Saturday, 24 August 2013

Improving care by doing nothing...well, almost nothing

Roger Watson, Editor-in-Chief, JAN

I first encountered the LPZ project – the Dutch national survey of care problems – a few years ago when I invited the leader of the project, Ruud Halfens, to visit the School of Nursing & Midwifery at the University of Sheffield.  Ruud came with his close colleague Jan Hamers with whom he works at the CAPHRI (School for Public and Primary Care) at Maastricht University, The Netherlands.  Ruud and Jan presented to colleagues on this project which, on the face of it, seemed straightforward: a longitudinal study of a set range of care problems (eg pressure ulcers and falls) in care settings.  The project originated from the LOPD, the Dutch National Prevalence of survey of Pressure Ulcers, and now includes Switzerland, Austria, Germany and New Zealand.

Ruud Halfens
Ruud and Jan’s presentation outlined the origins of the project, described the methods, the range of problems and the results.  They showed, for example, that the prevalence of pressure sores in The Netherlands was declining annually over the life of the project.  I had two questions – I think Ruud was anticipating them – and these were: What is the source of funding for the project?  What is the intervention in the pressure survey?  Having played into Ruud’s hands he answered with a smile, to the astonishment of those present, that: first, there was no funding and; second, there was no intervention.

Jan Hamers
If the main presentation had not already done so, this hooked the audience.  Ruud explained, in addition to there being no funding for the project, that the participating care settings paid to be part of the study; I did not have to ask, then, why the study had not found a foothold in the UK.  This funding model is remarkable, entrepreneurial and clearly successful.  The project continues to grow and serves to illustrate that you can sell good science.  In answer to the question about the intervention, Ruud also answered in the negative: there was no intervention.  While the precise link between cause and effect is hard to claim, this could also be an illustration of what many have long suspected: if you heighten the awareness of a problem and make people measure it, you are more than half way to reducing the problem, something like the well-known Hawthorne effect.
The Hawthorne effect

I was so taken with the LPZ project that, on taking over as Editor-in-Chief of JAN, I decided to invite the LPZ team to publish their annual reports in the journal.  This year we are pleased to present their most recentreport, along with the study protocol and my editorial; all free to download.  If you want any further information on the project then you can email the LPZ project and you can download previous reports from their website.