Introduction
Method
Design
Settings
Participants/recruitment
The tools
PC-SafeQuest safety climate survey
PC-SafeQuest | MaPSaF | |
---|---|---|
Aim | To survey patient safety climate and inform patient safety improvement. | To facilitate improvements in safety culture through constructive reflective practice. |
Facilitated | Self-completed with a summary report automatically generated. | Led by an independent moderator. |
Level of anonymity | Anonymous and completed confidentially. | Group members known to each other. |
Number of participants | All staff in the practice. | Up to 12 members of practice staff. |
Staff groups involved | All grades of staff | All grades of staff |
Format | Online questionnaire | Workshop and group discussion |
Structure of the tool | A total of 30 questions within 6 domains. Completed questionnaires are collated for each practice scores produced for each domain in a final report produced by PC-SafeQuest. | An evaluation sheet consisting of nine domains with the option of selecting one of 5 levels of ‘maturity’ for each. This is to be completed by each participant during the workshop and the results to be discussed as a group. |
Outputs | Generation of report where scores can be compared with previous reports from that practice or practices of similar characteristics. | Discussion of evaluation sheet results as part of workshop identifies any areas that might need to be looked at. |
Time to complete | 10 min for online questionnaire. (The time taken by senior staff to assimilate and act on this data was not formally recorded). | 60–120 min |
Manchester Patient Safety Framework (MaPSaF)
Data collection
Phase one: content analysis
Phase two: qualitative assessment
How easy was the tool to use? |
• Were there any issues regards facilitating their use? |
• Did individuals understand what was being asked? |
• Were the demands on time and resource as you expected? |
• Were there any significant/unforeseen issues? |
How effective or useful was the tool? |
• Which elements or domains did you find most useful for your practice? |
• Which elements or domains did you find least useful for your practice? |
• Were you surprised at the findings that emerged? |
• What changes might you make as a result of using the tool? |
In terms of its future use… |
• How would you feel about the practice using it again at a later stage? |
• Would you recommend other practices use it? |
Analysis
Phase one: content analysis
Phase two: qualitative assessment
Implementation outcome | Definition | Theoretical basis |
---|---|---|
Acceptability | Satisfaction with various aspects of the innovation (e.g. content, complexity, comfort, delivery, and credibility). | Concerning the complexity and relative advantage of the intervention where “Complexity” is a measure of the degree to which an innovation is perceived as difficult to understand and use [54] and relative advantage is The degree to which an innovation is perceived as better than the idea it supersedes. |
Appropriateness | Perceived fit; relevance; compatibility; suitability; usefulness; practicability | A measure of the degree to which an innovation is perceived as being compatible with existing values, past experiences, and the needs of potential adopters [54] |
Feasibility | Actual fit or utility; suitability for everyday use; including the ease with which it can be piloted or trialled. | Alongside the concept of compatibility, feasibility also includes Roger’s concept of trialability i.e. the degree to which the innovation may be piloted and modified [54]. |
Results
Phase 1: content analysis
Dimensions of safety culture | PC-SafeQuest | MapSaf | ||
---|---|---|---|---|
Related domain | Specific questions (closed) | Related domain | Specific questions (open) | |
1. Leadership, particularly the support of safe practice | Leadership | Is the hierarchy in the practice a barrier to effective working? Will highlighting a significant event likely result in negative repercussions for the person raising it? Does the practice leadership deal effectively with problem team members? How seriously do senior staff take suggestions that might improve how things are done? Is there a low level of trust between staff members? How frequently do staff disregard rules, protocols and procedures? | Not covered | |
2. Systems, procedures and processes exist that normalise or enshrine patient safety, or which are adhered to | Safety Systems | Are all staff encouraged to highlight significant events? Do practice procedures help to prevent significant events from happening? Does the development of practice protocols use inputs from all staff? Does the practice take the time to formally assess risks (e.g., to patients, colleagues, and to the practice)? Do all staff have the opportunity to participate in the analysis of significant events? Do you think the quality and safety of patient care in your practice is taken seriously? | Not covered | |
