BCMA as making them “feel safer”. Behavioural science frameworks highlighted the importance of professional role and an individual’s belief in their capability. Conclusion We present a novel exploration of facilitators and barriers to BCMA use from the viewpoint of both patients and nursing staff, highlighting a strong perception that BCMA enhances safety. Barriers were reported on both high and low usage wards, demonstrating the importance of behaviours and motivations. These findings provide a detailed understanding from which to design interventions to support behaviour change and increase BCMA use.

Antimicrobial resistance (AMR) is a significant global health threat. Several public health campaigns aimed to raise AMR awareness and inspire related behavioral changes have been delivered in a time-specific, coordinated manner, while others have placed less emphasis on campaign timing. Social media platforms can be leveraged as key vehicles for delivering public health campaigns, particularly by collaborating with health content creators who serve as influential messengers. Increasingly, organizations such as the World Health Organization and TikTok have created health content creator networks; however, the impact of such networks in public health campaigns, especially when delivered in a coordinated, time-specific manner, remains uncertain. This study aimed to investigate whether mobilizing an established health content creator network to create social media content on the topic of AMR, released in a coordinated, time-specific manner, can have an impact on audience engagement. We conducted a longitudinal observational study evaluating the effect of a coordinated social media campaign (\"Pulse\") on YouTube, delivered by an established health content creator network during an international event on AMR. Members of the network prepared and coordinated the release of AMR-related videos. Engagement analytics were evaluated 6 months after release. The engagement with each campaign video was compared with that for a similar noncoordinated video and with the average engagement of the same creators. Around the day of the Pulse campaign on September 26, 2024, 18 campaign videos were released across 14 YouTube channels. Compared with paired videos, Pulse videos were not associated with higher view counts (incidence rate ratio [IRR] 0.98, 95% CI 0.44-2.13; P=.95) or like counts (IRR 1.10, 95% CI 0.48-2.41; P=.81) but were associated with significantly higher comment counts (IRR 2.99, 95% CI 1.02-8.52; P=.03). When compared with the creators' 12-month channel averages, campaign videos had a significantly higher comment count (IRR 15.5, 95% CI 5.5-24.0; P<.001) but no difference in view counts (IRR -82.0, 95% CI -190.3 to 58.5; P=.26) or like counts (IRR -0.50, 95% CI -6.3 to 10.5; P=.93). Coordinating health content creators to release AMR-related videos on YouTube coinciding with an international AMR event increased audience interactivity but did not enhance reach. This study shows the need to better understand which AMR-specific content factors contribute toward greater traction and to assess audience needs among the wider public to discern how best to harness social media interventions as a tool to improve AMR-related outcomes.