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Systems and culture
Deimplementing processes in healthcare: learning from the case of paediatric early warning systems
Background
Paediatric Early Warning (PEW) systems are used in hospitals and other healthcare settings to assist staff with monitoring the signs of clinical deterioration so that they can act fast if someone’s condition is worsening.
A range of PEW systems are used across England. NHS England and the Royal College of Paediatrics and Child Health are introducing a standardised PEW system. Before a new system is put in place, the previous system needs to be deimplemented (in a healthcare context, deimplementation is defined as the process of stopping the use of practices or programmes that are ineffective or harmful).
The aim of this study is to build knowledge about how deimplementation processes happen in healthcare, and what influences them. We are doing this by focusing on learning from case studies and experiences of sites that have deimplemented their existing PEW systems and replaced them with a standardised PEW system.
Approach
This project has been in progress since 2021.
We started by working closely with NHS England to find out key characteristics that we needed to explore when we were looking at deimplementing PEW systems. We then selected four case study sites.
To help us shape the case studies, we talked to patient safety collaboratives and relevant teams from NHS England and then held a workshop that focused onlearning from pilot work. The workshop brought together representatives of organisations involved in the pilot phase to share key learning from the deimplementation experience. This guided the design of data collection tools for the next stages.
We interviewed staff in each case study location after deimplementation, and then after we’d finished collecting data at each site, we held online workshops with each site to explore the emerging themes and reflections about the process.
We then held a final online workshop involving the research team, policy organisations such as NHS England and representatives from case study sites to share emerging findings and to share emerging findings and seek input to refine the analysis and interpret the findings.
The research team are currently analysing the data and plan to publish their findings in an academic journal article.
Funding and ethics
This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute). It is independently led by RAND Europe. The project has been reviewed by RAND Europe’s institutional ethics committee, the RAND Human Subjects Protection Committee (Ref. 2022-N0235, determination provided 19th August 2022). The governance and legal compliance of the study have been assessed and approved by the Health Research Authority (HRA).