How not to waste a crisis: a qualitative study of problem definition and its consequences in three hospitals.
Journal of health services research & policy
SAGE Publications Inc.
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Martin, G., Ozieranski, P., Leslie, M., & Dixon-Woods, M. (2019). How not to waste a crisis: a qualitative study of problem definition and its consequences in three hospitals.. Journal of health services research & policy, 24 (3), 145-154. https://doi.org/10.1177/1355819619828403
Objective: The prominence given to issues of patient safety in healthcare organisations varies, but little is known about how or why. We sought to compare and contrast how three English hospitals came to identify, prioritise and address patient safety issues, drawing on insights from the sociological and political science literature on the process of problem definition. Methods: In-depth qualitative fieldwork, involving 99 interviews, 246 hours of ethnographic observation, and document collection, was carried out in three case-study hospitals as part of a wider mixed-methods study. Data analysis was based on the constant comparative method. Results: How problems of patient safety came to be recognised, conceptualised, prioritised and matched to solutions varied across the three hospitals. In each organisation it took certain ‘triggers’ to problematise safety, with crises having a particularly important role. How problems were constructed—and whose definitions were prioritised in the process— was highly consequential for organisational response, influencing which solutions were seen as most appropriate and allocation of responsibility for implementing them. Conclusions: A process of problem definition is crucial to raising the profile of patient safety and to rendering problems amenable to intervention. How problems of patient safety are defined and constructed is highly consequential, influencing selection of solutions and their likely sustainability.
Humans, Hospital Administration, Qualitative Research, Hospitals, Health Priorities, Interviews as Topic, Patient Safety
Funding: We thank the Department of Health Policy Research Programme (Reference No 0770017) for funding the wider research project on which this study is based. Analysis of the case studies and write-up of this paper was supported by Mary Dixon-Woods’ Wellcome Trust Senior Investigator award WT097899. GPM acknowledges the support of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM). MDW and GPM are supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. THIS Institute is supported by the Health Foundation—an independent charity committed to bringing about better health and health care for people in the UK. MDW is a National Institute for Health Research (NIHR) Senior Investigator (NF-SI-0617-10026). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Wellcome Trust (097899/A/11/Z)
Health Foundation (unknown)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10026)
Wellcome Trust (097899/Z/11/Z)
External DOI: https://doi.org/10.1177/1355819619828403
This record's URL: https://www.repository.cam.ac.uk/handle/1810/288894