3. Resources for safety (such as staffing, equipment, training) | Not covered | Staff education and training about safety issues | How, why and when are education and training programmes about patient safety developed? What do staff think of them? | |
4. The quality of interpersonal relationships (such as teamwork, collaboration within and across units) | Team working | Do all staff treat each other with respect? Do all staff always support one another? Are disagreements amongst staff resolved appropriately? Do staff at all levels within the practice work well together? Is your practice a good place to work? Are staff generally satisfied with their jobs? Is the need to work well as a team promoted by the practice leadership? | Team working around safety issues | How and why are teams developed? How are teams managed? How much team working is there around patient safety issues? |
5. Communication, particularly about safety, including perceptions of being able to report and speak up | Communication | Do all staff at your practice feel free to question the decisions of those with more authority? Are all staff comfortable in expressing concerns to the practice leadership about how things are done in the practice? Is there open communication between colleagues across all levels? Are all staff kept up to date about practice developments? How effectively does the practice leadership communicate its vision for the development of the practice? | Communication about safety issues | What communication systems are in place? What are their features? What is the quality of record keeping to communicate about safety like? |
6. A focus on learning from mistakes, responding and improving systems | Not covered | Perceptions of the causes of PSIs and their identification | What sort of reporting systems are there? How are reports of incidents received? How are incidents viewed, as an opportunity to blame or improve? | |
Investigating PSI incidents | Who investigates incidents and how are they investigated? What is the aim of the organisation? Does the organisation learn from the event? | |||
7. Individual staff characteristics and perceptions of their effect on work (such as job satisfaction, stress) | Workload | Is the performance of staff impaired by excessive workload? Do all staff have enough time to complete tasks safely? Is the level of staffing in the practice sufficient to manage the workload safely? When pressure builds are staff expected to work faster even if it means taking shortcuts? | Not covered | |
8. General awareness of patient safety and/or it being a priority | Not covered | Priority given to patient safety | How seriously is the issue of patient safety taken within the organisation? Where does responsibility lie for patient safety issues? | |
9. Other means of prioritising safety (such as through rewards and incentives) | Not covered | |||
10. Actual safety issues witnessed reported | Not covered | Investigating patient safety issues | Who investigates incidents and how are they investigated? What is the aim of the organisation? Does the organisation learn from the event? |
Phase II: qualitative assessment
Practice characteristics
Practice ID | Tool Used | Number of patients | Number of GPs | Number of nurses | Number of healthcare assistants | Number of admin. staff | Number of managerial staff | Deprivation scorec | Quality Outcomes Frameworkd | Clinical Commissioning Group |
---|---|---|---|---|---|---|---|---|---|---|
01a | PC-SafeQuest MapSaF | 9390 | 7 | 2 | 3 | 18 | 1 | 9 | 988 | Staffordshire Moorlands and Shropshire CCG |
02 | PC-SafeQuest | 6577 | 3 | 3 | 2 | 11 | 1 | 3 | 993 | Staffordshire CCG |
03 | PC-SafeQuest | 12,246 | 7 | 5 | 3 | 12 | 2 | 2 | 989 | Staffordshire CCG |
04 | PC-SafeQuest | 7427 | 5 | 3 | 2 | 7 | 1 | 7 | 996 | Staffordshire Moorlands and Shropshire CCG |
05a | PC-SafeQuest | 6217 | 6 | 3 | 3 | 6 | 1 | 9 | 974 | Staffordshire Moorlands and Shropshire CCG |
06b | PC-SafeQuest MapSaf | 4377 | 3 | 1 | 1 | 4 | 1 | 5 | 987 | Staffordshire CCG |
07a | PC-SafeQuest MapSaf | 9141 | 7 | 4 | 5 | 8 | 2 | 7 | 964 | Staffordshire Moorlands and Shropshire CCG |
08 | PC-SafeQuest | 3919 | 3 | 3 | 0 | 9 | 2 | 6 | 994 | Staffordshire Moorlands and Shropshire CCG |
09 | PC-SafeQuest MapSaf | 11,500 | 5 | 4 | 1 | 12 | 3 | 14 | 995 | Wolverhampton CCG |
