Harveian Oration 2018: Improving quality and safety in healthcare

Dixon‐Woods, Mary

doi:10.7861/clinmedicine.19-1-47

Cited by 22 publications

(19 citation statements)

References 79 publications

(67 reference statements)

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“…Our findings follow Øvretveit et al's [74] view of contextual conditions as 'influences which interact with each other, and interact with the implementation process'; however, we also acknowledge the dynamic relationship between contextual factors and system levels that occurs during the entire cycle of improvement, pre-and post-implementation. The mutually emergent domains and contextual factors identified in this review are all interconnected-and to a lesser degree, overlapping-so they cannot be viewed in isolation, underlining the complex systems approach to QI [3,24]. What also became apparent during the course of the review is that the key mechanisms underlying successful quality improvement initiatives are relational and social processes that are fluid, flexible and interrelated (Table 4), played out within equally fluctuating contexts and constantly changing systems.…”

Section: Discussionmentioning

confidence: 95%

“…'healthcare improvement', which incorporates changes leading to 'better patient outcomes (health), better system performance (care) and better professional development' [2]. Within the literature, there is also a distinction made between improvement interventions (for example, bundles or checklists) and the 'doing of improvement', the QI approaches and methods used to implement these interventions [3].…”

Section: Introductionmentioning

confidence: 99%

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The influence of contextual factors on healthcare quality improvement initiatives: a realist review

et al. 2020

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Background: Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare? Methods: A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework. Results: Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings. Conclusions: This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

et al. 2020

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“…A shift to a more learning centred NHS will need to focus on how organisations and professionals can develop the underlying competencies, conditions, and contexts that enable improvement. These range from practical issues such as data availability and analytical skills through to capabilities and skills in leadership 28. Some of the changes proposed in the NHS patient safety strategy, including the new safety learning system to replace the current reporting system, are likely to help.…”

Section: Really Commit To Learningmentioning

confidence: 99%

“…An evidence base on the characteristics of struggling units is now also emerging and has identified problems such as poor organisational culture, absence of a cohesive mission, experience of system shocks such as organisational scandals or leadership turnover, and dysfunctional external relationships 35. But repeated discovery of the same challenges risks lapsing into “admiring the problem” unless action is taken 28…”

Section: Learn From High Performancementioning

confidence: 99%

Clinical negligence costs: taking action to safeguard NHS sustainability

Yau

Leigh²,

Liberati

et al. 2020

BMJ

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Spending on clinical negligence is escalating, constituting a major threat to the sustainability of the NHS In England, payments for negligence awards are resourced from the same funds used to provide care Improvements in quality and patient safety might help to reduce litigation costs but need to be evidence based Solving the crisis in litigation costs will require a system-wide effort, with engagement and coordination of stakeholders across the health system

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“…As is tradition, the Harveian lecture features in this edition of the journal, and this year Mary Dixon-Woods gives a tour-de-force on improving quality and standards in healthcare. 2 While this topic has featured heavily in the Future Healthcare Journal, it is a critical topic in 21 st -century healthcare and one that all who undertake clinical medicine must embrace. Linked to this is another interesting piece of original research that investigates hindsight bias in the assessment of the quality of care given to patients in three fictitious scenarios.…”

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confidence: 99%

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Nicol¹

2019

Clinical Medicine

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Harveian Oration 2018: Improving quality and safety in healthcare

Cited by 22 publications

References 79 publications

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

Clinical negligence costs: taking action to safeguard NHS sustainability

All change, all change

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