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Unmet needs: system-focused investigations
  1. Nick Woodier1,
  2. Helen Jones1,
  3. Amanda Gregory2 and
  4. Matthew Wain1
  1. 1Healthcare Safety Investigation Branch (HSIB), Reading, UK
  2. 2Independent Subject Matter Advisor, Reading, UK
  1. Correspondence to Dr Nick Woodier, Healthcare Safety Investigation Branch (HSIB), Reading, UK; Nick.woodier{at}

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Meeting the needs of people when diagnosed with life-threatening or life-limiting illness is a fundamental requirement of healthcare services. However, national publications over the years have recurrently highlighted that palliative and end of life care (PEoLC) services cannot always provide people with what they need.1 This mismatch has again been highlighted in recent research published in this journal2 and via a recent national investigation undertaken by the Healthcare Safety Investigation Branch (HSIB) titled ‘Variations in the delivery of palliative care services to adults’.1

This letter reflects on how the two different approaches to exploring problems faced in the delivery of PEoLC—research and investigation—can provide powerful learning opportunities when used together.

Opportunity 1—the role of complex systems in care outcomes

Tavabie et al’s research found that ‘people dying in hospitals have significant and poorly identified unmet needs’.2 They go on to describe some potential factors that contribute to those unmet needs but acknowledge that ‘further evaluation to understand the relationships between patient, staff and service factors’ is needed. This further evaluation is alluding to the importance of understanding how the different components of the healthcare work system interact (figure 1) and influence PEoLC processes and patient outcomes; system-focussed investigation methodologies can help explore these system interactions.3 4

Figure 1

Examples of components of the work system considered in the HSIB investigation, based on the Systems Engineering Initiative for patient safety3 and Rasmussen’s Risk …

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  • Contributors The four authors were involved in HSIB’s investigation into palliative and end of life care. This letter was written by NW and contributed to and reviewed by HJ, AG and MW. Further HSIB colleagues have reviewed the letter and were involved with quality assurance of the investigation; these included Dr Rosie Benneyworth and Mr Deinniol Owens. All are in agreement for this submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NW, HJ and MW are employed by the Healthcare Safety Investigation Branch (HSIB). A HSIB investigation is referred to in this letter. AG was funded by HSIB to provide subject matter expertise for the specific investigation referred to.

  • Provenance and peer review Not commissioned; internally peer reviewed.