Implementing technological innovations into practice can often be a challenge. In this article, Shane Kirwan and colleagues describe the successful implementation of a virtual reality exposure therapy intervention in a mental health setting, explaining key steps, such as needs assessment, stakeholder engagement and ensuring the appropriate standards.

Healthcare professionals play a fundamental role in protecting and optimising the health of the UK public, but they are also vulnerable to illness. This article explores the practical and ethical considerations of expediting care for NHS staff, at a time when long waits can be the norm.

Postnatal care is an integral part of maternity care and support, but NHS England's national data have consistently shown an unmet need in postnatal care. This article describes the outcomes of an improvement project that used design thinking methodology to understand the experiences, needs and challenges in an NHS postnatal ward in London, then used these insights to co-design a solution to support the delivery of joint-up mother and baby care. Challenges identified included difficulties coordinating care and reliance on standalone communication systems (such as paper-based ward handover sheets and wipe-down whiteboards for ward activity planning). The project aimed to improve communication and information sharing, ward discharge processes, time and resource management, and data capability. This involved a co-designed, bottom-up digital innovation that centralised all operational processes relevant to postnatal ward care, implemented at the trust in December 2018. The bespoke online portal integrates mother and baby care, and helps to ensure joined-up working among healthcare professionals, with real-time data and predictive analysis to inform integrated, dynamic and iterative responses to an individual maternity system's operational needs and challenges. Learning from this approach is shared in this article, with recommendations for future practice.

Craig Brown highlights the importance of ‘voice’ in healthcare teams, while celebrating NHS managers who continue to strive for better for patients and staff, despite intense political, financial and operational pressures.

With major changes planned for the governance of the healthcare system, Joe Home, Sacha Wright and Joe Deegan underline the need for an overhaul of strategic decision making in the NHS, balancing data-driven direction with empathetic services that meet the needs of communities.

Background/Aims Ventilator-associated pneumonia is a common but avoidable healthcare-associated infection in intensive care units, leading to preventable deaths. The study aimed to assess the knowledge of, adherence to and barriers against evidence-based guidelines for preventing ventilator-associated pneumonia among nurses at an intensive care unit in Palestine. Methods A cross-sectional study was conducted, using a convenience sampling method to recruit 250 intensive care nurses working in the southern region of Palestine. Data were collected using a self-administered questionnaire comprising four sections: sociodemographic characteristics; knowledge of ventilator-associated pneumonia prevention (scored as a %); adherence to evidence-based guidelines (scored as a %); and barriers to adherence (rated on a 5-point Likert scale). Independent t-tests, ANOVA and Pearson's correlation were used to assess relationships between variables. Significance was set at P<0.05. Results Most participant had a moderate or low level of knowledge, while 61.2% reported good adherence to evidence-based guidelines for prevention of ventilator-associated pneumonia. Significant positive relationships were found between adherence scores and experience working in intensive care (P=0.033) and knowledge scores and completion of specific infection-prevention training (P=0.034). Barriers with the highest mean scores were lack of knowledge, lack of educational programmes and lack of time. Conclusions Intensive care nurses may be lacking knowledge regarding evidence-based guidelines for the prevention of ventilator-associated pneumonia, leading to difficulties implementing these guidelines in practice. Adherence may improve with experience working in intensive care, but interventions are needed to improve nurses' knowledge of infection prevention and ensure that this is translated to practice. Implications for practice Mentorship programmes should be implemented to enhance adherence to evidence-based guidelines in intensive care units. Incorporating guidelines for ventilator-associated pneumonia prevention into the nursing curriculum should also be considered, to ensure that all nurses are equipped for safe and effective practice.

