Background Despite significant attention to safety and quality in healthcare over two decades, patient harm in hospitals remains a challenge. There is now growing emphasis on continuous quality improvement, with approaches that engage front-line staff. Our objective was to determine whether a novel approach to reviewing routine clinical practice through structured conversations—map-enabled experiential review—could improve engagement of front-line staff in quality improvement activities and drive improvements in indicators of patient harm.
Methods Once a week over a 10-month period, front-line staff were engaged in 35 min team-based conversations about routine practices relating to five national safety standards. Structure for the conversations was provided by interactive graphical logic maps representing each standard. Staff awareness of—and attitudes to—quality improvement, as well as their perceptions of the intervention and its impact, were canvassed through surveys. The impact of the intervention on measures of patient safety was determined through analysis of selected incident data reported in the hospital’s risk management system.
Results The map-enabled experiential review approach was well received by staff, who reported increased awareness and understanding of national standards and related hospital policies and protocols, as well as increased interest in quality issues and improvement. The data also indicate an improvement in quality and safety in the two participating units, with a 34% statistically significant decrease in the recorded incident rates of the participating units relative to the rest of the hospital for a set of independently recorded incidents relating to patient identification.
Discussion This exploratory study provided promising initial results on the feasibility and effectiveness of map-enabled experiential review as a quality improvement approach in an acute clinical setting.
Cohen, D. R., Cohen, P. J. and Anderson, V. (2018) ‘Map-enabled experiential review: A novel approach to engaging healthcare staff in quality improvement’, Management in Healthcare, 3(2), pp. 187-198.
A common barrier to continuous and sustainable improvement in many organisations is the lack of staff engagement with quality improvement. In the healthcare sector, the failure to engage staff with quality has been associated with preventable patient harm, which persists despite more than two decades of emphasis on safety and quality in this sector. This paper describes a novel approach — map-enabled experiential review (MEER) — that has significant potential to address staff engagement issues and produce meaningful improvement outcomes. The MEER approach uses map-based simulation of organisational processes to enable structured conversations among staff about their daily implementation of those processes as a means of identifying and addressing latent safety threats and other areas for improvement.
Cohen, D. R., Cohen, P. J., Anderson, V., Goodarz, M., Dillon, K., Weidemann, K. E. (2018) ‘Implementation of the Best Practice Clinical Learning Environment Framework: A case study for improving learning in the clinical setting using a novel quality improvement approach’, Management in Healthcare, 3(1), pp. 24–40.
High-quality healthcare requires a highly skilled and well-trained workforce, and consequently, there is growing interest in the pathways and processes by which clinicians are trained. In 2008, the Victorian Department of Health and Human Services commissioned a project to investigate the nature of successful clinical placements, through which learners undertake experiential learning in clinical settings. That project resulted in the development of the Best Practice Clinical Learning Environment (BPCLE) Framework. In 2013, statewide implementation of the framework commenced using a novel approach to quality improvement, termed map-enabled experiential review (MEER). The MEER approach uses map-based simulation of organisational processes to facilitate structured conversations among staff about their daily implementation of those processes. Feedback on the use of MEER from staff involved in framework implementation indicated that the approach was well received by end users, while, most importantly, data collected through MEER assessments revealed that implementation of the BPCLE Framework results in improvements to the clinical learning environment.