Practice-01 | Practice-02 | Practice-03 | Practice-04 | Practice-05 | Practice-06 | Practice-07 | Practice-08 | Practice-09 | Total n | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
MSa | SQa | MS | SQ | MS | SQ | MS | SQ | MS | SQ | MS | SQ | MS | SQ | MS | SQ | MS | SQ | MS | SQ | |
GP | 2 | 1 | 1 | 1 | 1 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 8 | 11 | ||||||
PM | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 2 | 8 | ||||||||
HCA | 1 | 1 | 1 | 1 | 2 | |||||||||||||||
Pharm. | 1 | 1 | ||||||||||||||||||
P Nurse | 1 | 1 | 1 | 1 | 1 | 2 | 3 | |||||||||||||
Admin | 3 | 3 | 5 | 3 | 5 | 4 | 4 | 4 | 2 | 2 | 2 | 2 | 2 | 11 | 30 | |||||
Total | 6 | 5 | 8 | 6 | 7 | 6 | 8 | 8 | 6 | 5 | 4 | 5 | 5 | 25 | 54 |
Acceptability
“Well, they were questions that you actually could give an answer to. It was meaningful – you needed to answer, that they were relevant to the surgery, to you in your role, to you and your workmates, you and the practice. It was short, to the point…” Practice-08, Female
“I think you get a probably more honest answer when people fill in an anonymised questionnaire in their own time, when they’ve got time to think about it. You’re not pressured by a group environment, by time, by peer pressure.” Practice-08, Male
“Because once or twice I found myself – I knew what the answer I wanted was but then I went back and realised I’d done my scoring the wrong way round, it was completely at the other end!” Practice-07, Female
“Might have been nice to have had this before and actually read it and digested it because it’s a lot to take in.” Practice-01, Female
“We marked ourselves down on some things because of the wording, like you were saying ‘electronic’, or ‘the patient involvement in the training’ and all that, and I think it’s the wording around those—because it shouldn’t reflect a mark down really for us—should it? Because we’re just doing it in a different format that better suits the practice?” Practice-07, Female
“It feels like it’s come from business and I don’t think it’s made the transition has it from the business world? It does feel like a ‘Shell’ document still” Practice-05, Male
Appropriateness
“I think it would be quite useful for us… the outcome, you know, what answers came up could be discussed at a practice meeting when everybody’s present, you know? Everybody can have their input and as an add-on to what we would ordinarily do at a practice meeting when we have significant events and all that sort of stuff… I think it would be useful to be used in conjunction with that.” Practice-02, Female
“I think we would have to look at the feedback in different [staff] groups…and so work out ‘how did that happen? Why have we got such different numbers?’ But if actually the practice all came out with very much the same sort of things then you can do a development plan for your whole practice together. So I think it gives you a lot of information…” Practice-09, Female
“Talking to someone from a different clinical area or organisational area was really important because it just gives you that chance to see that other viewpoint and think—‘actually, yeah we might do it particularly well in our area but the rest of the organisation might be doing it really well!’ and it gives you a chance to do that.” Practice- 01, Male
“…you need an external facilitator that says – ‘What made you say that?’ and will actually say to somebody ‘You’ve got licence to talk because I'm asking you!’ “ Practice 09, Female
Feasibility
“It’s good to give you a comparator isn’t it? ‘Where were we last year? Where are we now?’ and ‘Who thinks differently? How is it the clinicians see this different to the non-clinicians? Managers to non-managers?’” Practice-09 Female
“…by involving everyone, you are just doing it as part of that ‘embedding the culture’ because it’s everyone seeing that actually they're totally involved in it you know? It isn't just a clinician, everyone is doing their bit and their bit is important, so whatever you do to a patient is important and it’s [all] part of it and I think that’s really important, quite powerful actually!” Practice-01, Male
“I think it helps you understand ‘what do these things mean?’ Because reading it makes you stop and think about ‘What do I do? How many of these things have I glossed over?’ So just reading in detail… it is learning without even realising you’re learning – so from that point of view I think the practice to be exposed to [it] is good …” Practice-08, Female
“… it is probably an extremely good place to start because I think it’s very comprehensive. I think the problem is it’s far too wordy and far too comprehensive and I don’t think it works well in this particular environment.” Practice-07, Male