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Patient Safety And Clinical Skills

What we have achieved

• We conducted a review of the existing healthcare literature to identify the common communication-related systems failures and harm typologies reported with specific reference to the management of clinical investigation requests and subsequent results handling. A further aim was to uncover interventions that have been implemented in these areas to improve systems management and mitigate risks.

• Informed by the literature review findings, we also conducted semi-structured/focus group interviews with purposive samples of primary care clinicians, administrative staff, managers and patients to explore common systems-based issues and began to build consensus on what ‘good systems-based practice’ would look like (Figure 1).

• Informed by human factors principles, we undertook process mapping and task analyses exercises in a range of general practices with different results handling systems to identify error potential as well as good practices

• We then drafted Consensus Statements on Standards and further refined these on an iterative basis using consensus building methods (e.g. educational workshops, modified Delphi groups and a content validity index) with at least 4 mixed groups.

• Next we achieved consensus from a Scottish perspective using similar methods with an ‘expert’ group of 15 primary care clinicians and managers who are informed in patient safety and quality improvement.

Figure 1.  Brief outline details of mixed study methods* applied to generate ‘good practice’ statements and achieve expert consensus using a Delphi group and CVI exercise


• Finally we identified and recruited relevant clinical and managerial staff groups in each participating European nation in the LINNEAUS collaboration and repeated the consensus building method using at least two rounds of the modified online Delphi process to gain European agreement and consensus.

• As part of this process we developed, content validated and pilot tested a method to monitor and improve the reliability of practice systems dealing with the management of investigation requests and results (e.g. audit checklist tool).