Dixon-Woods Mary, Campbell Anne, Aveling Emma-Louise, Martin Graham
THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0AH, UK.
Faculty of Medicine, Imperial College London, London, SW7 2AW, UK.
Wellcome Open Res. 2019 Dec 16;4:203. doi: 10.12688/wellcomeopenres.14993.1. eCollection 2019.
Large-scale data collection is an increasingly prominent and influential feature of efforts to improve healthcare delivery, yet securing the involvement of clinical centres and ensuring data comprehensiveness often proves problematic. We explore how improvements in both data submission and completion rates were achieved during a crucial period of the evolution of two large-scale data exercises. As part of an evaluation of a quality improvement programme, we conducted an ethnographic study involving 90 interviews and 47 days of non-participant observation of two UK national clinical audits in a period before submission of data on adherence to clinical standards became mandatory. Critical to the improvements in submission and completion rates in the two exercises were the efforts of clinical leaders to refigure "data work" as a professionalization strategy. Using a series of strategic manoeuvres, leaders constructed a cultural account that tied the fortunes of the healthcare professions to the submission of high-quality data, proposing that it would demonstrate responsibility, transparency, and alignment with the public interest. In so doing, clinical leadership deployed tactics that might have been seen as unwarranted managerial aggression had they been imposed by parties external to the profession. Many residual challenges were linked not to principled objection by clinicians, but to mundane problems and frustrations in obtaining, recording, and submitting data. The cultural framing of data work as a professional duty was important to resolving its status as an abject form of labour. Improving data quality in large-scale exercises is possible, but requires cooperation with clinical centres. Enabling professional leadership of data work may offer some significant advantages, but attention is also needed to mundane and highly consequential obstacles to participation in data collection.
大规模数据收集是改善医疗服务工作中一个日益突出且具有影响力的特征，但要确保临床中心的参与并保证数据的全面性往往存在问题。我们探讨了在两项大规模数据工作演变的关键时期，是如何提高数据提交率和完成率的。作为对一项质量改进计划评估的一部分，我们开展了一项人种志研究，在提交关于遵守临床标准的数据成为强制性要求之前的一段时间里，对两项英国国家临床审计进行了90次访谈和47天的非参与式观察。两项工作中提交率和完成率的提高，关键在于临床领导者将“数据工作”重塑为一种职业化策略的努力。领导者通过一系列战略行动，构建了一种文化观念，将医疗行业的命运与高质量数据的提交联系起来，提出这将展示责任感、透明度并符合公共利益。这样做时，临床领导力所采用的策略，如果是由行业外部的各方强加的，可能会被视为无端的管理侵犯。许多遗留的挑战并非与临床医生的原则性反对有关，而是与获取、记录和提交数据时的日常问题和挫折有关。将数据工作文化构建为一项职业责任，对于解决其作为一种低贱劳动形式的地位很重要。在大规模工作中提高数据质量是可能的，但需要与临床中心合作。让数据工作由专业人员领导可能会带来一些显著优势，但也需要关注参与数据收集的日常且影响重大的障碍。