Background/Aims Professional governance and organisational citizenship behaviours can play a pivotal role in organisational performance in the healthcare sector. The perspectives of healthcare professionals are important indicators of these factors and the relationships between them. This study explored the views of healthcare professionals regarding the relationship between professional governance, organisational citizenship behaviours and the quality of healthcare services. Methods This study used a correlational design, with data collected from 223 healthcare professionals at a specialist cancer hospital in Oman. Data were collected using a validated questionnaire, including the Organisational Citizenship Behaviours Scale (15 items), the Index of Professional Governance (50 items) and the SERVQUAL (22 items). All items were scored on a 5-point Likert scale. Descriptive statistics and path analysis were applied to examine relationships between variables and identify any mediation effects. Results The mean score on the Organisational Citizenship Behaviours Scale was relatively high at 3.72/5.00. Professional governance scores indicated a shared approach to governance (mean total score: 126.5/250.00). Participants had a moderately positive perception of service quality (mean score: 3.21/5.00). Path analysis showed a positive relationship between professional governance and both organisational citizenship behaviours (r=0.247) and service quality (r=0.236). Professional governance had a direct and indirect relationship with perceived service quality, with organisational citizenship behaviours having a partial mediation effect. Confidence interval plots confirmed the statistical significance of both direct and indirect effects. Conclusions Both directly and indirectly, healthcare professionals' perceptions of the professional governance and organisational citizenship behaviours in their workplace affect their views of the service quality delivered. This highlights the importance of professional governance in influencing staff behaviours and perceptions. Implications for practice Healthcare organisations should regularly assess their professional governance frameworks to ensure that they align with the needs of their staff and evolving healthcare goals. Recognising and rewarding organisational citizenship behaviours may also help to foster positive workplace dynamics, which could ultimately improve perceived service quality among staff.

Background/Aims This study aimed to gain a deeper understanding of the career aspirations and learning needs of NHS support staff and to explore the factors that encourage or prevent them from developing their careers. Methods A qualitative interview study was conducted with staff working in the NHS support workforce in Scotland, comprising business and administration, estates and facilities roles. Semi-structured interviews were conducted via telephone with 41 staff members from two health boards in 2023–24. Data were analysed using a theoretical thematic analysis approach, with open coding. Data coding and categorisation were undertaken using NVivo 12 software. Results Four main themes were identified: career aspirations; learning needs; enablers of learning and development; barriers to learning and development. Participants had undertaken a large amount of training, but several learning needs remained, especially relating to digital skills, project management, leadership, people skills and presentation skills. Enablers of learning and development included: clarity about the skills and qualifications required to progress; managerial support; positive role models; protected time and/or funding; and thorough job inductions. Barriers to development included: a lack of structured plans for learning and development; lack of availability of courses; lack of managerial support; and limited time and budgets for training. Conclusions The NHS support workforce face challenges in developing their skills and careers. Managerial support for development is crucial, highlighting the need for managers to undergo leadership and mentoring training to help them develop their teams. Every role needs clear objectives; staff should know what is required to progress and suitable training should be provided to facilitate this. Implications for practice Where possible, protected time and space for learning should be provided, as well as the promotion of flexible, hybrid and part-time working and recognition of previous learning, to help recruit and retain staff. Focusing on succession planning, as well as encouraging experienced staff to stay in their posts, should be a priority in NHS support services.

An implantable loop recorder is a device that can be surgically inserted into a patient to continuously monitor cardiac activity over a longer period of time. Data from these devices can be sent directly to a smartphone app and shared with the clinical team, allowing the patient to be monitored in the community. Implantable loop recorders are used to diagnose the causes of conditions such as syncope and detect atrial fibrillation in high-risk individuals. This article discusses the LINQ II device (Medtronic), an implantable loop recorder that has been developed to detect heart rhythms more effectively, handle larger quantities of data, improve the patient experience and streamline clinical workflows. The authors discuss the features and uses of this device, including an example of its implementation in a major NHS hospital in London.

Technology is often held up as a panacea for healthcare systems, but it must be implemented strategically to ensure that digital systems are resilient and secure. Andrew Raynes and Stephen Bush discuss key considerations for the NHS's digital strategy, drawing on lessons from the healthcare system's recent history.