Using behavioural science to understand threats to patient safety and explore intervention options to improve transitions of care from hospital to primary care settings
File(s)
Author(s)
Markiewicz, Ola
Type
Thesis
Abstract
Healthcare is delivered in many settings in the United Kingdom’s National Health Service, but patients are vulnerable when their care is transferred from one provider to another. It is estimated that up to 23% of patients come to harm during or soon after discharge. Several behaviours of healthcare professionals (HCPs) must occur to ensure safe transfer of care from hospital to primary care. Behavioural science has been used to address many healthcare challenges, but it’s use in the field of patient safety during discharge has been limited.
This thesis combines empirical evidence generation and stakeholder engagement to design an intervention to improve patient safety during discharge, based on the Behaviour Change Wheel process. In my first study (Chapter 2) I prioritised threats to safe patient transitions through a Delphi consensus-generating exercise in primary care. The next two studies (Chapters 3 and 4) used different methodologies to explore behavioural influences underpinning the threat identified in Chapter 2. Chapter 3 describes a secondary analysis of ethnographic observations of hospital staff performing routine ward work. Chapter 4 describes semi-structured interviews with hospital HCPs. Chapter 5 describes the triangulation of findings from Chapters 3 and 4, summarising the most important influences on my target behaviour and enabling subsequent identification of suitable intervention components and generation of intervention ideas. Chapter 6 describes three workshops with stakeholders from hospital, primary care, patients and carers to select and refine a single intervention, culminating in recommendations for an evidence- and theory-based intervention to improve patient safety during discharge.
My research demonstrates the use of behavioural science to explore an important threat to safe patient transitions, with clear rationale and transparency throughout my intervention development process. Integration of stakeholder recommendations into the intervention’s design optimise its chances of successful implementation and outcomes in real clinical settings.
This thesis combines empirical evidence generation and stakeholder engagement to design an intervention to improve patient safety during discharge, based on the Behaviour Change Wheel process. In my first study (Chapter 2) I prioritised threats to safe patient transitions through a Delphi consensus-generating exercise in primary care. The next two studies (Chapters 3 and 4) used different methodologies to explore behavioural influences underpinning the threat identified in Chapter 2. Chapter 3 describes a secondary analysis of ethnographic observations of hospital staff performing routine ward work. Chapter 4 describes semi-structured interviews with hospital HCPs. Chapter 5 describes the triangulation of findings from Chapters 3 and 4, summarising the most important influences on my target behaviour and enabling subsequent identification of suitable intervention components and generation of intervention ideas. Chapter 6 describes three workshops with stakeholders from hospital, primary care, patients and carers to select and refine a single intervention, culminating in recommendations for an evidence- and theory-based intervention to improve patient safety during discharge.
My research demonstrates the use of behavioural science to explore an important threat to safe patient transitions, with clear rationale and transparency throughout my intervention development process. Integration of stakeholder recommendations into the intervention’s design optimise its chances of successful implementation and outcomes in real clinical settings.
Version
Open Access
Date Issued
2023-07-01
Date Awarded
01/12/2023
License URL
Advisor
Judah, Gaby
Lorencatto, Fabiana
Darzi, Ara
Sponsor
National Institute for Health Research (Great Britain)
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)