How to specify process improvements collaboratively using rapid, remote consensus-building: a framework and case study

van der Scheer, JW, Woodward, M, Ansari, A, Draycott, T, Winter, C, Martin, G, Kuberska, K, Richards, N, Kern, R, Dixon-Woods, M, Thiscovery Authorship Group (Richards, D.) ORCID: https://orcid.org/0000-0002-7176-0440 and Obstetric Emergency Consensus Authorship Group, 2021. How to specify process improvements collaboratively using rapid, remote consensus-building: a framework and case study. BMC Medical Research Methodology, 21: 103. ISSN 1471-2288

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Abstract

Background: Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements – the changes that need to be made in a healthcare process – remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study.

Methods: Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus.

Results: We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video.

Conclusions: The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.

Item Type:	Journal article
Publication Title:	BMC Medical Research Methodology
Creators:	van der Scheer, J.W., Woodward, M., Ansari, A., Draycott, T., Winter, C., Martin, G., Kuberska, K., Richards, N., Kern, R., Dixon-Woods, M., Thiscovery Authorship Group (Richards, D.) and Obstetric Emergency Consensus Authorship Group
Publisher:	BioMed Central Ltd.
Date:	11 May 2021
Volume:	21
ISSN:	1471-2288
Identifiers:	Number Type 10.1186/s12874-021-01288-9 DOI 1396799 Other
Rights:	© the author(s). 2021, corrected publication 2021 (https://doi.org/10.1186/s12874-021-01345-3). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Divisions:	Schools > School of Science and Technology
Record created by:	Jonathan Gallacher
Date Added:	04 Jan 2021 16:48
Last Modified:	24 Nov 2021 11:31
URI:	https://irep.ntu.ac.uk/id/eprint/41940

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