Impact case study database

Our research on occupational safety has been presented at international forums and conferences in the US, Europe, Australia, South Korea, United Arab Emirates, Mexico, Peru, and Canada. It has been adopted by governments and professional bodies leading to the following impacts.

Impact 1: Underpinned a new European Standard for the manual handling of patients

In the UK, working with clinical Royal Colleges (nursing, midwifery, occupational therapy) we developed national guidance to improve patient safety and staff safety during care [S1] which has achieved impact, being used by over 560,000 clinical staff. This was used to develop a European Standard Technical Report (ISO/CD 12296 **[S2]**) to establish a best practice baseline for the manual handling of patients across the healthcare sector [R1, R2] for over 4 million nursing and healthcare staff.

Pathway to Impact 1: Our research underpinned a White Paper from the Chartered Institute of Ergonomics & Human Factors (CIEHF) [R4, R5], co-written with clinicians. It has established the Human Factors/Ergonomics approach to patient safety culture which is now used in the UK [S5] and internationally [S6] (Mexico (Spanish translation), Australia, New Zealand, USA, Portugal and Peru) and during the COVID-19 pandemic . The Head of the Ergonomics Research Centre, Universidad de Guadalajara, Mexico, said:

‘without your research and our collaboration all these activities and benefits would not have occurred. The value of this … is to provide a clear path … of integrating HFE principles and practices to transform all aspects of our healthcare systems in México and Latin America’ [S6].

The reach of this change in working practice has been extended internationally and been adopted by multiple agencies across multiple geographies. For example, Fray has supported the implementation of government policy in New Zealand with the Accident Compensation Corporation and in the USA with the Ohio Bureau of Workers Compensation [S8].

Impact 2: Reduced injuries for nursing and other clinical staff in 120 countries

The analytics for multinational company AON’s insurance for patient handling injuries are based on our research [R2] and benefit AON and their clients by reducing volatility and improving performance to achieve financial savings due to a reduction staff and patient injuries. Furthermore, AON [S3] has reported a trend of reduced injuries across 120 countries which they attribute to the implementation of the Technical Report for ISO/CD 12296 [S2].

To reduce the injury risks associated with working in cramped spaces, our research changed how space in hospital buildings is planned. Our UK research [R3] developed the methodology to determine dynamic space requirements for treatment and care and specific design standards, for example: communication and circulation space throughout the hospital (including ward design and space around each bed); intensive care (adult and neonatal); and accident and emergency departments.

Pathway to Impact 2: We raised awareness and increased understanding of how to change safety culture and practice with Human Factors/Ergonomics (HFE) approaches via competitively commissioned ‘Taster Workshops’ to over 600 clinical staff [R5]. We delivered training and education to clinical staff and healthcare managers with case studies of changes in safety culture and practice both directly and other media, for example a webinar to over 37 countries [S6]. The CEO, International Society for Quality in Healthcare (network of health care professionals) said:

‘if HFE was used routinely as the foundation for interventions in healthcare, then the wellbeing of healthcare workers would be improved. … The attention to the wellbeing of healthcare workers was a focus of the WHO Patient Safety Day recently and that embodied the importance of this research. … You and your team have contributed to our programmes to spread the principles of HFE and the findings of your research’ [S6].

Our Taster Workshops have been transferred to an online platform and we are delivering it through Learning Management Systems at NHS Education for Scotland and Health Education England to make this available to over 1.5 million NHS staff.

Our approach was incorporated into the guidance produced by the Center for Health Design, working with the American Institute of Architects (AIA) and Facility Guidance Institute (FGA) to develop the Safety Risk Assessment (SRA) tool ( https://www.healthdesign.org/sra). This tool is used across the world, with Hignett providing expert consultancy services, e.g., to the Cleveland Clinic in Dubai [S4]. The Vice President for Research, Center for Health Design, USA said:

‘Our online evidence-based safety Risk Assessment Toolkit, funded through multiple grants awarded by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), has a specific focus on these same areas. Your papers become extremely valuable additions to our industry’s evidence base [S4]

Impact 3: Improved patient safety practices in the UK, USA, Latin America, Australasia and Asia

Our research has led to national and international impact for healthcare incident investigation (HSIB), clinical procedures (AHSN) and influence on strategic focus (with associated allocated budget) for Patient Safety Advisors in every NHS Trust.

Pathway to Impact 3 *: We created a resource, the ‘Systems Thinking Video’ [R6] which has changed attitudes of healthcare professionals and mangers towards the human contribution to safety [S7]. It was viewed over 20,000 times across over 100 countries, with the resource website being visited by over 5,500 people from 87 countries (over 200 visitors every month). The video was shared through various national e-learning platforms and websites: NHS Education for Scotland; Health Quality & Safety Commission (New Zealand); Clinical Human Factors Group (UK); Korean Society for Quality in Health Care and used by academics and practitioners in medical schools and hospitals around the world for incident investigation and training [S7]. As the Professor of Health Policy and Management University of Ulsan College of Medicine, South Korea, reported:

‘Over 2,000 healthcare professionals and managers in hospitals … attended the KoSQua conference … including … Dr. Jun’s … advice on systems approach to healthcare incident investigation to the national body, KoIHA, was very instrumental in improving … current investigation methods for patient safety incidents. … The newly revised methods will help KoIHA to better learn from incidents and make effective changes for patient safety improvement in various healthcare systems in South Korea. and improved the existing investigation methods for serious patient safety incidents’ [S7].

Our research has influenced the planning practices of education and training for patient safety in the NHS which has underpinned the development of a national patient safety syllabus (launched 2020) [R4-R6]. The Deputy Director of Patient Safety, NHS England & Improvement said:

‘The Human Factors for Health and Social Care White Paper enabled a better understanding and supported the foundation for change that we have built into the national Patient Safety Strategy for the NHS … with a strong focus on human factors, safe systems and learning from incidents’ [S5]

Further, during the COVID-19 pandemic in 2020 we were requested by AHSN (UK) to improve clinical protocols for use when wearing PPE. The AHSN Patient Safety Director (UK) said:

‘During the COVID-19 pandemic the Patient Safety Collaboratives, [we] launched the National Tracheostomy Programme. A suite of resources were developed to include a set of Human Factors Action Cards for the 3 tracheostomy safety interventions These have been shared [nationally] across all 15 PSCs … [and] … to individual hospital trusts. We have achieved 87% adoption of the 3 safety interventions across England. [S5]