From embracing to managing risks

Abstract

ObjectiveTo assess developments over time in the capture, curation and use of quality and safety information in managing hospital services.SettingFour acute National Health Service hospitals in England.Participants111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff.ResultsThere were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff.ConclusionsThe findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.

Health boards' governance of quality and risk: quality improvement agenda for the board

“…Directors described working relationship and trust dimensions as critical for specialists and clinicians who provide exception reports to boards on quality, risk and safety matters. The growth and development of capacity and systems to report on quality and risk matters over the last decade in health delivery organisations has been previously reported (Keen et al, 2018). Knowledge brokering in relation to quality assurance and quality improvement activities has been identified in this study and also in the literature (Quartz-Topp, 2019).…”