Professor Andrew Carson-Stevens

(he/him)

Publication

• Date
• Type

Research

Overview of Research

Learning from unsafe health and social care outcomes experienced by patients and their families

I have developed a mixed-methods approach for measuring the frequency and avoidability of harm, and identifying priorities for safety improvement.

The Patient Safety (PISA) classification system, inclusive of multi-axial coding frameworks is aligned to the WHO International Classification for Patient Safety, and was empirically developed during a national agenda setting study of patient safety incidents in General Practice (funded by NIHR Health Services and Delivery Research programme and colloquially known as the 'PISA study').

The PISA study was the largest characterisation of patient safety incidents in general practice worldwide. The PISA classification system has since provided a foundation for other researchers to replicate and extend the research, and advance the primary care patient safety agenda, internationally. Within the UK, for example, PISA has been applied to identify 'significant avoidable harm' in General Practices in England (funded by the NIHR Policy Research Programme), the NIHR-funded study to investigate avoidable harm in prison healthcare services in England, and the Cancer Research Wales-funded Think Cancer! Trial exploring causes of the longest delays for cancer diagnoses.    

The PISA group has a vast portfolio of completed studies that have identified safety improvement priorities across the health and social care continuum, including: unsafe discharge from secondary to primary care settings and safety incidents experienced by children in primary care, older adults, patients receiving palliative care, advanced care planning, patients with dementia, adults receiving mental health services in primary care, and adults receiving opiate replacement.

Example areas of completed studies:

Healthcare in prisons

• Patient safety incidents in prisons – published in the Journal of the Royal Society of Medicine https://doi.org/10.1177/01410768231166138

Paediatric care in community contexts

• Patient safety incidents involving sick children in primary care in England and Wales: A mixed methods analysis – published in PLOS Medicine https://doi.org/10.1371/journal.pmed.1002217
• Safety incidents involving children in general practice – published in Pediatrics https://doi.org/10.1542/peds.2014-3259
• Paediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database– published in Vaccine https://doi.org/10.1016/j.vaccine.2015.06.068

Acute care settings

• Harms from discharge to primary care: Mixed methods analysis of incident reports – published in British Journal of General Practice https://doi.org/10.3399/bjgp15X687877
• Diagnostic error in the emergency department: learning from national patient safety incident report analysis – published in BMC Emergency Medicine https://doi.org/10.1186/s12873-019-0289-3.
• Learning from patient safety incident involving acute sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement – published in Journal of the Royal Society of Medicine. https://doi.org/10.1177/01410768211032589
• Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis – published in BMC Emergency Medicine https://doi.org/10.1186/s12873-021-00537-w  

Dentistry

• Patient safety incidents in primary care dentistry in England and Wales: A mixed-methods study – published in the Journal of Patient Safety http://dx.doi.org/10.1097/PTS.0000000000000530

Vulnerable societal groups across the care continuum 

• Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports – published in Archives of Disease in Childhood. http://dx.doi.org/10.1136/archdischild-2019-318406
• A mixed-methods analysis of patient safety incidents involving opioid substitution treatment with methadone or buprenorphine in community-based care in England and Wales – published in Addiction https://doi.org/10.1111/add.15039
• Patient safety incidents in advance care plans for serious illness: a mixed methods analysis – published in BMJ Supportive and Palliative Care http://dx.doi.org/10.1136/bmjspcare-2019-001824
• Sources of unsafe primary care for older adults: A mixed-methods analysis of patient safety incident reports – published in Age and Ageing https://dx.doi.org/10.1093%2Fageing%2Fafx044
• Quality improvement priorities for safer out-of-hours palliative care: Lessons from a mixed-methods analysis of a national incident-reporting database – published in Palliative Medicine https://doi.org/10.1177%2F0269216318817692
• Patient safety in palliative care: A mixed-methods study of reports to a national database of serious incidents – published in Palliative Medicine https://doi.org/10.1177/0269216318776846

Building capacity and capability to enable a transition from 'learning to action'

Teaching

Overview of educational scholarship

Internationally, I have shared with other researchers the innovative mixed method approaches developed by my research group to investigate and understand the epidemiology of patient safety incidents (guest lecturer at the Harvard Chan School of Public Health in 2017). I have trained researchers to learn from patient safety incidents using the PISA Method nationally and worldwide (Australia, Brazil, Canada, France, Kuwait, Mexico, Spain, Turkey, USA) leading to many international research collaborations and impactful outputs. The PISA Group welcomes expressions of interests from those seeking to advance their patient safety research proficiencies (postgraduate students, clinical academics, post-doctoral fellows, senior academics) through visiting appointments at Cardiff University.

