Dr Harry Jones

Professor Tracy Levett-Jones is working towards evidence-based curricula redesign to ensure future health professionals are equipped to provide safe, effective and person-centred care.

When compared to international healthcare systems, Australia has one of the safest.  Yet Levett-Jones' research, along with multiple patient safety reports, indicates it is safer to go hang-gliding or to work in the nuclear power industry than it is to be a patient in an Australian hospital.

'The statistics are quite staggering,' she concedes.

As a clinician and more recently as an educator and researcher, Levett-Jones' primary emphasis has been on patient safety and preventing adverse patient outcomes. Combined with her commitment to improving the learning experiences of healthcare students, the internationally published author is working with an interdisciplinary team to design and undertake research that addresses patient safety concerns.

'I lead a large, extremely dedicated team who collaborates with academics from other countries, universities and clinical contexts,' she states.

'This ensures the international relevance of our research and optimises its translation to practice.'

Multipronged and multipurpose

Levett-Jones' team has expertise in a wide range of research methodologies, including quasi-experimental designs, case studies, cross-sectional surveys, Delphi technique, systematic reviews and narrative inquiry, as well as many other qualitative and quantitative approaches.

The University of Newcastle's world-renowned and award winning simulation program is excellent for teaching and research into patient safety. Sessions are conducted using high fidelity manikins, actors, masked educators, 3D cultural simulations, disaster simulations and inter-professional simulations. Each scenario is linked to a specific learning outcome and integrated into the curriculum.

'These simulation strategies create authentic learning situations that expose students to real practice but in a safe environment,' Levett-Jones explains.

'While some research can be undertaken in healthcare settings, it's not always ethical or safe for patients, so we prefer to recreate authentic simulated environments and scenarios instead.'

Seeking to put evidence into practice, the multiple-award winner is working collaboratively with researchers and educators across Australia and internationally to implement and evaluate patient safety simulations.

'In healthcare, when we teach and research, we are focused on both the here and now,' she reveals.

'But we're also looking beyond the horizon to ensure our work influences the recipients of our care, such as residents in aged-care facilities, the community, and many other health services. Without this focus the work we do has little meaning or relevance.  We are committed to truly making a difference.'

Moral courage and patient safety

Levett-Jones first began examining the relationship between education and patient safety during her PhD candidateship nearly ten years ago. While exploring the clinical learning experiences of nursing students in Australia and the United Kingdom, it became apparent that students who didn't experience a strong sense of belonging were constantly preoccupied with trying to fit in.

'While they identified practices that were unsafe, they were too afraid of 'rocking the boat' to speak up,' she disclosed.

'Essentially, students chose to conform and comply, rather than risk exclusion from the team.'

By contrast, students who experienced a strong sense of belonging were much more likely to demonstrate moral courage and address issues that may have threatened patient safety.

'So it became apparent that one of the most effective ways to improve patient safety is to empower students to become agents of change.'

Thinking about thinking

Post PhD, Levett-Jones has continued to work with her team to identify and address patient safety issues that could be improved through meaningful educational initiatives.

'We've identified that nearly 60% of adverse patient incidents in healthcare are related to the way health professionals think, or fail to think, about the complex data they are presented with during emergent clinical situations,' Levett-Jones asserts.

'For many years university nursing and other health programs failed to teach and research these cognitive processes effectively.'

'But over the last five or six years, we have turned our attention to the relationship between clinical reasoning and patient safety, and this has had a significant impact not only on our own curriculum, but also on health professional curricula in Australia and internationally.'

Describing the term 'clinical reasoning' as one that necessitates an awareness of the assumptions, biases and preconceptions health professionals often hold, Levett-Jones is a firm believer in the importance of teaching students to think 'differently and deeply' to improve patient safety.

'Through our research, simulations, classroom and online teaching, we have given considerable attention to enhancing graduates' clinical reasoning skills, and this has resulted in measurable improvements,' she conveys.

Adding to this body of work, the Director of the University's Research Centre for Health Professional Education is currently working with researchers and clinicians to improve medication safety in Australia.  Together with a team from the University of Western Sydney, Levett-Jones is designing simulations to help registered nurses and students confidently prevent and manage interruptions.

'There is growing evidence that they lead to significant numbers of medication errors each day,' she explains.

This research is part of a broader agenda to improve the inter-professional and therapeutic communication skills of health professional students.

'Lack of communication is implicated in 70 to 80% of all sentinel events,' she admits.

'Again, there hasn't been enough research on the most effective way to teach students and health professionals how to communicate in a manner that prevents errors from occurring.'

Cultural competence

Culturally and linguistically diverse patients experience twice as many adverse outcomes in Australian hospitals as English-speaking patients.  This is another area that needs much more attention in the education of health professionals, and in the research sphere.  While most educators focus on cultural competence, Levett-Jones' team is looking at cultural empathy as an antecedent to cultural competence.

'We have found that cultural empathy may be the key to changing attitudes and the way health professionals care for patients from culturally and linguistically diverse backgrounds,' she advises.

To this end, Levett-Jones' team has undertaken a number of research projects specifically designed to enhance students' cultural empathy and competence, with very encouraging results. Levett-Jones is also collaborating with Flinders University to create a set of interactive resources that focus on the mental illness experiences of people from different cultural backgrounds.

The interactive resources include a young Aboriginal man with depression, an older Chinese immigrant with dementia, and a woman from Middle Eastern background with postnatal depression.  The modules also address issues associated with stigma and social justice, and take learners on a journey that helps them to reflect on their own biases and preconceptions.

What matters most

When asked about her future research directions, Levett-Jones is quick to answer.

'There is a real need for evidence-based education,' she enthuses.

'We need to work collaboratively to invest in the education of future health professionals so that they make a tangible difference to the way graduates' practice, and ultimately, to patient safety.' 

'Our education and research agenda must lead to knowledgeable, effective, safe, compassionate and person-centred health professionals.'