Search

The healthcare industry is a major contributor to climate change globally. There is growing interest in using quality improvement methods to improve the sustainability of healthcare. East London NHS Foundation Trust uses quality improvement as its approach to solving complex problems. This article uses a case study methodology to describe how the trust's programme of sustainability used quality improvement at both systemic and local levels to support the organisation to reduce direct greenhouse gas emissions by 40% by 2025 and indirect emissions by 40% by 2036. Using quality improvement in a structured way enabled staff and service users to consider their contribution to sustainability and develop, test and measure ideas that were within their control. This led to an organisational reduction in gas emissions of 37% and CO2emissions by 14% in winter months. At a local level, three case studies showcase the accomplishments of teams who successfully reduced medication waste by 66.2kg CO2e per year, reduced spending on single-use plastics by 54% and lowered CO2emissions by 10798kg per year through the return of walking aids. Supporting structures for the programme included active and visible participation from senior stakeholders, with service users and carers involved at both strategic and operational levels, and tracking data over time. Future work should focus on creating a change package of ideas to serve as a blueprint to scale up these initiatives across the organisation.

There has been an increase in the adoption of quality improvement methods to tackle complex problems in healthcare. One of the key requisites for sustainable quality improvement is ensuring that organisations have the capacity and capability to make these changes effectively. This article uses a case study methodology to describe the learning from 9 years of developing, delivering and evaluating quality improvement learning programmes at East London NHS Foundation Trust. The key quality improvement learning progammes are evaluated using a Kirkpatrick framework across four levels: reaction, learning, behaviour and outcomes. Five key principles were identified: using a dosing approach; standardising development, delivery and evaluation; developing a community to support learners; making training relevant; and the importance of leadership. However, the authors believe that more research is needed to develop standardised approaches to evaluating quality improvement capability building and to understand why some quality improvement projects are less successful than others.

The triple aim is defined as the simultaneous pursuit of improvement across three areas: population health outcomes, quality of care and value for the system. Since the triple aim framework was first introduced in 2008, it has been applied in various contexts across several countries. The triple aim has been proposed as a core purpose of the integrated health and care systems in England. However, little has been written about how the systematic application of quality improvement can support the process of achieving the triple aim, despite the increasingly widespread use of quality improvement methods and tools in the quality of care element of the triple aim. This article, the third in a three-part series about applying quality improvement to practice, puts forward a step-by-step guide for healthcare systems to use their existing quality improvement capabilities to help them achieve the triple aim, with examples and learning from the authors' experience at East London NHS Foundation Trust.

Hypnotizability may play a moderating role in the internalization of body image ideals and may also mediate suggested distortion of body image self‐representations, especially in restrained eaters. A modified version of the Creative Imagination Scale (CIS) incorporating a body expansion and a body reduction item, was used to examine the relationship between hypnotizability, dietary restraint and body image manipulation in restrained and non‐restrained eaters. Dietary restraint was measured in 40 female undergraduate participants using the Three‐Factor Eating Questionnaire and the Revised Restraint Scale. The results suggest that hypnotizability, as measured by the CIS, correlates significantly with both measures of dietary restraint. In addition, restrained eaters demonstrated generally elevated susceptibility to body image modification compared with unrestrained eaters, though both restrained and non‐restrained eaters appeared to be more susceptible to imagining body size expansion than reduction. These results are discussed in relation to social influences on eating and dietary disorders. Copyright © 1998 British Society of Experimental and Clinical Hypnosis

Hypnosis research and theory has recently paid increasing attention to hypnotizability as a trait in its own right and to a convergence with ideas in neuropsychology. Hypnotizability, or F‐bias, may be broadly characterized as involving focused attention, flexibility in switching cognitive styles and the activity of frontal cortical systems. F‐bias/hypnotizability correlates with a number of activities other than hypnotic performance, one of which is disordered eating behaviour. Within the clinical literature the general finding has been that restricting anorexics are of normal or slightly above normal hypnotizability whereas bulimics are very significantly above normal hypnotizability and show increased dissociative tendencies. In normal weight non‐clinical populations also there is also a positive correlation between hypnotizability, dissociative tendencies and attitudes to food intake. A recent study looked at both dissociation and hypnotizability in relation to disordered eating, as measured by an eating questionnaire, in a normal weight female undergraduate population. The data confirmed that those with bulimic tendencies scored higher on both hypnotizability and dissociation. The results also showed that hypnotizability was specifically related to a factor of dietary restraint, whereas dissociation was related to a factor of impulsive eating. The latter may account for the binge components of disordered eating. In contrast to earlier views, which tended to equate hypnotizability and dissociative tendencies, these data suggest that they are independent factors which influence different aspects of eating behaviour. Other work is described, which indicates that restrained eaters are more responsive than non‐restrained eaters to suggestions of increased body size, which may account in part at least for the distortions of body image seen in clinical eating disorders. The ways in which both hypnotizability and dissociative tendencies might operate as independent moderators in a sociocultural model of the development of anorexia and bulimia nervosa are discussed. Copyright © 1998 British Society of Experimental and Clinical Hypnosis

No Abstract.