Neither magic bullet nor a mere tool: negotiating multiple logics of the checklist in healthcare quality improvement

Kocman, David; Stöckelová, Tereza; Pearse, Rupert M; Martin, Graham

doi:10.1111/1467-9566.12861

Cited by 4 publications

(4 citation statements)

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“…Kocman et al . (), for example, show how the design of a quality improvement checklist can reflect different modes of clinical responsibility with contrasting, and sometimes conflicting, logics. Tools and measures, in other words, arguably embody sets of ethical dispositions and thus operate as ethical actors in their own right (for an extended example of this see Gardner and Cribb ).…”

Section: Ethics In Practice – Both Emergent and Submergedmentioning

confidence: 99%

Managing ethical uncertainty: implicit normativity and the sociology of ethics

Cribb

2019

Sociology Health & Illness

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This article illustrates and discusses the idea of ‘implicit normativity’, and specifically its relevance to the management of ethical uncertainty. In particular I consider (i) the role implicit normativity plays in masking and containing potential ethical uncertainty and (ii) the contrast and boundary between implicit normativity and ‘overt ethics’ where ethical contestation – as well as particular processes and agents – are highlighted as salient. Using examples I show how the idea of implicit normativity can be applied not only to specific practices but also to whole fields of practice. The notion of ‘moral settlements’ – along with the explanatory role of the threat of ‘chaos’ – is introduced and elucidated to develop these points. I argue that attention to the management of ethical uncertainty shows the critically important contribution that an ambitious sociology of ethics can make to clinical ethics, including by helping to formulate and drive home questions about the ‘ethics of ethics’. The account presented here has resonances with work that seeks to use sociological lenses to move beyond conventional bioethics, including Petersen's (2013) call for a ‘normative sociology’.

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Section: Ethics In Practice – Both Emergent and Submergedmentioning

confidence: 99%

Managing ethical uncertainty: implicit normativity and the sociology of ethics

Cribb

2019

Sociology Health & Illness

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“…On the one hand, it was recognised as useful, and on the other hand, it was seen as expendable, something nonessential in high demand situations. This resonates with Kocman, Stöckelová, Pearse, and Martin (2019) who outline the different logics, or purposes, of a checklist (check, prompt, audit and record) and the tensions that emerge between them which can undermine implementation and use. We explore potential causes of ambivalence and tension in the use of the ED safety checklist below.…”

Section: Discussionmentioning

confidence: 88%

The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use

Stone

Banks

Brant

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To explore the extent to which a checklist designed to support patient safety in hospital Emergency Departments was recognised and used by staff. Background Patient crowding in UK Emergency Departments makes it difficult for staff to monitor all patients for signs of clinical deterioration. An Emergency Department Safety Checklist was developed at a UK hospital to ensure patients are regularly monitored. It was subsequently implemented in six hospitals and recommended for use across the National Health Service in England. Methods This was a qualitative study in two UK hospital Emergency Departments. Data collection consisted of sixty‐six hours of nonparticipant observation and interviews with twenty‐six staff. Observations were sampled across different days and times. Interviews sampled a range of staff. Data were analysed thematically. The study was undertaken in accordance with COREQ guidelines. Results Staff described the Emergency Department Safety Checklist as a useful prompt and reminder for monitoring patients' vital signs and other aspects of care. It was also reported as effective in communicating patient care status to other staff. However, completing the checklist was also described as a task which could be overlooked during busy periods. During implementation, the checklist was promoted to staff in ways that obscured its core function of maintaining patient safety. Conclusions The Emergency Department Safety Checklist can support staff in maintaining patient safety. However, it was not fully recognised by staff as a core component of everyday clinical practice. Relevance to clinical practice The Emergency Department Safety Checklist is a response to an overcrowded environment. To realise the potential of the checklist, emergency departments should take the following steps during implementation: (a) focus on the core function of clinical safety, (b) fully integrate the checklist into the existing workflow and (c) employ a departmental team‐based approach to implementation and training.

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“…The understanding that an intervention cannot be isolated from implementation contexts given their co-constructive nature as they interact in multiple, complex and dynamic ways8 16 26 is reinforced in our study. Prior research clearly demonstrates the different ways in which healthcare providers engage with a single safety tool that consequently leads to different types of behaviours and impacts 27 28. In this paper, we report on the varied ways that participants engaged with the Framework and how they used it, as shaped by their workplace settings.…”

Section: Discussionmentioning

confidence: 96%

Measurement and Monitoring of Safety Framework: a qualitative study of implementation through a Canadian learning collaborative

et al. 2022

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BackgroundThe Measurement and Monitoring of Safety Framework (MMSF) aims to move beyond a narrow focus on measurement and past harmful events as the major focus for safety in healthcare organisations. There is limited evidence of MMSF implementation and impact.ObjectiveWe aimed to examine participants’ perspectives and experiences to increase understanding of the adaptive work of implementing the MMSF through a learning collaborative programme in diverse healthcare contexts across Canada.MethodsThe Collaborative consisted of 11 teams from seven provinces. We conducted a qualitative study involving interviews with 36 participants, observations of 5 sites and learning sessions, and collection of documents.ResultsCollaborative sessions and coaching allowed participants to explore reliability, sensitivity to operations, anticipation and preparedness, and integration and learning, in addition to past harm, and move beyond a project and measurement oriented safety approach. Participants noted the importance of time dedicated to engaging stakeholders in talk about MMSF concepts and their significance to their settings, prior to moving to implementing the Framework into practice. While participants generally started with a small number of ways of integrating the MMSF into practice such as rounds or huddles, many teams continued to experiment with incorporating the MMSF into a range of practices. Participants reported changes in thinking about safety, discussions and behaviours, which were perceived to impact healthcare processes. However, participants also reported challenges to sharing the Framework broadly and moving beyond its surface implementation, and difficulties with its sustained and widespread use given misalignments with existing quality and safety processes.ConclusionThe MMSF requires a dramatic departure from traditional safety strategies that focus on discrete problems and emphasise measurement. MMSF implementation requires extensive discussion, coaching and experimentation. Future implementation should consider engaging local leaders and coaches and an organisation or system approach to enable broader reach and systemic change.

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Neither magic bullet nor a mere tool: negotiating multiple logics of the checklist in healthcare quality improvement

Cited by 4 publications

References 46 publications

Managing ethical uncertainty: implicit normativity and the sociology of ethics

Managing ethical uncertainty: implicit normativity and the sociology of ethics

The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use

Measurement and Monitoring of Safety Framework: a qualitative study of implementation through a Canadian learning collaborative

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