How not to waste a crisis: a qualitative study of problem definition and its consequences in three hospitals

Published in


Martin, G., Ozieranski, P., Leslie, M., & Dixon-Woods, M. (2019). How not to waste a crisis: a qualitative study of problem definition and its consequences in three hospitals. Journal of Health Services Research & Policy

  • 06 March 2019


Why it matters

Despite an increased focus on quality and safety in recent years, certain problems in healthcare get more attention than others.

Efforts to make surgery safer, for example, have led to significant improvements, while safety issues in mental healthcare haven’t seen the same research and policy attention. It remains unclear how healthcare organisations identify problems, define them, prioritise them, and match them with solutions.

So how does a problem of quality or safety become a problem? And what implications does this have for what organisations do about it?

Our approach

Our study looked at three UK hospitals to examine how senior managers came to identify and characterise patient safety problems and organise responses.

We conducted interviews with managers, clinicians and other staff, observed hospital staff on the job, and reviewed relevant hospital documents.

To analyse our findings, we used insights from social and political science literature on how problems get prioritised or marginalised, and looked at how that affected improvement efforts in the three hospitals.

What we found

In each hospital, it took certain triggers to recognise quality and safety problems. And there were key differences in how they defined those problems.

How problems were ‘constructed’ influenced how they were received by frontline staff. It also impacted the perception of who ‘owned’ the problem and who was responsible for improving them.

When trying to engage staff in improvement efforts, it’s important to carefully balance personal accountability, systems improvement, and the use of data and feedback.

Hospital 1

Hospital 2

Hospital 3

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