Lessons learnt from my research studies have influenced World Health Organization strategy for patient safety. Learning is shared back to frontline providers through established educational systems like the Royal College of General Practitioners; one example includes a programme designed to support the primary care workforce to recognise, report and learn from patient safety incidents through e-learning courses, national seminars, and a practical ‘how to’ guide. I have also contributed internationally to Boston Children's Hospital / Harvard Medical School's OPEN Pediatrics programme, aimed predominantly at learners from low- and middle-income settings, on disclosure and apology to patients and families following unsafe healthcare. 

From 2012-16, I was the Institute for Healthcare Improvement UK and Ireland Faculty Lead for the online and community-based educational programme, the IHI Open School (2012-16) – now the largest provider of quality improvement and patient safety education worldwide. In 2008, I was an intern to Professor Donald Berwick at the Institute for Healthcare Improvement in Cambridge, USA. I was a co-founding leader of the IHI Open School. Utilising social organising methods and the IHI Open School's growing network of quality improvement enthusiasts, I was co-founder of a global patient safety campaign for junior healthcare professionals called "Check a Box. Save a Life." supporting the spread and dissemination of the WHO Surgical Safety Checklist. In later years, as a faculty member, I developed methods for students to learn about the experience of patients and families in healthcare to inform quality improvement through Ask One Question – encouraging students to adopt simple strategies like asking every patient they meet, "What can I do to improve your care today?". These educational innovations have since been implemented into multiple medical curricula, for example, at Cardiff University and the University of British Columbia (Canada).

Educational leadership at Cardiff University

Module leadership and contributions

Academic leadership, management and teaching/research-related administration roles

• Director of Research, Division of Population Medicine, April 2021 – September 2024
• Division of Population Medicine Academic Meeting Schedule Co-ordinator, November 2018 – September 2024.
• Member of School of Medicine Research Ethics Committee, July 2020 – April 2021
• Medical students interviewer, December 2019 – ongoing
• Wellcome INSPIRE taster day, December 2019 – ongoing
• PhD Exam Board Chair, September 2019
• Member of faculty securing Welsh Government funding for the Cardiff University Diploma in Healthcare Planning, 2018
• Member of Cardiff University Phoenix project, 2018 – 2020
• C21 Lead and Member, Education Management Group, Division of Population Medicine, School of Medicine, October 2018 – March 2021
• Patient safety theme leader, Division of Population Medicine, School of Medicine, August 2018 – ongoing
• Member of Senior Leadership Team, Division of Population Medicine, School of Medicine, August 2018 – ongoing
• Member of Research Management Group, Division of Population Medicine, August 2018 – March 2021
• Primary and Emergency Care Centre: work package lead for patient safety, May 2015 – ongoing
• Exam board for Intercalated BSc Clinical Epidemiology, June 2017 – ongiong
• Academic mentor / personal tutor, November 2015 – ongoing

Quality assurance / examiner roles

• Expert advisor, BMJ Learning Collection on Quality Improvement, 2023 – ongoing
• PhD Examiner, Swansea University, University of Glasgow, University College London, University of Sydney
• PhD Examination Chair, Cardiff University
• External Examiner, Quality Improvement in MB BS curriculum, King's College London, 2016 – 2021.
• External Evaluator for the European Commission to the 'Improvement Science Training for European Healthcare Workers' Study, a multi-country educational research and development project, 2013 – 2016.

