When we think about a patient’s experience in the clinical setting, it can often be broken down into a series of different processes or landmarks. The transition of care refers to the integral points throughout a patient’s journey, when they move through these significant actions, between physical locations, or make contact with new clinicians. This includes the transfer from home to hospital, ward to ward, and the clinical handover from one healthcare professional to another.
People are particularly vulnerable as they move through these points of the healthcare system, so managing healthcare transitions effectively is essential. Without proper coordination, patient safety can be at greater risk and there can be a potential increase in mortality, morbidity, and adverse events.[i]
Perhaps one of the biggest and most widespread transitions in healthcare, which occurs every August, is the arrival of thousands of newly qualified medical and nursing graduates in UK hospitals. Due to the influx of junior staff, there is a perceived increase in the risk of medical errors and mortality across NHS wards.[ii] Though there are research articles that support and disprove the perceived decline in quality of care and patient outcomes as new clinicians start in hospitals, the fact remains that this year’s medical school graduates are entering a more complex environment than ever before. Ensuring that the new healthcare workforce is adequately supported in this moment of transition and prepared with proper training and support for when they enter the clinical practice, is therefore of critical importance.
Newly qualified clinicians in the UK are facing a progressively demanding healthcare landscape, with more complex patient needs and a deepening health service staffing crisis. NHS Digital data shows that there were almost 40,000 nurse vacancies and a further 8,000 unfilled doctor posts in England as of March 2022,[iii] adding further pressure on the newly qualified workforce who are expected to help reduce the 6.6 million treatment backlog caused by COVID-19.[iv]
It’s important to note that the pandemic has also had a significant impact on the delivery of healthcare education, with the required transitions to remote teaching at the start of the pandemic often being rushed and providing inconsistent support. A GMC survey of students from UK medical schools found 70% of junior doctors had their training disrupted by the pandemic.[v] In addition to this, a 2020 study of 440 final-year medical students found over 38% of respondents had their final objective structured clinical examinations cancelled, 43% had their assistantship placements postponed, and over 77% had electives cancelled, which caused a significant effect on student’s confidence and preparedness.[vi] Not only are newly qualified clinicians entering a more challenging scenario than ever before, it could be argued that they are significantly less equipped than they perhaps could have been.
Elsevier Health recently developed the Clinician of the Future report to explore global trends and changes that will impact the future of healthcare. Through a global survey of nearly 3,000 clinicians from 111 countries, healthcare professionals considered the consequences of the pandemic and provided insights on the challenges and opportunities they expect to face over the next decade.
The data published in the report reveals that 97% of clinicians globally believe the COVID-19 global pandemic is a key driver of change in healthcare. Many of the planned changes that we may have expected to see emerge across healthcare have accelerated because of the pandemic, which in turn, is now increasing pressures and challenges on the workforce. Now, new graduates need to be appropriately equipped to ensure they can deliver the care required – they must learn new skills, adapt their thinking and approaches, and work with their peers and patients in new ways.
The report also highlighted the pace at which technological advancements in healthcare are accelerating, to an extent where teaching institutions and medical educators need to quickly and regularly adapt, in order to adequately reflect the changing clinical world that students will be entering. Clinicians identified training in the effective use of digital health technologies to assist in the delivery of patient care as a key priority for the future, though 83% surveyed believed their training needs to be overhauled to keep pace with the introduction of new technologies and help them better perform in their roles.
In addition to this, the data in the report shows 68% of clinicians surveyed from the UK believe that the current volume of patient data is already overwhelming. This will likely worsen as clinicians will have to manage more data from an increasing number of digital tools and technologies available to them and their patients.
Another immediate issue that newly qualified clinicians are set to face is the widespread workforce shortages and staff burnout resulting from sustained work pressure. Data from the Clinician of the Future report reveals that 47% of UK clinicians indicate they are considering leaving their current role within the next two to three years, while 86% and 88% believe there will be a shortage of doctors and nurses in the next 10 years.
Survey findings suggested those leaving the profession may be doing so due to a general feeling of being undervalued and unappreciated. Only 18% of UK doctors believe the critical importance of the work they do is fully appreciated by government officials, and only 39% feel appreciated by the public.
In turn, staff shortages are likely to influence the quality of patient care and the ability to match the ongoing demand for patient services. Significantly, only 35% of UK nurses feel the amount of time they can spend with patients currently is sufficient to give them good care. Should the staffing crisis persist, many newly qualified clinicians may find their jobs are not meeting previous expectations.
There is no such thing as a one-size-fits-all approach to mitigating the risks associated with transitions of healthcare. However, by listening to clinicians, and understanding the challenges they are facing, we can help to address the evolving needs of educators and healthcare systems. As a company committed to improving patient outcomes, Elsevier Health will continue to innovate through our broad healthcare solutions such as Transitions to Practice and Shadow Health, and help newly qualified professionals as they enter a unique and demanding working environment through evidence-based Care Planning, empowering healthcare professionals to deliver optimal patient care around the world.
By Tim Morris, Vice President, Clinical Solutions, Elsevier Health
References
[i] Russell, L., Doggett, J., Dawda, P. and Wells, R., 2013. Patient safety – handover of care between primary and acute care. Policy review and analysis. Canberra: National Lead Clinicians Group, Australian Government Department of Health and Ageing.
[ii]Jen, M., Bottle, A., Majeed, A., Bell, D. and Aylin, P., 2020. Early In-Hospital Mortality following Trainee Doctors’ First Day at Work. PLoS ONE, 4(9), p.e7103.
[iii]NHS Digital. 2022. NHS Vacancy Statistics England April 2015 – December 2021 Experimental Statistics – NHS Digital. [online] Available at: <https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey/april-2015—december-2021-experimental-statistics#resources>
[iv]The British Medical Association is the trade union and professional body for doctors in the UK. 2022. NHS backlog data analysis. [online] Available at: <https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis>
[v]Rimmer, A., 2020. Covid-19: Most trainees have faced disruption to their training, GMC survey shows. BMJ, p.m4093.
[vi] Choi, B., Jegatheeswaran, L., Minocha, A., Alhilani, M., Nakhoul, M. and Mutengesa, E., 2020. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey. BMC Medical Education, 20(1).