Our aim is to make a significant impact on the safety of patients and well-being of clinical staff, the beneficiaries of our research, by documenting and shaping communication between nurses and surgeons. Our detailed, video-supported observations and analyses of communication in the operating theatre will be used to engage nurses and surgeons in ‘critical cases’ of miscommunication and effective communication in more and less transient teams. Critical cases illustrate patterns of communication in the form of transcripts, video clips, photographs etc., providing a multimodal basis for articulating professional visions and inter-professional learning that can be jointly revisited, scrutinized and evaluated. This approach is aligned with NHS policies aimed at developing a safety and learning culture, i.e. a culture that fosters transparency and accountability (in our case through reflecting and reporting on and sharing clinical experiences) and responsibility (in our case by empowering staff to voice their opinions and concerns). Focusing on rich documentation of critical cases it complements patient safety strategies such as briefings, debriefings and root cause analysis and numerically based research accounts of what goes on in operating theatres. We use critical cases to engage clinicians, at the research site and elsewhere, through the following two pathways.
Pathway to impact I: Engaging clinicians at research site
At our research site engagement activities bring together nurses, surgeons and social scientists so as to build up a dialogue between the various user groups of the study (who constitute distinctly different ‘tribes’). The activities are designed to promote a ‘bottom up’ approach to improvement, turning our research ‘subjects’ into active research participants and allowing for co-production of interpretations of what happened in concrete, contextualized, lived cases (instead of ‘transmitting’ ‘our’ generalized research findings). The critical cases will be discussed at professional meetings (e.g. audit/departmental meetings of nursing staff, surgical research seminars) and in dedicated inter-professional meetings. We anticipate facilitating 5 such engagement activities. The activities will be recorded and evaluated and feed into the analysis and writing up of the critical cases. A key deliverable of the project will be an impact evaluation report, exploring how engagement with critical cases facilitates inter-professional learning within operating teams and identifying the potentialities as well as the limitations (e.g. ethical constraints) of this pathway to impact. The evaluation will be based on qualitative analysis of the video recordings of the activities and on questionnaires filled out after each activity. This pathway will be realized throughout and immediately after the data collection period. The report will be available upon completion of the project.
Pathway to impact II: Engaging clinicians outside research site
While for professionals who do not work at our research site the critical cases do not document their own practices, we expect that they will nonetheless provide a powerful basis for reflection on professional practices and identification of ‘good’ and ‘bad’ practice. To ensure maximum benefit from these materials we will transform the critical cases into a multimedia learning resource which will be freely available on a website that outlives the project (e.g. Imperial College Website, NCRM’s ReStore). Pedagogic guidelines will be written to contextualize and frame the critical cases, detailing how they might be used to collaboratively identify and tackle communication problems affecting patient safety. The evaluation of the engagement activities at our research site will feed into these guidelines. Technical support will be drawn on to edit (and anonymize) relevant video clips. Web statistics will be used to monitor the potential impact of the learning resources. Users will also be given the opportunity to leave comments online. The online resources will be developed in the final 4 months of the project.