Imperial College London
Alternate

Dr Sam Pannick

Faculty of Medicine, Faculty of Medicine Centre

 
 
 
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Contact

 

s.pannick

 
 
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Location

 

Medical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Pannick:2017:10.1136/bmjopen-2016-014401,
author = {Pannick, SAJ and Archer, S and Johnston, MJ and Beveridge, I and Long, SJ and Athanasiou, T and Sevdalis, N},
doi = {10.1136/bmjopen-2016-014401},
journal = {BMJ Open},
title = {Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards},
url = {http://dx.doi.org/10.1136/bmjopen-2016-014401},
volume = {7},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - ObjectivesTo understand how frontline reports of day-to-day care failings might be better translated into improvement.DesignQualitative evaluation of an interdisciplinary team intervention to capitalise on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS.ResultsPCTS fostered psychological safety – a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and the relative comfort afforded by the avoidance of accountability. At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described.ConclusionsProspective safety strategies relying on staff-volunteered data do approximate the realities of frontline care, but still produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, they give managers access to these accounts, and support frontline staff to make incremental changes in their daily work. These are
AU  - Pannick,SAJ
AU  - Archer,S
AU  - Johnston,MJ
AU  - Beveridge,I
AU  - Long,SJ
AU  - Athanasiou,T
AU  - Sevdalis,N
DO  - 10.1136/bmjopen-2016-014401
PY  - 2017///
SN  - 2044-6055
TI  - Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards
T2  - BMJ Open
UR  - http://dx.doi.org/10.1136/bmjopen-2016-014401
UR  - http://hdl.handle.net/10044/1/44396
VL  - 7
ER  -
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