School of Medicine, Griffith University, Gold Coast, Queensland, Australia
Patient Safety Research, NHS Education for Scotland, Glasgow, UK.
BMJ Open. 2019 Sep 18;9(9):e029914. doi: 10.1136/bmjopen-2019-029914.
Patient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting.
Qualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT).
Scottish general practice.
We conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland.
We identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants' involvement; (3) the characteristics of the reviewers-implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful.
This study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors.
患者安全是现代卫生系统的一个关键关注点，有许多方法可以支持安全。触发审查方法（TRM）是苏格兰全国推广的一种方法，旨在提高一般医疗实践中的护理安全性。然而，目前尚不清楚哪些因素促进或阻碍了它的实施。本研究的目的是确定在这种情况下促进或阻碍 TRM 实施的重要因素。
采用半结构化访谈的定性研究。数据分析采用正常化过程理论（NPT）进行理论指导。
苏格兰的普通诊所。
我们在苏格兰对普通医生（n=12）、执业护士（n=11）和执业经理（n=5）进行了 28 次半结构化访谈。
我们确定了四个促进或阻碍实施的重要因素：（1）时间和分配资源的数量；（2）将 TRM 整合到现有计划和框架中，促进了实施，并证明了参与者的参与是合理的；（3）审查员的特征-具有领导角色的经验丰富、有反思能力的临床医生促进了实施；（4）参与者对 TRM 的可接受性、可行性和有用性的感知程度。
这项研究是首次尝试调查 TRM 是如何被普通诊所临床医生和工作人员实施和感知的。促进 TRM 实施的四个主要因素与更广泛的实施科学文献相媲美，这表明，如果不是所有的话，大多数复杂的医疗干预措施的成功取决于少数特定因素。这些因素可以通过 NPT 等理论框架来识别、描述和理解，并可以通过干预来改变。研究人员和政策制定者应该主动识别和解决这些因素。
