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The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice

BACKGROUND: The handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is...

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Autores principales: Grant, Suzanne, Checkland, Katherine, Bowie, Paul, Guthrie, Bruce
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408428/
https://www.ncbi.nlm.nih.gov/pubmed/28449716
http://dx.doi.org/10.1186/s13012-017-0586-8
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author Grant, Suzanne
Checkland, Katherine
Bowie, Paul
Guthrie, Bruce
author_facet Grant, Suzanne
Checkland, Katherine
Bowie, Paul
Guthrie, Bruce
author_sort Grant, Suzanne
collection PubMed
description BACKGROUND: The handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is achieved in everyday practice. This paper ethnographically examines the role of informal dimensions of test results handling routines in the achievement of safety in UK general practice and how these findings can best be developed for wider application by policymakers and practitioners. METHODS: Non-participant observation was conducted of high-volume organisational routines across eight UK general practices with diverse organisational characteristics. Sixty-two semi-structured interviews were also conducted with the key practice staff alongside the analysis of relevant documents. RESULTS: While formal results handling routines were described similarly across the eight study practices, the everyday structure of how the routine should be enacted in practice was informally understood. Results handling safety took a range of local forms depending on how different aspects of safety were prioritised, with practices varying in terms of how they balanced thoroughness (i.e. ensuring the high-quality management of results by the most appropriate clinician) and efficiency (i.e. timely management of results) depending on a range of factors (e.g. practice history, team composition). Each approach adopted created its own potential risks, with demands for thoroughness reducing productivity and demands for efficiency reducing handling quality. Irrespective of the practice-level approach adopted, staff also regularly varied what they did for individual patients depending on the specific context (e.g. type of result, patient circumstances). CONCLUSIONS: General practices variably prioritised a legitimate range of results handling safety processes and outcomes, each with differing strengths and trade-offs. Future safety improvement interventions should focus on how to maximise practice-level knowledge and understanding of the range of context-specific approaches available and the safeties and risks inherent in each within the context of wider complex system conditions and interactions. This in turn has the potential to inform new kinds of proactive, contextually appropriate approaches to intervention development and implementation focusing on the enhanced deliberation of the safety of existing high-volume routines.
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spelling pubmed-54084282017-05-02 The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice Grant, Suzanne Checkland, Katherine Bowie, Paul Guthrie, Bruce Implement Sci Research BACKGROUND: The handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is achieved in everyday practice. This paper ethnographically examines the role of informal dimensions of test results handling routines in the achievement of safety in UK general practice and how these findings can best be developed for wider application by policymakers and practitioners. METHODS: Non-participant observation was conducted of high-volume organisational routines across eight UK general practices with diverse organisational characteristics. Sixty-two semi-structured interviews were also conducted with the key practice staff alongside the analysis of relevant documents. RESULTS: While formal results handling routines were described similarly across the eight study practices, the everyday structure of how the routine should be enacted in practice was informally understood. Results handling safety took a range of local forms depending on how different aspects of safety were prioritised, with practices varying in terms of how they balanced thoroughness (i.e. ensuring the high-quality management of results by the most appropriate clinician) and efficiency (i.e. timely management of results) depending on a range of factors (e.g. practice history, team composition). Each approach adopted created its own potential risks, with demands for thoroughness reducing productivity and demands for efficiency reducing handling quality. Irrespective of the practice-level approach adopted, staff also regularly varied what they did for individual patients depending on the specific context (e.g. type of result, patient circumstances). CONCLUSIONS: General practices variably prioritised a legitimate range of results handling safety processes and outcomes, each with differing strengths and trade-offs. Future safety improvement interventions should focus on how to maximise practice-level knowledge and understanding of the range of context-specific approaches available and the safeties and risks inherent in each within the context of wider complex system conditions and interactions. This in turn has the potential to inform new kinds of proactive, contextually appropriate approaches to intervention development and implementation focusing on the enhanced deliberation of the safety of existing high-volume routines. BioMed Central 2017-04-27 /pmc/articles/PMC5408428/ /pubmed/28449716 http://dx.doi.org/10.1186/s13012-017-0586-8 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Grant, Suzanne
Checkland, Katherine
Bowie, Paul
Guthrie, Bruce
The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice
title The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice
title_full The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice
title_fullStr The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice
title_full_unstemmed The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice
title_short The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice
title_sort role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in uk general practice
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408428/
https://www.ncbi.nlm.nih.gov/pubmed/28449716
http://dx.doi.org/10.1186/s13012-017-0586-8
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