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Posted Fri, 21 Jan 2011 15:49:56
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Dear Medsoc news
Please could you post this on your mailing list? This is for anyone who
might be interested in applying for a funded PhD in patient safety,
supervised jointly by myself and Prof Della Freeth.
We've been successful in getting a QMUL studentship for this, and are keen
to get some good applicants. The successful candidate will get their fees
paid and a 15K stipend for three years. Details below.
THANKS
Trish Greenhalgh
Full-time PhD Studentship from October 2011
Barts and The London School of Medicine & Dentistry, Queen Mary, University
of London
Three years, home/EU fees paid plus stipend of £15,590 per annum
‘Examining embedded use of the WHO Surgical Safety Checklist’
Apply by 20th February 2011 by following the link at the top of this web
page and searching for vacancy QMUL0313
http://www.smd.qmul.ac.uk/research/studentships/index.html
Interviews: 14th March
Main supervisors: Prof Della Freeth and Prof Trisha Greenhalgh
This project would suit a social science researcher, health services
researcher or a healthcare professional. It is essential to possess a
strong background in qualitative research methods. Synopsis below;
informal enquiries to [log in to unmask]
Title: Examining embedded use of the WHO Surgical Safety Checklist
Need: Patient Safety is a global concern and a high priority for the NHS.
60-80% of medical errors are due to poor communication and half are
avoidable through implementation of safety practices which establish a
safety culture.[i] Protocols and checklists represent one approach to
establishing safety cultures.[ii],[iii] The World Health Organisation
developed a surgical safety checklist[iv] evaluated in an international
study focused on reductions in mortality and post-operative
complications.[v] The UK National Reporting and Learning Service adapted it
and issued guidelines for implementation by February 2010.[vi] NHS trusts
are required to implement the full checklist for every surgical procedure.
Context-specific adaptation was encouraged. However Pronovost3,[vii]
cautions against regarding checklists as a panacea, drawing attention to the
influence and meaning of surrounding processes and cultures; while
Dixon-Woods[viii] notes that establishing a safety culture does not afford a
technical problem, but a site for contested ideas and values. Canadian
research developed and evaluated a surgical checklist focused facilitating
team communication.[ix],[x],[xi] While this work concluded that checklist
briefings reduced the number of communication failures, it also noted that
use of a checklist introduced paradoxical effects that served to inhibit
team process. The embedding of the UK surgical safety checklist should be
expected to be uneven and, unless used mindfully, prone to unintended
consequences or atrophy. NIHR funded an evaluation of the introduction of
the checklist, but not longer-term work. This PHD will address this
significant omission. Senior clinicians and key trusts in three Strategic
Health Authorities are willing to host data collection.
Theoretical orientation: Cultural-historical activity theory (CHAT) is a
framework for analysing and redesigning work and for informing research in
work-based settings.[xii],[xiii] CHAT treats an activity (eg surgical work)
as a social system of necessarily related factors (people working in a
community of practice with rules, roles, artefacts and multiple aims). This
can be viewed as an extended and embodied 'mind'.[xiv] Activity systems are
complex, dynamic and inherently unstable, but held in temporary stability by
a common object of concern (eg safe surgery) and by negotiated use of
artefacts (e.g. protocols). Analysis is anticipated to draw from theories of
sustainability and conflict resolution (e.g. following Lord and Young[xv]).
Data collection: Lightly structured observations and short interviews with
key informants in purposively selected theatre environments. Sampling will
include some operations conducted under local anaesthetic, where checklist
use is intended to include patient input. We aim to conduct post-discharge
telephone interviews with this group of patients. Field notes will be made
in all observation sites and some sites may grant permission for limited
video recording of checklist use. Video recordings will afford the
opportunity for additional structured analysis of communication, using the
Heron framework[xvi]. Once competence is gained real-time structured
observation can occur. Emerging analyses will be discussed with surgical
teams and their insights will guide subsequent cycles of data collection and
analysis.
Practice development: Findings will inform educational interventions to
support more mindful use of the WHO checklist and similar protocols.
References
_____
[i] Kohn, L.T., Corrigan, J. M., & Donaldson, M. S. (Eds.) 2000., To Err is
Human: Building a Safer Health System. Washington DC.: National Academy
Press/ Institute of Medicine.
[ii] Gawande, A. 2009., The Checklist Manifesto: How to Get Things Right.
New York: Metropolitan Books.
[iii] Pronovost, P., Vohr, E., 2010., Safe Patients, Smart Hospitals: How
One Doctor's Checklist Can Help Us Change Health Care from the Inside Out.
New York: Hudson Street Press.
[iv] World Health Organization (WHO): Safe Surgery Saves Lives. 2008.,
Implementation Manual Surgical Safety Checklist. Geneva; WHO Press.
[v] Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., et al.,
2009. A Surgical Safety Checklist to Reduce Mortality and Morbidity in a
Global Population. New England Journal of Medicine, 360, pp. 491-499.
[vi] National Patient Safety Agency (NPSA). 2009.
www.who.int/patientsafety/challenge/safe.surgery/en/
[vii] Bosk CL, Dixon-Woods M, Goeschel CA, Pronovost PJ, 2009. Reality check
for checklists The Lancet, 374, pp.444 - 445
[viii] Dixon-Woods, M., 2010. Why is patient safety so hard?: A selective
review of ethnographic studies. Journal of Health Services Research &
Policy, 15, pp. 11-16.
[ix] Lingard, L., Espin, S., Whyte, S., Regehr, G., Baker, G. R., Reznick,
R., et al., 2004., Communication failures in the operating room: an
observational classification of recurrent types and effects. Quality &
Safety in Health Care, 13, pp. 330-334.
[x] Lingard, L., Regehr, G., Espin, S., & Whyte, S., 2006., A theory-based
instrument to evaluate team communication in the operating room: balancing
measurement authenticity and reliability. Quality & Safety in Health Care,
15, pp. 422-426.
[xi] Lingard, L., Regehr, G., Orser, B., et al., 2008., Evaluation of a
preoperative checklist and team briefing among surgeons, nurses, and
anesthesiologists to reduce failures in communication. Archives of Surgery,
143, pp. 12-18
[xii] Engeström, Y., 2000. Activity theory as a framework for analyzing and
redesigning work. Ergonomics, 43, pp. 960-974.
[xiii] Engeström, Y., 2008. From Teams to Knots. Cambridge: Cambridge
University Press.
[xiv] Clark, A., 2008., Supersizing the Mind: Embodiment, Action, and
Cognitive Extension. Oxford: Oxford University Press.
[xv] Lord M, Young G 2008 Curriculum development for interprofessional
learning, pp. 69-86 in Howkins E, Bray J Preparing for Interprofessional
teaching: theory and practice, Abingdon: Radcliffe.
[xvi] Heron, J., 2001., Helping the Client: A Creative, Practical Guide, 5th
ed., London: Sage
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