External teaching contributions

• Expert advisor, Cancer Research UK's project to develop a series of educational screencasts on 'Quality Improvement to Aid Early Diagnosis of Cancers in General Practice', Royal College of General Practitioners, London, UK, March – October 2019
• Expert advisor, as above for CRUK, for RCGP 'Improvement of End of Life Care' screencasts, Royal college of General Practitioners, July 2019 –
• Developed two online e-learning modules on 'Improving patient safety in general practice', RCGP eLearning modules, Royal College of General Practitioners, London, UK, April 2018
• Delivered national workshops on 'Learning from patient safety incidents in general practice', Royal College of General Practitioners (Cardiff, Liverpool, London), Spring 2017
• Invited speaker at RCGP Faculty events (RCGP Midlands, RCGP West of Scotland, Winter 2017 / Spring 2018) and RCGP Annual Conference (Liverpool), October 2017
• Faculty, 'Building Essential QI Skills', co-taught (with Dr Kedar Mate) one-day course for Institute for Healthcare Improvement at the University of British Columbia, Vancouver, Canada, June 2017
• Invited faculty, 'Epidemiologic methods for patient safety', co-taught (with Prof Malcolm Maclure) one-week course at the Harvard Chan School of Public Health, Boston, USA, January 2017
• Online lecturer, 'Disclosure and apology to patients and families following unsafe healthcare', Boston Children's Hospital / Harvard Medical School's OPEN Pediatrics programme, Boston, USA, December 2015 (delivered for CPD on a recurring annual basis)
• Faculty, IHI Open School Student Organizing Leadership Academy, Institute for Healthcare Improvement, Cambridge, USA; and, delivered workshop on 'Utilising social media for social mobilizing to improve patient and population health', August 2015
• Online lecture, 'What is quality Improvement?' for the Master of Public Health Programme at King's College London, 2015
• Co-organiser, Quality Improvement Masterclass for Healthcare and Policy Leaders, Faculty of Medical Leadership and Management, March 2013

Textbook

• Co-editor, Patient Safety and Healthcare Improvement at a Glance, Wiley Blackwell

Biography

Education and qualifications

• 2024: Fellow of the Royal College of General Practitioners
• 2019: Value Measurement for Health Care, Harvard Business School Executive Education, Boston USA
• 2018: Member of the Royal College of General Practitioners
• 2017: Doctor of Philosophy, Generating learning from patient safety incident reports from general practice, Cardiff University, UK
• 2014: Improvement Advisor Professional Development Program, Institute for Healthcare Improvement, Cambridge, USA
• 2011: Leading Innovation in Health Care & Education, Harvard Macy Institute, Harvard University, Boston, USA
• 2010: Master of Philosophy (Medical Education), Cardiff University, Cardiff, UK
• 2010: MB BCh, University of Wales College of Medicine, Cardiff, UK
• 2007: BSc (1st Class Hons, Public Health), University of Wales, Cardiff, UK

Honours and awards

Awards

• Cardiff University Celebrating Excellence Award for Voluntary Contribution, 2024
• Health and Social Care Research Partnership Award with Industry (co-recipient) awarded by MediWales, 2020
• Awarded 'ISQua Expert' status by the The International Society for Quality in Healthcare (ISQua), 2018
• Public Involvement Achievement Award – Runner-up, Health and Care Research Wales, 2018
• Honorary Membership (nominated by two former Chief Medical Officers), Faculty of Public Health, Royal College of Physicians, 2017
• Best Research Team Award (Primary and Emergency Care Research Centre), School of Medicine, Cardiff University, 2017
• Royal College of General Practitioners 'Spotlight Award', 2016
• International Visiting Peter Wall Scholar, Institute of Advanced Studies, University of British Columbia, 2016/17
• Health Service Journal Rising Star Award, 2015
• Churchill Fellow, Winston Churchill Memorial Trust, 2013–2015
• Innovation and Engagement Award, School of Medicine Cardiff University, 2013
• NHS Wales Award (co-recipient) for Promoting Clinical Research and Application to Practice, 2012
• Permanente Journal Health Services Award, 2012
• Gold Award Winner, Worshipful Livery Company of Wales, 2010

Professional memberships

• Fellow, Royal College of General Practitioners (2023–)
• Member, Royal College of General Practitioners (2018–2024)
• Fellow, Royal Society of Arts (2018–)
• Member, European Public Health Association (2017–)
• Honorary Member, UK Faculty of Public Health (2017–)
• Associate Member, Royal College of General Practitioners (2012–2018)
• Registered medical practitioner, General Medical Council (2010–)

Academic positions

• 2019 – present: Adjunct Professor, Queen's University, Kingston, ON, Canada
• 2016 – present: Honorary Professor, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
• 2015 – 2018: Visiting Chair (Professor) of Healthcare Improvement and Leadership, Department of Family Practice, University of British Columbia
• 2015 – 2025: Patient Safety Research Lead, Primary and Emergency Care Research Centre, Wales
• 2012 – 2018: Wales Clinical Academic Training Lectureship (Clinical Lecturer), Cardiff University
• 2010 – 2012: Clinical Fellow, Cochrane Institute of Public Health, Cardiff University

