Title: Mobilising knowledge about safety to patients using smartphone technology: empowering patients to enhance safety in surgical care
Funder: Department of Health and Social Care

Abstract: Background: Surgical patients are more likely to experience an adverse event during their care than patients admitted to hospital for any other type of treatment. Whilst clinical and team-based interventions are critical for minimising risk during surgery, the scope for patients to play a role in reducing the opportunity for error is increasingly recognised as the NHS moves towards a model of patient empowerment. Such patient-focussed interventions rely on the translation of what we know about risk during surgery (i.e. the evidence) into an educational format that is easily digestible and useable by patients to improve the safety of their care as they interface with service delivery. Aims: Mobilisation of evidence in this manner i.e. at the level of the patient, will be the focus of this fellowship which aims to test the feasibility of using smartphone apps to impart knowledge about risk to surgical patients and their carers. An app, called MySurgery, was recently designed to collate evidence regarding risk during surgery and inform patients of the actions they can take to mitigate these risks through asking the right questions, providing useful information, completing appropriate checks, and engaging in appropriate preparation and recovery behaviours. MySurgery will be used as a case-study to explore the following:Service users’ and service providers’ views regarding the use of smartphone technology as a KM device for communicating evidence about risk to surgical patients, and the appropriate design features that should be built in. How MySurgery is used in practice and the impact it is likely to have on patient and clinician behaviour and the traditional doctor/patient relationship.The barriers and facilitators to implementing such applications (if recommended) in a manner that gets them into the hands of the patients, embedded in surgical care pathways, and allows impact at scale.Methods: A mixed-methods, phased approach will be undertaken. Phase one will involve qualitative semi-structured interviews (n=30) with multi-disciplinary healthcare staff working in surgical units at Guys and St Thomas’ (GSTT) Hospital, and focus groups with patient and public volunteers (n=30). This phase will explore views regarding the use and design of smartphone technology for communicating information about risk. Phase 2, informed by the themes from phase 1, will involve the development and administration of a survey instrument based on the ‘Theory of Planned Behaviour’, to assess patients’ intentions to modify their behaviour after using the app. The questionnaire will be administered to patients at pre-operative clinics at GSTT across a range of surgical specialties. A sub-set of these patients will complete reflective diaries during their surgical journey to document use of the app and its perceived impacts. These collective research elements, along with a placement at Mindwave Ventures (experts in the implementation of digital technology in healthcare), will build an understanding of how best to design and implement such technology and its impact on behaviour. This will be fed into Phase 3- triangulation and dissemination of data gathered to key stakeholders and the KM community. Benefits to patients and NHS: Smartphone apps have the potential to significantly improve surgical safety by empowering patients to engage in safety enhancing behaviours, they are a pre-package product and allow for implementation and accessibility at scale. This work will increase understanding of the feasibility of using this technology as a KM approach and will inform, more broadly, our understanding of the barriers and facilitators to incorporating it into surgical care pathways to improve patient experience and reduce adverse events. Whilst the current KM activity focuses on the context of surgery, this model can be rolled out across a range of clinical specialties increasing applicability.

Lay abstract: Research suggests that around 1 in 10 patients entering NHS hospitals will experience an unintended error (termed an ‘adverse event’) in their care. Such events can result in harm and have catastrophic implications, not only for the patient and their family, but for the healthcare staff involved and for the NHS organisation as a whole (at both a reputational and financial level). Analysis of research figures shows that surgical care settings are the most ‘risky’ – with surgical patients at greater risk of experiencing an adverse event than patients admitted for any other type of treatment. Improving surgical safety is therefore a priority for NHS England. As a result, numerous tools have been introduced to surgical settings to help staff make fewer errors, ranging from safety checklists similar to those used on aeroplanes, to electronic devices for counting swabs. However, being at the centre of their care, patients and their families can also help to improve safety if they are appropriately informed of the potential risks. With this in mind, the current research project aims to explore how we can effectively translate what the evidence tells us about the causes of error in surgery into a format that is usable by patients to improve their safety. Specifically, the project looks at the use of smartphone apps for this this purpose. An app, called MySurgery, designed to help patients and their carers understand the risks associated with having surgery and inform them of the actions they can take to improve their safety and recovery, will be used as a case-study to explore the following research questions:Do patients and doctors support the use of smartphone apps for communicating information about safety?What design features should be built into such apps to make them more user-friendly?How is the MySurgery app likely to affect doctors’ and patients’ behaviour and the doctor/patient relationship?How is MySurgery used in practice?If recommended, how can we raise awareness about such apps so that their uptake is increased?Research question 1 will be addressed by conducting group discussions (focus-groups) with patient and public volunteers and interviews with doctors and other staff who work in the surgical environment. Results from this part of the study will be used to inform the design of a questionnaire to address research questions 2 and 3, which will be given to surgical patients attending Guys and St Thomas’ Hospital for their pre-operative appointment. A number of these patients will also be asked to volunteer to use MySurgery throughout their surgical journey and to keep reflective diaries detailing how they use the app and the impact that feel it has had (research question 4). Research question 5 will be answered partly via the focus-groups and interviews but also by visiting Mindwave ventures - a company with expertise in the development and implementation of digital technology in healthcare – to learn how best to raise awareness and uptake of such apps. Involving patients and the public has been considered carefully in the design of this research and has been built in from the outset by asking patient and public volunteers with experience of surgery to feed back on the proposed approach -this has been used to improve the design of the study. Patients and public will continue to play this role by attending a project steering group and/or a patient advisory board periodically throughout the study, where they will also help to make sense of the data, decide how to communicate the final results to interested parties; and plan how to implement the app.The effective communication of the results will be critical for generating impact from this research and for raising awareness and uptake of these novel technologies. Results will be shared with communications teams at a number of important organisations, including the National Institute for Health Research, the Collaboration for Leadership in Applied Health Research and Care, Guys and St Thomas’ Hospital, the Royal College of Surgeons, NHS England and relevant charities. The findings will also be presented at high profile academic conferences and published in patient safety and implementation science journals. By getting information about safety into the hands of NHS users and encouraging them to be advocates of their own care, smartphones apps, like MySurgery, offer a novel and currently unavailable approach to knowledge mobilisation, which can be spun-out across a range of healthcare specialties, and has the potential to reduce adverse events and bring about real improvements to patient experience.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE