The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice
Abstract 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 sa...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | Implementation Science |
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| Online Access: | http://link.springer.com/article/10.1186/s13012-017-0586-8 |
| _version_ | 1828743664634953728 |
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| author | Suzanne Grant Katherine Checkland Paul Bowie Bruce Guthrie |
| author_facet | Suzanne Grant Katherine Checkland Paul Bowie Bruce Guthrie |
| author_sort | Suzanne Grant |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-13T01:41:56Z |
| format | Article |
| id | doaj.art-5a6dc1f3b55e4a5fbedf55d59051ebee |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-04-13T01:41:56Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-5a6dc1f3b55e4a5fbedf55d59051ebee2022-12-22T03:08:09ZengBMCImplementation Science1748-59082017-04-0112111210.1186/s13012-017-0586-8The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practiceSuzanne Grant0Katherine Checkland1Paul Bowie2Bruce Guthrie3Population Health Sciences, School of Medicine, University of DundeeHealth Policy, Politics and Organisation (HiPPO) Research Group, Centre for Primary Care, Institute of Population Health, University of ManchesterNHS Education for ScotlandPopulation Health Sciences, School of Medicine, University of DundeeAbstract 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.http://link.springer.com/article/10.1186/s13012-017-0586-8Test results handlingGeneral practicePrimary careOrganisational routinesSafetyEthnography |
| spellingShingle | Suzanne Grant Katherine Checkland Paul Bowie Bruce Guthrie The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice Implementation Science Test results handling General practice Primary care Organisational routines Safety Ethnography |
| 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 | Test results handling General practice Primary care Organisational routines Safety Ethnography |
| url | http://link.springer.com/article/10.1186/s13012-017-0586-8 |
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