Committees and reviewing

National

• Member, Strategic Advisory Group, Health and Care Research Wales Evidence Centre, 2022 – ongoing.
• Member, Marie Curie Research Funding Committee, January 2022 – ongoing. 
• Member, Clinical Research Delivery in Wales Review, Welsh Government, September – December 2023.
• Member, Data for Research Programme for Wales Working Group, June 2022 – ongoing. 
• Observer (representing Health and Care Research Wales), NIHR Primary Care Programme Board, August 2021 – ongoing. 
• Member, Long COVID in Children Expert Group, NIHR, August 2021
• Member, Health Service Research Wales Expert Reference Group, Health and Care Research Wales, August 2021.
• Member, Long COVID (non-hospitalised patients) research funding panel, NIHR, June 2021
• Member, COVID-19 Understanding and Eliminating COVID-19 Trials Implementation Panel (CUE-TIP), April 2021 - March 2022
• Member, Primary Care Reference Group, Our Future Health (December 2020 – ongoing)
• Member, Wales COVID-19 Vaccine Research Delivery Group (now Wales Vaccines Research Delivery Group), July 2020 – ongoing
• Member, Urgent Public Health Group (COVID-19), NIHR / DHSC / CMOs, March 2020 – 2021
• Prioritisation Oversight Committee, NIHR / Health and Care Research Wales – RfPPB (2020–) and Health Research Awards (2020–)
• Grant / final report reviewer for: National Institute for Health Research – HS&DR (2015-); NIHR Policy Research Programme (2019–), Health Foundation (2017–), NIHR Programme grants for Applied Research (2018-); NHS Innovation Accelerator Awards (2018–); Medical Research Council (2019-); NIHR Advanced Fellowships (2020–); Wellcome (2022 –). 
• Invited expert, Funding Committee of the National Institute for Health Research Policy Research Programme (2019)
• Member, Advanced Disease and End of Life Care workstream, Living With and Beyond Cancer Group, National Cancer Research Institute (NCRI), London, UK (2019-2022)
• Member, Salford Integrated Care Organisation Evaluation Panel, Advancing Quality Alliance (AQuA) (2019-2020)
• Scientific advisor, Patient Safety and Quality Improvement Research and Educational Development, NHS Education for Scotland (2018- ongoing)
• Member, College of Assessors for Innovating for Improvement and Scaling Up Improvement grants, Health Foundation (2017)
• Member, Primary Care Safety Expert Group, 1000 Lives Improvement Service, Public Health Wales (2017)
• Member, Reducing Medicines Related Harm in NHS Wales Working Group, Welsh Government (2017)
• Executive Management Committee, PRIME Centre Wales (2015-ongoing) and co-Chair of PRIME Annual Meeting (2021)

International

• Guest Academic Editor, PLOS Medicine (2020)
• Grant reviewer, Health Research Board, Ireland (2019), Health Research Board, New Zealand (2020), Swiss National Science Foundation (2020).
• International Research Advisory Panel, Centre for Research Excellence for Indigenous Health Care Equity funded by the Australian Government's National Health and Medical Research Council (NHMRC) Centre for Research Excellence, Sydney. CI: Prof Ross Bailie. (2020-)
• Member, Working Party for the OECD Patient Reported Indicator Surveys (PaRIS) programme. Organisation for Economic Co-operation and Development. Paris, France. (2019-2022)
• Member, Working Group for the OECD Patient Reported Safety Outcomes programme. Organisation for Economic Co-operation and Development. Paris, France. (2019-)
• Expert advisory group, WHO Global Knowledge Sharing Platform for Patient Safety (1st meeting 2017, 2nd meeting 2019)
• International scientific advisory board, "Care Track Aged: appropriate care delivered to Australians living in residential aged care." Project No. 1143223 awarded by the National Health and Medical Research Council to Macquarie University, Sydney. CI: Prof Jeffrey Braithwaite. (2018-)
• International scientific advisory board, “Harnessing systems science to build an effective and efficient health system” programme grant ($10.75 million) awarded by the National Health and Medical Research Council to Macquarie University, Sydney. CI: Prof Jeffrey Braithwaite. (2017-)
• Editorial advisory board, BMJ Open Quality (2017-)
• Institute for Healthcare Improvement Scientific Symposium Advisory Board Member (2013)
• Coordinating member, World Health Organization Safer Primary Care Expert Group, (2012-)

Supervisions

Current PhD / supervision of researchers / postgraduate research students:

