Abstract
BackgroundPractical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements – the changes that need to be made in a healthcare process – remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study.MethodsOrganised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus.ResultsWe gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video.ConclusionsThe proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.
Highlights
Practical methods for facilitating process improvement are needed to support high quality, safe care
We offer an approach for developing specifications for process improvements using rapid, remote, consensus-building methods, and we illustrate it using a case study conducted during the COVID-19 pandemic
A proposed methodological approach for developing specifications for process improvements using rapid, remote, consensus-building methods The approach we propose for rapid consensus-building of process improvement specifications involves five steps, which we have organised into a framework (Table 1)
Summary
Practical methods for facilitating process improvement are needed to support high quality, safe care. Getting clinical guidance into practice is typically complex, requiring multi-modal approaches, and is the subject of a burgeoning science and associated literature [3, 4] It is clear, that the implementation of evidence-based practices (what should be done) depends crucially on process improvement – changes to how things are done [5, 6]. That the implementation of evidence-based practices (what should be done) depends crucially on process improvement – changes to how things are done [5, 6] For this reason, the specification of process improvements (i.e. identifying and defining the changes in processes that need to be made to deliver good care) is a key task. We offer an approach for developing specifications for process improvements using rapid, remote, consensus-building methods, and we illustrate it using a case study conducted during the COVID-19 pandemic
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