You are here

  • Home
  • Archive
  • Volume 9, Issue 4
  • User redesign, testing and evaluation of the Monitoring Risk and Improving System Safety (MoRISS) checklist for the general practice work environment

Article Text

Article menu
XML
Original research
User redesign, testing and evaluation of the Monitoring Risk and Improving System Safety (MoRISS) checklist for the general practice work environment
  1. Paul Bowie1,2,
  2. Carl de Wet3,4,
  3. Tracey Crickett1,
  4. Jan McCulloch5,
  5. Pauline Young5,
  6. John Freestone5,
  7. Paul Watson1,
  8. Neil Houston6,
  9. Jill Gillies6,
  10. Duncan McNab1
  1. 1Medical Directorate, NHS Education for Scotland West Region, Glasgow, UK
  2. 2Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  3. 3Healthcare Improvement Unit, Queensland Health, Brisbane, Queensland, Australia
  4. 4School of Medicine, Griffith University, Nathan, Queensland, Australia
  5. 5Primary Care, NHS Ayrshire and Arran, Ayr, UK
  6. 6Healthcare Improvement Scotland, Edinburgh, UK
  1. Correspondence to Professor Paul Bowie; paul.bowie{at}nes.scot.nhs.uk

Abstract

Background Inadequate checking of safety-critical issues can compromise care quality in general practice (GP) work settings. Adopting a systemic, methodical approach may lead to improved standardisation of processes and reliability of task performance, strengthening the safety systems concerned. This study aimed to revise, modify and test the content and relevance of a previously validated safety checklist to the current GP context.

Methods A multimethod study was undertaken in Scottish GP involving: consensus building workshops with users and ‘experts’ to revise checklist content; regional testing of the modified checklist and follow-up usability evaluation survey of users. Quantitative data underwent descriptive statistical analyses and selected survey free-text comments are presented.

Results A redesigned checklist tool consisting of eight themes (eg, medication safety) and 61 items (eg, out-of-date stock is appropriately disposed) was agreed by 53 users/experts with items reclassified as: mandatory (n=25), essential (n=24) and advisory (n=12). Totally 42/55 GPs tested the tool and submitted checklist data (76.4%). The mean aggregated results demonstrated 92.0% compliance with all 61 checklist items (range: 83.0%–98.0%) and 25/42 GP managers responded to the survey (59.5%) and reported high mean levels of agreement on the usefulness of the checklist (77.0%), ease of use (89.0%), learnability (94.0%) and satisfaction (78.4%).

Conclusions The checklist was comprehensively redesigned as a practical safety monitoring and improvement tool for potential implementation in Scottish GP. Testing and evaluation demonstrated high levels of checklist content compliance and strong usability feedback, but some variation was evident indicating room for improvement in current safety-critical checking processes. The checklist should be of interest in similar GP settings internationally and to other areas of primary care practice.

  • checklists
  • audit and feedback
  • general practice
  • human factors
  • safety management
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2020-000977

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Supplementary materials

    Footnotes

    • Twitter @pbnes, @duncansmcnab

    • Contributors PB was responsible for the study idea/design and leading the data collection, analysis and reporting. PB, CdW, TC, JM, PY, PW, NH, JG, JF, DM all contributed to data collection and analysis. PB drafted and led the writing of the manuscript to which CdW, TC, JM, PY, PW, NH, JG, JF and DM also contributed to this process as well as critically appraising and revising different iterations. All authors read and approved the final manuscript.

    • Funding The study was jointly funded by NHS Education for Scotland and Healthcare Improvement Scotland.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Under UK ‘Governance Arrangements for Research Ethics Committees,’ ethical research committee review is not required for service evaluation or research which, for example, seeks to elicit the views, experiences and knowledge of health carehealthcare professionals on a given subject area.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data are available on request from NHS Education for Scotland.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.