RT Journal Article
SR Electronic
T1 Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons’ perspectives
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e002672
DO 10.1136/bmjoq-2023-002672
VO 13
IS 2
A1 Øyri, Sina Furnes
A1 Wiig, Siri
A1 Tjomsland, Ole
YR 2024
UL http://bmjopenquality.bmj.com/content/13/2/e002672.abstract
AB Introduction Transparency about the occurrence of adverse events has been a decades-long governmental priority, defining external feedback to healthcare providers as a key measure to improve the services and reduce the number of adverse events. This study aimed to explore surgeons’ experiences of assessment by external bodies, with a focus on its impact on transparency, reporting and learning from serious adverse events. External bodies were defined as external inspection, police internal investigation, systems of patient injury compensation and media.Methods Based on a qualitative study design, 15 surgeons were recruited from four Norwegian university hospitals and examined with individual semi-structured interviews. Data were analysed by deductive content analysis.Results Four overarching themes were identified, related to influence of external inspection, police investigation, patient injury compensation and media publicity, (re)presented by three categories: (1) sense of criminalisation and reinforcement of guilt, being treated as suspects, (2) lack of knowledge and competence among external bodies causing and reinforcing a sense of clashing cultures between the ‘medical and the outside world’ with minor influence on quality improvement and (3) involving external bodies could stimulate awareness about internal issues of quality and safety, depending on relevant competence, knowledge and communication skills.Conclusions and implications This study found that external assessment might generate criminalisation and scapegoating, reinforcing the sense of having medical perspectives on one hand and external regulatory perspectives on the other, which might hinder efforts to improve quality and safety. External bodies could, however, inspire useful adjustment of internal routines and procedures. The study implies that the variety and interconnections between external bodies may expose the surgeons to challenging pressure. Further studies are required to investigate these challenges to quality and safety in surgery.Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. Data retrieved from the interviews are not publicly available due to the risk of identification but may be available from the corresponding author on reasonable request and with permission from the participant(s).