Abstract
Research on patient safety campaigns has mostly concentrated on large-scale multi-organisation efforts, yet locally led improvement is increasingly promoted. The purpose of this paper is to characterise the design and implementation of an internal patient safety campaign at a large acute National Health Service hospital trust with a view to understanding how to optimise such campaigns. The authors conducted a qualitative study of a campaign that sought to achieve 12 patient safety goals. The authors interviewed 19 managers and 45 frontline staff, supplemented by 56 hours of non-participant observation. Data analysis was based on the constant comparative method. The campaign was motivated by senior managers' commitment to patient safety improvement, a series of serious untoward incidents, and a history of campaign-style initiatives at the trust. While the campaign succeeded in generating enthusiasm and focus among managers and some frontline staff, it encountered three challenges. First, though many staff at the sharp end were aware of the campaign, their knowledge, and acceptance of its content, rationale, and relevance for distinct clinical areas were variable. Second, the mechanisms of change, albeit effective in creating focus, may have been too limited. Third, many saw the tempo of the campaign as too rapid. Overall, the campaign enjoyed some success in raising the profile of patient safety. However, its ability to promote change was mixed, and progress was difficult to evidence because of lack of reliable measurement. The study shows that single-organisation campaigns may help in raising the profile of patient safety. The authors offer important lessons for the successful running of such campaigns.
Highlights
Health systems worldwide face challenges in ensuring the delivery of safe, high-quality care (Wachter, 2010); adverse event studies indicate that approximately 5%-10% of hospitalised patients in high-income countries experience harm, and about one third of harmful events are preventable (Vincent, Neale and Woloshynowych, 2001, Baker et al, 2004, Thomas et al, 2000, Baines et al, 2013)
We present a qualitative study of one organisation’s patient safety campaign
How to design and run patient safety campaigns so that they deliver on their goals is an important question (Vincent, 2010)
Summary
Health systems worldwide face challenges in ensuring the delivery of safe, high-quality care (Wachter, 2010); adverse event studies indicate that approximately 5%-10% of hospitalised patients in high-income countries experience harm, and about one third of harmful events are preventable (Vincent, Neale and Woloshynowych, 2001, Baker et al, 2004, Thomas et al, 2000, Baines et al, 2013). Though no consensual definition of campaigns exists, they are generally characterised by their purposeful attempts to achieve planned effects in their target audiences within a specific time period using organised communication (McQuail, 2010) They have been a feature of patient safety improvement efforts since the early 2000s, with the US “100,000 Lives” campaign (Berwick et al, 2006) an early example. Research on patient safety campaigns has typically focused on large-scale, multi-organisation efforts, including the US “Door to Balloon” campaign (Krumholz et al, 2008), the UK “cleanyourhands” campaign (Stone et al, 2012) the German hand hygiene campaign (Reichardt et al, 2013), and the international “Surviving Sepsis” campaign (Levy et al, 2012) Studies of these campaigns have offered important lessons for those seeking to undertake improvements across multiple organisations. Some of the advantages of large-scale campaigns include their ability to create conditions known to be important to achieving change on a large-scale, including developing and standardising technical interventions(Pronovost et al, 2009), establishing data collection systems, mobilising peer norms and competitive pressures across different organisations, sharing learning, and providing the infrastructure for improvement (Dixon-Woods et al, 2011, Dixon-Woods, McNicol and Martin, 2012, Aveling et al, 2012b)
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