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dc.contributor.authorPower, Men
dc.contributor.authorBrewster, Len
dc.contributor.authorParry, Gen
dc.contributor.authorBrotherton, Aen
dc.contributor.authorMinion, Jen
dc.contributor.authorOzieranski, Pen
dc.contributor.authorMcNicol, Sen
dc.contributor.authorHarrison, Aen
dc.contributor.authorDixon-Woods, Maryen
dc.date.accessioned2016-09-06T10:02:23Z
dc.date.available2016-09-06T10:02:23Z
dc.date.issued2016-09-22en
dc.identifier.issn2044-6055
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/259972
dc.description.abstract${\bf Objectives:}$ We aimed to evaluate whether a large-scale two-phase quality improvement programme achieved its aims and to characterise the influences on achievement. ${\bf Setting:}$ National Health Service (NHS) in England. ${\bf Participants:}$ NHS staff. ${\bf Interventions:}$ The programme sought to: 1) develop a shared national, regional and locally aligned safety focus for four high-cost, high volume harms; 2) establish a new measurement system based on a composite measure of “harm-free” care; 3) deliver improved outcomes. Phase 1 involved a quality improvement collaborative intended to involve 100 organisations; phase 2 used financial incentives for data collection. ${\bf Measures:}$ Multi-method evaluation of the programme. In Phase 1, analysis of regional plans and of rates of data submission and clinical outcomes reported to the programme. A concurrent process evaluation was conducted of Phase 1, but only data on submission rates and clinical outcomes were available for Phase 2. ${\bf Results:}$ A context of extreme policy-related structural turbulence impacted strongly on Phase 1. Most regions’ plans did not demonstrate full alignment with the national programme; most fell short of recruitment targets and attrition in attendance at the collaborative meetings occurred over time. Though collaborative participants saw the principles underlying the programme as attractive, useful and innovative, they often struggled to convert enthusiasm into change. Developing the measurement system was arduous, yet continued to be met by controversy. Data submission rates remained patchy throughout Phase 1 but improved in reach and consistency in Phase 2 in response to financial incentives. Some evidence of improvement in clinical outcomes over time could be detected but was hard to interpret owing to variability in the denominators. ${\bf Conclusions:}$ These findings offer important lessons for large-scale improvement programmes, particularly when they seek to develop novel concepts and measures. External contexts may exert far-reaching influence. The challenges of developing measurement systems should not be underestimated.
dc.description.sponsorshipThe Department of Health Policy Research Programme (Reference No 0770017), Wellcome Trust (Senior Investigator award WT097899)
dc.languageengen
dc.language.isoenen
dc.publisherBMJ Group
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectimprovement programmesen
dc.subjectmeasurementen
dc.subjectmixed-methodsen
dc.subjectpatient safetyen
dc.subjectquality improvement collaborativesen
dc.titleMultimethod study of a large-scale programme to improve patient safety using a harm-free care approach.en
dc.typeArticle
prism.issueIdentifier9en
prism.numbere011886en
prism.publicationDate2016en
prism.publicationNameBMJ Openen
prism.volume6en
dc.identifier.doi10.17863/CAM.4199
dcterms.dateAccepted2016-07-15en
rioxxterms.versionofrecord10.1136/bmjopen-2016-011886en
rioxxterms.versionVoRen
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2016-09-22en
dc.contributor.orcidDixon-Woods, Mary [0000-0002-5915-0041]
dc.identifier.eissn2044-6055
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idWellcome Trust (097899/Z/11/Z)
cam.issuedOnline2016-09-22en


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International