The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study

Abstract

BackgroundThere is growing interest in the role of patients in improving patient safety. One such role is providing feedback on the safety of their care. Here we describe the development and feasibility testing of an intervention that collects patient feedback on patient safety, brings together staff to consider this feedback and to plan improvement strategies. We address two research questions: i) to explore the feasibility of the process of systematically collecting feedback from patients about the safety of care as part of the PRASE intervention; and, ii) to explore the feasibility and acceptability of the PRASE intervention for staff, and to understand more about how staff use the patient feedback for service improvement.MethodWe conducted a feasibility study using a wait-list controlled design across six wards within an acute teaching hospital. Intervention wards were asked to participate in two cycles of the PRASE (Patient Reporting & Action for a Safe Environment) intervention across a six-month period. Participants were patients on participating wards. To explore the acceptability of the intervention for staff, observations of action planning meetings, interviews with a lead person for the intervention on each ward and recorded researcher reflections were analysed thematically and synthesised.ResultsRecruitment of patients using computer tablets at their bedside was straightforward, with the majority of patients willing and able to provide feedback. Randomisation of the intervention was acceptable to staff, with no evidence of differential response rates between intervention and control groups. In general, ward staff were positive about the use of patient feedback for service improvement and were able to use the feedback as a basis for action planning, although engagement with the process was variable. Gathering a multidisciplinary team together for action planning was found to be challenging, and implementing action plans was sometimes hindered by the need to co-ordinate action across multiple services.DiscussionThe PRASE intervention was found to be acceptable to staff and patients. However, before proceeding to a full cluster randomised controlled trial, the intervention requires adaptation to account for the difficulties in implementing action plans within three months, the need for a facilitator to support the action planning meetings, and the provision of training and senior management support for participating ward teams.ConclusionsThe PRASE intervention represents a promising method for the systematic collection of patient feedback about the safety of hospital care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1919-z) contains supplementary material, which is available to authorized users.

Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation

“…The facilitative processes incorporated into PRASE were designed to help address this challenge. These processes arose from the findings of feasibility testing of the intervention7 where our research team found that, for example, access to senior management at regular intervals and assistance in interpreting patient feedback were important factors which may support action planning. The assumption was that by providing these processes, staff would be better placed to successfully navigate complex organisational territory.…”

“…9 A feasibility study was undertaken prior to commencement of the full RCT and details of our logic model and moderating factors are reported in the feasibility write up. 7 Here, we provide a synopsis of the intervention and results of the trial for the reader to be able to view our process evaluation in context. Online supplementary appendix 1 provides a detailed summary of the cyclical activities and facilitative processes of the intervention that were trialled, alongside anticipated outcomes.…”

“…This paper provides an account of a qualitative process evaluation of a randomised controlled trial (RCT) where PRASE was tested. PRASE was designed,5 6 tested for feasibility7 and trialled8 9 between 2010 and 2015. This period has been charted as an era of paradigm shift for patient safety research when the dominant ‘measure and manage’ orthodoxy has been enriched by approaches sensitive to setting and sociocultural/political influences 10.…”

“…A feasibility study was undertaken prior to commencement of the full RCT and details of our logic model and moderating factors are reported in the feasibility write up 7. Here, we provide a synopsis of the intervention and results of the trial for the reader to be able to view our process evaluation in context.…”

A qualitative formative evaluation of a patient‐centred patient safety intervention delivered in collaboration with hospital volunteers

“…The PRASE intervention was developed and codesigned with staff and patients to address this need. The intervention supplies healthcare providers with theory and evidence‐based measurement tools for the routine collection of feedback around the safety of care from patients, alongside a framework for staff to interpret and act on that feedback …”