PhD students

• Dr Peter Edwards, The AI-SAFE-GP study: Evaluating Artificial Intelligence (AI) to SAFEly improve
  General Practitioner (GP) documentation and safety-netting advice in complex consultations (NIHR Doctoral Fellowship).
• Dr Ellen Haire, Developing a core outcome set to evaluate the palliative and supportive care needs of patients with end stage non-malignant liver disease. Wales Clinical Academic Training Fellowship (HEIW / Welsh Government). 
• Dr Imogen John, Safety of end of life care. Wales Clinical Academic Training Fellowship (HEIW / Welsh Government).
• Dr Thomas Purchase, IncorporAting parental health aDVOcaCy when mAnaging unwell Children in primarY care (ADVOCACY): a multi-methods systems approach to co-develop a complex intervention. NIHR Doctoral Fellowship.
• Dr Joy McFadzean, Methods to learn from patient safety incidents. PhD by portfolio. 
• Setareh Majidian, The influence of artificial intelligence (AI) capabilities and innovative performance on new service development.  
• Shalini Ganasan, Resilience-driven learning to improve and sustain safer healthcare systems. ESRC PhD Fellowship.
• Laura Pozzobon, Measurement of medication-related harm with patients.
• Samantha Laws, Safety of ambulance non-conveyance.

In-Practice / Post-doctoral mentorship

• Dr Sarah Yardley, Use of 'close-to-practice' methodologies to explain and change impact of interpersonal relationships in quality improvement. THIS Institute Post-doctoral Fellowship, University College London (2019–).
• Dr Ben Bowers, Using injectable end-of-life symptom control medications at home: understanding human and system factors through inclusive design. Wellcome Early Career Fellowship Award, University of Cambridge (2023–).
• Dr Rebecca Barnes, Optimising patient risk management in urgent primary care services. NIHR Advanced Fellowship, University of Oxford (2023–).

Current supervision

Shalini Ganasan-Ryan

Sam Laws

Tom Purchase

Past projects

• Nichole Pereira, Evaluating the implementation of electronic health record implemention in paediactric care. PhD. Supervisory committee member. Awarded 2024. 
• Elinor MacFarlane, Evaluation of patient safety in the delivery of care to patients with eye-related problems. KESS. PhD. Co-Supervisor. Awarded 2024.
• Thomas Hewson, Exploring Mental Healthcare Patient Safety Incidents in English Prisons: a multi-methods study. MRes. Co-supervisor. Awarded 2023. 
• Jaafer Qasem, Exploring the Acceptability of an International Patient Safety Learning System: An Exploratory Sequential Mixed Methods Approach, PhD. Supervisor. Awarded 2023. 
• Samuel Evans, The quality of evidence collected at the child protection medical: The development and pilot testing of infrared, ultraviolet, cross polarisation and high frequency ultrasound to improve standardised
  collection of bruises, PhD. Co-supervisor. Awarded 2022. 
• Khalid Muhammad, Primary Care Medication Safety Incidents Reported to the National Reporting and Learning System (NRLS), PhD. Co-supervisor. Awarded 2021. 
• Alison Cooper, Exploring opportunities for patient safety when GPs work in or alongside emergency departments: realist synthesis and evaluation, PhD. Co-supervisor. Awarded 2020. 
• Flore Laforest, MPH, and Jawaher Alkhaldi, MPH,Cardiff University. Supervisor. Awarded 2019. 
• Doctoral students at Macquarie University, Sydney: Melissa Riddoch DPT, Avanthi Rajaratnam DPT,  Natalie Fowler DPT, Kelsy Weavil DPT, Michelle Khan DPT, Maxine Delaney DPT. Co-supervisor. Awarded 2019. 
• Haroon Chughtai, MSc Clinical Bioinformatics, University of Liverpool. Co-supervisor. Awarded 2019. 
• Doctoral students at Macquarie University, Sydney: Harriet Amey DPT, Luke Davies DPT, Sarah Trifogli DPT, Kathryn Walker DPT. Co-supervisor. Awarded 2018. 
• Eduardo Ensaldo-Carrasco, Describing and understanding patient safety incidents in primary care dentistry and building consensus on Never Events, PhD, University of Edinburgh. Co-supervisor. Awarded 2018. 
• Huw Evans, MSc Health Informatics, Swansea University. Co-supervisor. Awarded 2016. 
• Philippa Claire Rees, Paediatric safety in primary care: A cross-sectional mixed methods study of national incident report data, MPhil, Cardiff University (intercalating medical student). Supervisor. Awarded 2015. 

Engagement

Examples of engagement activities