Context This was a pilot study in a single department (Paediatric Intensive Care Unit) in a tertiary children’s hospital.
Problem and Assessment of problem and analysis of its causes Safety in healthcare has traditionally focussed on reducing the rates of harm by learning from adverse events. This approach may miss opportunities to learn from episodes of clinical excellence. Furthermore, there is a potential negative impact on staff through the second victim phenomenon, whereby staff involved in adverse events may experience negative emotional consequences (e.g. fear and avoidance).
Safety 2 is an emerging concept, advocating for learning from “what goes right”, rather than “what goes wrong”. Currently, Safety 2 methodology is not well described in healthcare.
Intervention We piloted a system of peer-reporting for episodes of clinical excellence, to identify common themes of excellence practice. The “Learning from excellence” initiative was launched in April 2014 in our PICU. Reporting was accessible to all staff via a simple online form. Excellence was identified by individual reporters: a standardised definition of excellence was not provided.
Study design This is a descriptive study of themes identified from a system of peer-reported excellence in healthcare. All reports were analysed for themes in 2 domains:
Excellent practice (i.e. what was done?)
Strategy for change The project was designed in conjunction with the Trust governance department. An online reporting form was published on the hospital intranet, and the initiative was championed by members of the PICU team. Reported individuals and teams were notified of their excellence citation via email. Briefings with summaries of excellence reports, highlighting learning opportunities are circulated to the department weekly. The next phase is to include the contents of these reports in the educational programme to develop role modelling and emulation of excellent practice. This process is underway at the time of writing.
Measurement of improvement To date, 74 reports have been submitted and analysed. Staff members from every clinical group have contributed to the reporting, and received reports. 19 practice themes and 24 discrete clinical context themes have been identified. Table 1 shows the 10 commonest themes in each domain.
Effects of changes There is a general trend of increasing numbers of reports since launch. The scope of the project is increasing through reporting outside the PICU. This has occurred without external championing, presumably via a “viral” spread.
At the time of writing we have not evaluated staff satisfaction or any impact on clinical metrics. However, the rising frequency of reporting, and the spread outside the unit provides evidence of proof of concept, and acceptance of potential utility.
Lessons learnt Involvement of the Trust governance department allowed us to use an existing infrastructure for reporting, and provided useful insights into safety management.
Championing within the environment of the intervention was essential.
Message for others We have demonstrated that peer-reported excellence can be captured from a wide range of themes and clinical contexts. We intend to use these reports to generate a positive movement to change, to inspire excellent practice through role modelling and emulation.
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