Background Despite significant attention to safety and quality in healthcare over two decades, patient harm in hospitals remains a challenge. There is now growing emphasis on continuous quality improvement, with approaches that engage front-line staff. Our objective was to determine whether a novel approach to reviewing routine clinical practice through structured conversations—map-enabled experiential review—could improve engagement of front-line staff in quality improvement activities and drive improvements in indicators of patient harm.
Methods Once a week over a 10-month period, front-line staff were engaged in 35 min team-based conversations about routine practices relating to five national safety standards. Structure for the conversations was provided by interactive graphical logic maps representing each standard. Staff awareness of—and attitudes to—quality improvement, as well as their perceptions of the intervention and its impact, were canvassed through surveys. The impact of the intervention on measures of patient safety was determined through analysis of selected incident data reported in the hospital’s risk management system.
Results The map-enabled experiential review approach was well received by staff, who reported increased awareness and understanding of national standards and related hospital policies and protocols, as well as increased interest in quality issues and improvement. The data also indicate an improvement in quality and safety in the two participating units, with a 34% statistically significant decrease in the recorded incident rates of the participating units relative to the rest of the hospital for a set of independently recorded incidents relating to patient identification.
Discussion This exploratory study provided promising initial results on the feasibility and effectiveness of map-enabled experiential review as a quality improvement approach in an acute clinical setting.
- quality improvement
- continuous quality improvement
- process mapping
- healthcare quality improvement
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Contributors AC: contributed to initial conceptualisation and study design; collected observations at almost all intervention sessions; contributed to data analysis and interpretation, as well as drafting and review of the article. VA: contributed to initial study design; contributed to data analysis and performed all statistical tests; prepared figures for publication; contributed to drafting and review of the article. FB: contributed to initial study design; provided support and advice on project conduct during the intervention; reviewed data and data analysis; reviewed the article. DRC: provided initial conceptualisation of the study and study design; collected observations at some intervention sessions; contributed to data analysis and interpretation; prepared tables for publication; drafted the article.
Funding AC, VA and FB received a grant from the Epworth Research Institute (ERI) to cover costs associated with the conduct of the project. ERI had no involvement in study design; collection, analysis and interpretation of the data or preparation and submission of this article.
Competing interests AC and VA have a financial interest in MEERQAT Pty Ltd; DRC is a Director of MEERQAT Pty Ltd.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval The project was approved by the Epworth Human Research Ethics Committee (Protocol # EH 2017-261). All participants provided informed consent prior to taking part in the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Survey data: De-identified individual participant data that underlie the results reported in this article, as well as the statistical analysis plan, will be available immediately following publication for any researchers whose proposed use of the data has been approved by an independent review committee. RiskMan data: The incident report data used in this study are not publicly available; researchers wishing to access de-identified incident report data or tabulated incident count data will need to submit a proposal to Epworth Hospital.
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