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Room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (WAD) and work-as-imagined (WAI) in hospitals

BACKGROUND: Central to Safety-II is promoting resilience of healthcare practices. In the “Room for Resilience” research project we focus on the role of horizontal and vertical accountability in healthcare teams and aim to discover how the relation between the two impacts team reflections and discuss...

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Autores principales: Weenink, Jan-Willem, Tresfon, Jaco, van de Voort, Iris, van Muijden, Teyler, Hamming, Jaap, Bal, Roland
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543860/
https://www.ncbi.nlm.nih.gov/pubmed/37777751
http://dx.doi.org/10.1186/s12913-023-10035-3
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author Weenink, Jan-Willem
Tresfon, Jaco
van de Voort, Iris
van Muijden, Teyler
Hamming, Jaap
Bal, Roland
author_facet Weenink, Jan-Willem
Tresfon, Jaco
van de Voort, Iris
van Muijden, Teyler
Hamming, Jaap
Bal, Roland
author_sort Weenink, Jan-Willem
collection PubMed
description BACKGROUND: Central to Safety-II is promoting resilience of healthcare practices. In the “Room for Resilience” research project we focus on the role of horizontal and vertical accountability in healthcare teams and aim to discover how the relation between the two impacts team reflections and discussions. In this article, we report on an explorative study at the start of the project which aimed to assess the structures and dynamics of horizontal and vertical accountability. METHODS: A qualitative study in six teams in three hospitals in the Netherlands. For the project, each team selected a specific clinical process to work on (e.g. pain assessment). We interviewed healthcare professionals, managers, and quality advisors about these processes, how they are discussed in practice and how teams need to account for them. Additionally, we observed the processes and how teams discuss them in practice. In total, we conducted 35 interviews and 67.5 h of observation. Transcripts and field notes were analyzed using thematic analysis. RESULTS: Professionals at times varied in what they considered the right approach in the clinical process, with differing views on the importance of certain actions. When processes were discussed, this mostly was done during clinical work, and it often concerned reflections about the care for a specific patient instead of reflecting on the team’s general approach of the clinical process. Organized reflections on the processes were sparse. How processes were conducted in practice deviated from guidelines, mainly due to staff shortages, a perceived lack of value of a guideline, equipment issues, and collaboration issues. For most processes, accountability to hierarchical layers consisted of quality indicator scores. Professionals were tasked with registering indicator data but did not find this meaningful for their work. CONCLUSIONS: The observed different perspectives within teams on what good quality care is show the importance of having team reflections about these processes. How vertical accountability was organized at times impacted the conditions for teams to discuss resilient performance. Following these findings, we recommend that reflection on resilient practice and the role of accountability processes is organized on all levels in (and outside) the organization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-10035-3.
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spelling pubmed-105438602023-10-03 Room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (WAD) and work-as-imagined (WAI) in hospitals Weenink, Jan-Willem Tresfon, Jaco van de Voort, Iris van Muijden, Teyler Hamming, Jaap Bal, Roland BMC Health Serv Res Research Article BACKGROUND: Central to Safety-II is promoting resilience of healthcare practices. In the “Room for Resilience” research project we focus on the role of horizontal and vertical accountability in healthcare teams and aim to discover how the relation between the two impacts team reflections and discussions. In this article, we report on an explorative study at the start of the project which aimed to assess the structures and dynamics of horizontal and vertical accountability. METHODS: A qualitative study in six teams in three hospitals in the Netherlands. For the project, each team selected a specific clinical process to work on (e.g. pain assessment). We interviewed healthcare professionals, managers, and quality advisors about these processes, how they are discussed in practice and how teams need to account for them. Additionally, we observed the processes and how teams discuss them in practice. In total, we conducted 35 interviews and 67.5 h of observation. Transcripts and field notes were analyzed using thematic analysis. RESULTS: Professionals at times varied in what they considered the right approach in the clinical process, with differing views on the importance of certain actions. When processes were discussed, this mostly was done during clinical work, and it often concerned reflections about the care for a specific patient instead of reflecting on the team’s general approach of the clinical process. Organized reflections on the processes were sparse. How processes were conducted in practice deviated from guidelines, mainly due to staff shortages, a perceived lack of value of a guideline, equipment issues, and collaboration issues. For most processes, accountability to hierarchical layers consisted of quality indicator scores. Professionals were tasked with registering indicator data but did not find this meaningful for their work. CONCLUSIONS: The observed different perspectives within teams on what good quality care is show the importance of having team reflections about these processes. How vertical accountability was organized at times impacted the conditions for teams to discuss resilient performance. Following these findings, we recommend that reflection on resilient practice and the role of accountability processes is organized on all levels in (and outside) the organization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-10035-3. BioMed Central 2023-09-30 /pmc/articles/PMC10543860/ /pubmed/37777751 http://dx.doi.org/10.1186/s12913-023-10035-3 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Weenink, Jan-Willem
Tresfon, Jaco
van de Voort, Iris
van Muijden, Teyler
Hamming, Jaap
Bal, Roland
Room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (WAD) and work-as-imagined (WAI) in hospitals
title Room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (WAD) and work-as-imagined (WAI) in hospitals
title_full Room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (WAD) and work-as-imagined (WAI) in hospitals
title_fullStr Room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (WAD) and work-as-imagined (WAI) in hospitals
title_full_unstemmed Room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (WAD) and work-as-imagined (WAI) in hospitals
title_short Room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (WAD) and work-as-imagined (WAI) in hospitals
title_sort room for resilience: a qualitative study about accountability mechanisms in the relation between work-as-done (wad) and work-as-imagined (wai) in hospitals
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543860/
https://www.ncbi.nlm.nih.gov/pubmed/37777751
http://dx.doi.org/10.1186/s12913-023-10035-3
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