Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards

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Title: Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards
Authors: Pannick, SAJ
Archer, S
Johnston, MJ
Beveridge, I
Long, SJ
Athanasiou, T
Sevdalis, N
Item Type: Journal Article
Abstract: Objectives To understand how frontline reports of day-to-day care failings might be better translated into improvement. Design Qualitative evaluation of an interdisciplinary team intervention to capitalise on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS. Results PCTS fostered psychological safety – a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and the relative comfort afforded by the avoidance of accountability. At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described. Conclusions Prospective safety strategies relying on staff-volunteered data do approximate the realities of frontline care, but still produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, they give managers access to these accounts, and support frontline staff to make incremental changes in their daily work. These are goals for learning healthcare organisations.
Issue Date: 1-Apr-2017
Date of Acceptance: 7-Feb-2017
ISSN: 2044-6055
Publisher: BMJ Publishing Group
Journal / Book Title: BMJ Open
Volume: 7
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: licenses/by/4.0/
Sponsor/Funder: Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
West Middlesex University Hospital NHS Trust
Imperial College Healthcare Charity
Funder's Grant Number: RDPSC 79560
RDPSC 79560
Research Fellow
Keywords: healthcare quality
interdisciplinary teams
medical ward
patient safety
prospective surveillance
Publication Status: Published
Article Number: e014401
Appears in Collections:Division of Surgery
Faculty of Medicine

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