Safety lessons: shifting paradigms and new directions for patient safety research

Lamont, Tara; Waring, Justin

doi:10.1177/1355819614558340

Cited by 28 publications

(35 citation statements)

References 42 publications

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“…Our findings support the growing understanding that emphasis in patient safety research must continue to shift from the measure and manage orthodoxy of data collection to interpretation and process 10. In this research, the collection of patient feedback was the least problematic element.…”

Section: Discussionsupporting

confidence: 73%

“…This period has been charted as an era of paradigm shift for patient safety research when the dominant 'measure and manage' orthodoxy has been enriched by approaches sensitive to setting and sociocultural/political influences. 10 It became essential for a process evaluation to capture the nuances involved in the PRASE implementation. Process evaluations have been used to explain suboptimum outcome effects, specifically whether there was a 'fault' with the intervention itself, its key components or with delivery.…”

Section: Open Accessmentioning

confidence: 99%

“…PRASE was designed,5 6 tested for feasibility7 and trialled8 9 between 2010 and 2015. This period has been charted as an era of paradigm shift for patient safety research when the dominant ‘measure and manage’ orthodoxy has been enriched by approaches sensitive to setting and sociocultural/political influences 10. It became essential for a process evaluation to capture the nuances involved in the PRASE implementation.…”

Section: Introductionmentioning

confidence: 99%

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Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation

et al. 2017

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ObjectivesA patient safety intervention was tested in a 33-ward randomised controlled trial. No statistically significant difference between intervention and control wards was found. We conducted a process evaluation of the trial and our aim in this paper is to understand staff engagement across the 17 intervention wards.DesignLarge qualitative process evaluation of the implementation of a patient safety intervention.Setting and participantsNational Health Service staff based on 17 acute hospital wards located at five hospital sites in the North of England.DataWe concentrate on three sources here: (1) analysis of taped discussion between ward staff during action planning meetings; (2) facilitators’ field notes and (3) follow-up telephone interviews with staff focusing on whether action plans had been achieved. The analysis involved the use of pen portraits and adaptive theory.FindingsFirst, there were palpable differences in the ways that the 17 ward teams engaged with the key components of the intervention. Five main engagement typologies were evident across the life course of the study: consistent, partial, increasing, decreasing and disengaged. Second, the intensity of support for the intervention at the level of the organisation does not predict the strength of engagement at the level of the individual ward team. Third, the standardisation of facilitative processes provided by the research team does not ensure that implementation standardisation of the intervention occurs by ward staff.ConclusionsA dilution of the intervention occurred during the trial because wards engaged with Patient Reporting and Action for a Safe Environment (PRASE) in divergent ways, despite the standardisation of key components. Facilitative processes were not sufficiently adequate to enable intervention wards to successfully engage with PRASE components.

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Section: Discussionsupporting

confidence: 73%

Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation

et al. 2017

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“…2 To date, however, there is limited knowledge about patient safety in other settings and how work for patient safety is addressed at the micro level in direct contact with patients. [3][4] Research on patient safety in nursing homes highlights a poorly developed patient safety culture, [5][6][7] which may indicate that these patients may be at risk of harm, especially as preventable patient injuries are more common among patients over 65 years of age.…”

Section: Introductionmentioning

confidence: 99%

Patient safety in nursing homes in Sweden: nurses’ views on safety and their role

Andersson

Hjelm

2017

J Health Serv Res Policy

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Objective Knowledge about patient safety in nursing homes is limited. The aim of this study was to describe what patient safety means to nurses working in nursing homes for the elderly and how these nurses address patient safety. Method Qualitative study of semi-structured interviews with 15 nurses aged 27–62 years. Qualitative content analysis was applied. Results Nurses describe the meaning of patient safety in terms of proper care and treatment, and a sense of security. Based on nurses’ description of patient safety, several factors were identified as prerequisites to achieve safe health care: competence; clear information transfer between health care organizations; continuity of care and appropriate environment. Barriers to patient safety were described as lack of sufficient resources; lack of communication and negative attitudes to incident reporting. To a great extent, nurses’ work for patient safety consists of efforts to compensate for defects and ensure good health care in their daily work, since work with patient safety is not a management priority. Conclusion Patient safety needs to be clarified and prioritized in nursing homes, and there is a need to understand nurses’ role among other care givers and the need for shared routines among care givers.

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“…The solution proposed for this framing of the problem was implementation of standardised processes and 'designing out' errors, both at the level of specific interventions and whole-organisation safety systems. While this perspective informs much empirical patient safety research, Lamont and Waring (2015) offer a subtle reading of a tension evident within the literature: is patient safety a 'thing' that may be enhanced through technical solutions; or a more nebulous, contested phenomenon requiring attendance to the socio-cultural context of proposed changes to practice (Rowley and Waring 2011)? From a socio-cultural perspective, transfer of technical 'solutions' between industries risks subversion by existing professional hierarchies, as observed by Currie et al (2009) in an evaluation of incident reporting techniques developed in the aviation industry and subsequently implemented within a hospital.…”

Section: Introductionmentioning

confidence: 99%

Enacting Corporate Governance of Healthcare Safety and Quality: A Dramaturgy of Hospital Boards in England

Freeman¹,

Millar²,

Mannion³

et al. 2016

The Sociology of Healthcare Safety and Quality

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The governance of patient safety is a challenging concern for all health systems.Yet, while the role of executive boards receives increased scrutiny, the area remains theoretically and methodologically underdeveloped. Specifically, we lack a detailed understanding of the performative aspects at play: what board members say and do to discharge their accountabilities for patient safety. This article draws on qualitative data from overt non-participant observation of four NHS hospital Foundation Trust boards in England. Applying a dramaturgical framework to explore scripting, setting, staging and performance, we found important differences between case study sites in the performative dimensions of processing and interpretation of infection control data. We detail the practices associated with these differences -the legitimation of current performance, the querying of data classification, and the naming and shaming of executives -to consider their implications.

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Safety lessons: shifting paradigms and new directions for patient safety research

Cited by 28 publications

References 42 publications

Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation

Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation

Patient safety in nursing homes in Sweden: nurses’ views on safety and their role

Enacting Corporate Governance of Healthcare Safety and Quality: A Dramaturgy of Hospital Boards in England

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