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  • Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory

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    Author(s)
    de Wet, Carl
    Bowie, Paul
    O'Donnell, Catherine A
    Griffith University Author(s)
    de Wet, Carl
    Year published
    2019
    Metadata
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    Abstract
    OBJECTIVES: Patient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting. DESIGN: Qualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT). ...
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    OBJECTIVES: Patient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting. DESIGN: Qualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT). SETTING: Scottish general practice. PARTICIPANTS: We conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland. RESULTS: We identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants' involvement; (3) the characteristics of the reviewers-implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful. CONCLUSIONS: This study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors.
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    Journal Title
    BMJ Open
    Volume
    9
    Issue
    9
    DOI
    https://doi.org/10.1136/bmjopen-2019-029914
    Copyright Statement
    © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions.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/.
    Subject
    Public Health and Health Services
    Clinical Sciences
    Other Medical and Health Sciences
    General Practice
    Patient Safety
    implementation
    normalisation process theory
    patient safety incidents
    Publication URI
    http://hdl.handle.net/10072/387744
    Collection
    • Journal articles

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