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A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people

BACKGROUND: The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people. METHODS: A qualitative positive deviance study was co...

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Autores principales: Baxter, Ruth, Taylor, Natalie, Kellar, Ian, Lawton, Rebecca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716359/
https://www.ncbi.nlm.nih.gov/pubmed/30760607
http://dx.doi.org/10.1136/bmjqs-2018-008023
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author Baxter, Ruth
Taylor, Natalie
Kellar, Ian
Lawton, Rebecca
author_facet Baxter, Ruth
Taylor, Natalie
Kellar, Ian
Lawton, Rebecca
author_sort Baxter, Ruth
collection PubMed
description BACKGROUND: The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people. METHODS: A qualitative positive deviance study was conducted on four positively deviant and four slightly-above-average matched comparator wards, which had been identified using routinely collected NHS Safety Thermometer data. In total, 70 multidisciplinary staff participated in eight focus groups to explore staff perceptions about how their teams deliver safe patient care. A thematic analysis was conducted in two stages: first to identify the tools, processes, strategies, and cultural and social contexts that facilitated safety across all wards; and second to generate hypotheses about the characteristics that facilitated ‘positively deviant’ patient care. RESULTS: Based on identifiable qualitative differences between the positively deviant and comparison wards, 14 characteristics were hypothesised to facilitate exceptionally safe care on medical wards for older people. This paper explores five positively deviant characteristics that healthcare professionals considered to be most salient. These included the relational aspects of teamworking, specifically regarding staff knowing one another and working together in truly integrated multidisciplinary teams. The cultural and social context of positively deviant wards was perceived to influence the way in which practical tools (eg, safety briefings and bedside boards) were implemented. CONCLUSION: This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.
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spelling pubmed-67163592019-09-13 A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people Baxter, Ruth Taylor, Natalie Kellar, Ian Lawton, Rebecca BMJ Qual Saf Original Research BACKGROUND: The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people. METHODS: A qualitative positive deviance study was conducted on four positively deviant and four slightly-above-average matched comparator wards, which had been identified using routinely collected NHS Safety Thermometer data. In total, 70 multidisciplinary staff participated in eight focus groups to explore staff perceptions about how their teams deliver safe patient care. A thematic analysis was conducted in two stages: first to identify the tools, processes, strategies, and cultural and social contexts that facilitated safety across all wards; and second to generate hypotheses about the characteristics that facilitated ‘positively deviant’ patient care. RESULTS: Based on identifiable qualitative differences between the positively deviant and comparison wards, 14 characteristics were hypothesised to facilitate exceptionally safe care on medical wards for older people. This paper explores five positively deviant characteristics that healthcare professionals considered to be most salient. These included the relational aspects of teamworking, specifically regarding staff knowing one another and working together in truly integrated multidisciplinary teams. The cultural and social context of positively deviant wards was perceived to influence the way in which practical tools (eg, safety briefings and bedside boards) were implemented. CONCLUSION: This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes. BMJ Publishing Group 2019-08 2019-02-13 /pmc/articles/PMC6716359/ /pubmed/30760607 http://dx.doi.org/10.1136/bmjqs-2018-008023 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0
spellingShingle Original Research
Baxter, Ruth
Taylor, Natalie
Kellar, Ian
Lawton, Rebecca
A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
title A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
title_full A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
title_fullStr A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
title_full_unstemmed A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
title_short A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
title_sort qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716359/
https://www.ncbi.nlm.nih.gov/pubmed/30760607
http://dx.doi.org/10.1136/bmjqs-2018-008023
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