Studying large-scale programmes to improve patient safety in whole care systems: Challenges for research

Benn, Jonathan; Burnett, Susan; Parand, Anam; Pinto, Anna; Iskander, Sandra; Vincent, Charles

doi:10.1016/j.socscimed.2009.09.051

Cited by 89 publications

(78 citation statements)

References 29 publications

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“…During the course of the programme, two organisations merged into one with a combined programme governance structure prior to the first study time-point, resulting in a final sample that included 19 separate organisations. Due to the organic nature of development of the programme at each participating site, prespecification of individuals for inclusion was not possible 7. Instead, sampling was stratified according to criteria defined by the researchers to include representation of the full multi-disciplinary programme team at each site, including the subprogramme leads and the broader network of healthcare professionals, clinicians, nurses and health service managers involved in local implementation.…”

Section: Methodsmentioning

confidence: 99%

“…A further scale quantified a series of 14 local programme implementation factors in terms of the degree of positive or negative impact in the initial structured phase of the SPI. The individual items are listed in table 2 and further details may be found in a number of related articles 7 9 51 52. The SCC scale comprised 31 items which encompassed a range of sociotechnical factors designed to quantify cultural and organisational dimensions relating to: safety awareness, commitment to safe practice, senior management support, leadership for safety, communication, teamwork, information processes, organisational learning and improvement processes, with the majority of items based upon established safety climate surveys 31 32.…”

Section: Methodsmentioning

confidence: 99%

“…Several authors have drawn attention to limitations in the evidence base, including over-reliance upon case study and anecdotal reports 20–25. Other authors have highlighted the research challenges that exist in studying complex longitudinal interventions which are subject to a range of sociotechnical and contextual influences beyond the control of programme developers 7 22 25. In the context of the Safer Patients Initiative, a robust multiple outcome evaluation of the main phase of the programme found no evidence of positive change in either clinical outcomes or care process quality metrics when compared with control sites 26.…”

Section: Introductionmentioning

confidence: 99%

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Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: a longitudinal survey study

et al. 2012

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: a longitudinal survey study

et al. 2012

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“…Organizations vary in their structures, missions, resource availability, and staff over given time periods. And, just as individuals change over time, organizations and communities evolve, which affects outcomes and the fidelity with which an intervention is practiced (11).…”

Section: Time and Organizational Change In MLI Researchmentioning

confidence: 99%

“…Greater recognition of the potential for a planned intervention to deviate from the intended design or attenuate over time requires evaluators to more closely focus on identifying essential (ie, active) program components and monitoring the extent to which the treatment protocol is adhered to or modified in practice and over time (11). This implies a longitudinal assessment of interventions (vs a single point in time assessment of intervention implementation).…”

Section: Time As a Factor In Implementation And Sustainability Of Mlismentioning

confidence: 99%

Time Issues in Multilevel Interventions for Cancer Treatment and Prevention

2012

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The concept of time introduces important complexities in designing and evaluating programs, measuring and analyzing individual changes, and estimating intervention effects in multilevel interventions (MLIs). For example, investigators may focus on time to address whether interventions are more effective in early stages of implementation or whether their effects attenuate over time. Assessing how time is experienced by individual patients may influence both the design of MLIs and the analysis of the effects of such interventions. For example, assessing how interventions interact with individual growth trajectories to affect outcomes of interest may allow investigators to gain a more nuanced understanding of an intervention's impact on individuals. At the environmental and organizational levels, interventions that change structures or processes often play out over extended time intervals and not always in linear fashion.In this chapter, we discuss issues of time related to 1) conceptual relevance of time in multilevel cancer interventions, 2) time as a research and program design issue in MLIs, 3) analytic methods for dealing with time in MLIs, and 4) resource considerations and trade-offs when incorporating time as a component of multilevel research. Conceptual Relevance of Time in Multilevel Cancer InterventionsThe empirical literature is scant regarding the role of time in MLI research. The limited number of published studies have cited the challenges of insufficient time allowed for implementing the intervention (1) and for introducing changes into existing work load or routines. Some work has described different ways in which time may be treated in the context of intervention studies. Time has been conceptualized in four ways: 1) "clock and calendar time," which is structured, and addresses "when," "how often," "how long," and "in what order" activities need to occur (this conceptualization recognizes that time may be linear but its effects as experienced are frequently nonlinear); 2) "temporality," which conveys processes that unfold in time; 3) "timing," which is dependent on the organizational context in which an intervention is applied; and 4) "tempo," which is related to a patient's perception of time (eg, the rate at which a patient perceives his or her disease to have progressed) (2,3).The Symptoms Experience in Time (SET), developed for symptom management research, is another conceptual model for understanding time. It incorporates antecedents that include a precipitating event, such as cancer or a disease process. In addition to clock/calendar time and tempo, three other temporal assumptions describe time as both a concrete (ie, biological/social time) and an abstract concept (ie, sense of timelessness amid intense symptoms) (4).This conceptual work underscores the importance of understanding complex temporal dynamics from both the patient's perspective and the care delivery standpoint when planning or analyzing MLIs. Such notions of time imply a range of dynamic interactions between the intervention...

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Safe Organizations: Bringing it all together

Vincent

2010

Patient Safety

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Studying large-scale programmes to improve patient safety in whole care systems: Challenges for research

Cited by 89 publications

References 29 publications

Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: a longitudinal survey study

Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: a longitudinal survey study

Time Issues in Multilevel Interventions for Cancer Treatment and Prevention

Safe Organizations: Bringing it all together

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