IHEEM ROUNDTABLE – PART ONE
Detailed research protocols JB: “What’s the process for getting that?” CN: “You need a very detailed research protocol, and must then go through a whole series of approvals, including things like temporary contracts for academics to be employed by the hospital. With some estates-related projects you don’t require ethics approval, but anything which involves direct contact with patients and patient data requires it. From an engineering perspective, that can be a bit of a barrier. It’s doable, but you have to really want to undertake the project for it to work. Of course the governance is much better as a result. I think the ethical review process is set up because people are doing treatment and drug trials, but if you’re going in and doing observations of patients from an environmental standpoint, you must essentially go through the same processes.” IH: “Cath, I absolutely agree about the need for good governance; we are dealing with a high-risk environment where patient privacy and dignity are key. It’s a process we have to go through, but I was interested to hear your comments about organisations being busy. Before we started today I was talking to Claire (Hennessy) about our work environment, and she was reflecting on how, as
apprentices, we’d get involved in development schemes and diverse work applications. I think it’s a sad indictment of
much harder to navigate. When you’ve been working with a hospital for a while you figure your way through, but it tends to be clinicians leading the research. If you can get engineers talking to engineers, some may work out how they can navigate this whole research process and governance, etc. There might be something IHEEM could do around this. Perhaps there might a simple toolkit or
Kim Shelley.
guidance that could be developed to facilitate people getting access for engineering research?” JB: “What’s your experience, Claire?” CH: “We are always striving for new sustainable operating methods, and to identify valuable technologies, but it’s very difficult – unless you can get to a good conference and see something new that you can then go away and
Claire Hennessy.
the current state of the industry, and the pressure on funding, that everyone is now really sweating their assets, and time to commit to research projects is extremely limited. NHS organisations are more recently concerned about the here and now, primarily due to financial constraints and performance improvement targets. I think that being a learning organisation is a sign of a successful one, and I’ve always been very keen to engage in research – as it can engage many stakeholders. It raises the hospital’s profile very positively, and there’s a corporate and social responsibility too. So, it’s something I applaud, and there’s maybe something we could use as an outreach to NHS organisations to ‘offer’ these connections in a very positive manner, although it will mean some commitment in time from NHS organisations.”
Could IHEEM make the difference? CN: “I think this is an area where IHEEM could make a real difference. Hospitals are learning organisations, and usually have a very good research arm, but this is often largely driven by medical research, and therefore has its strongest connection into universities’ medical and biological departments. For engineers this can be
investigate. Hospitals tend to be very much geared towards medical and clinical research, so when you are looking at researching new technologies and engineering, it’s hard to get anyone to engage; there’s not much appetite unless you can identify a potential saving. That’s the only way you can get an appetite from a Trust board. So, for example, when I was at Oxford (University Hospitals NHS Foundation Trust), we did a major energy
project which incorporated old technologies, but used them in a different way. It was a fantastic scheme and achieved the savings identified, but we only overcame the hurdles because there were savings attached. I think if we can identify ways of working together to actually develop outside of that, and then come to the Trust Board with something ready to introduce to them, we could have more of an avenue into developing services to create a much better, more modern healthcare facility. With many hospitals, the front looks fantastic, but open the plant room and you’re stepping back 40-50 years.” JB: “Ghasson, What’s your experience?”
Changing the culture GS: “My view probably aligns with Cath’s, i.e. it’s about changing the culture of how we access information, as well being able to access the spaces where we undertake the experiments. I recently tried to get access to two specific critical healthcare areas at New Cross Hospital in Wolverhampton, and Heartlands Hospital in
Birmingham. You go through a lot of hoops just to start a study; it takes months. Ethical issues are a big barrier. I think you simply have to put in more effort; keep pushing the process to achieve your goals. You set up a project plan, but it sometimes drags on forever, because you cannot get the people in time, or elicit a response on what you want to do. Even setting up simple sensor technology in a ducting system, it took me ages to get access. By nature, hospitals are highly complex buildings, used around the clock, 365 days a year. The barriers aren’t insurmountable, but it’s very frustrating for us at times, and we don’t seem to be able to get much out of the healthcare estate. You guys have got to be able to work with us more.” He continued: “I teach at Master’s level, and two of my students are facilities managers who work in the hospitals I mentioned previously; they were the only people I could rely on to be able to set up the experiments, but that shouldn’t really be the case. Why is it so difficult to get help and input from NHS Trusts? We tried to set up an experiment to compare how many airborne infections occur in different hospital facilities, focusing on pneumonia in this instance. No Trust would allow us access to the level of infection data we needed.
Dr Richard Beattie.
Lack of access to key data “How, after all,” Ghasson Shabha continued, “can you compare and contrast data if you cannot access the previous or secondary data to be able to see historical trends? Consequently, we try to find ways around the problem, by extrapolating, relying on more indirect indicators to measure the prevalence of, for instance, airborne infection. You start looking at demographics, generalising from age groups, for instance, trying to get some idea about which group will be most affected. We really need to change the way we operate, and to have a better system based on transparency and openness. We’re not, after all, in the business of divulging information about patients. It’s all kept confidential, but if we cannot access the necessary data, how can we push things forward and develop more innovative engineering techniques to tackle current healthcare problems? My particular area of expertise – airborne infection – is quite a prevalent and serious issue in our hospitals, because we don’t seem to have any effective ways of monitoring or controlling it – mainly because we don’t have a
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