Abstract
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.