Black, Georgia;
(2023)
Temporal structures that determine consistency and quality of care: a case study in hyperacute stroke services.
BMJ Quality and Safety
10.1136/bmjqs-2022-015620.
(In press).
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Abstract
Background Temporal structuring is determined by practices and social norms and affects the quality and timing of care. In this case study of hyperacute stroke wards which provide initial stroke investigation, treatment, and care, we explored temporal structuring patterns to explain how these may affect quality of care. Methods This paper presents a thematic analysis of qualitative interviews with hyperacute stroke staff (n=76), non-participant observations (n=41; ~102 hours), and documentary analysis of the relevant service standards guidance. We used an inductive coding process to generate thematic findings around the concept of temporal structuring, with graphically illustrated examples. Results Five temporal structures influence what happens when. (1) Clinical priorities and quality assurance metrics motivate rapid activity for the initial life-prolonging assessments and interventions. (2) Static features of ward organisation such as rotas and ward rounds impact consistency of care, determining timing and quality of care to patients. (3) Some services experimented with staff rotas to try to meet peaks in demand, sometimes unsuccessfully. (4) Implicit social norms or heuristics about perceived necessity affected staff motivation to make changes or improvements to consistency of care, particularly around weekend work. (5) After-effects such as bottlenecks or backlogs affect quality of care, which are hard to measure effectively to drive service improvement. Conclusions Patients need temporally consistent high quality of care. Temporal consistency stems from the design of services, including staffing, targets and patient pathway design as well as cultural attitudes to working patterns. Improvements to consistency of care will be limited without changes to structures such as rotas and ward rounds, but also social norms around weekend work for certain professional groups.
| Type: | Article |
|---|---|
| Title: | Temporal structures that determine consistency and quality of care: a case study in hyperacute stroke services |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1136/bmjqs-2022-015620 |
| Publisher version: | https://doi.org/10.1136/bmjqs-2022-015620 |
| Language: | English |
| Additional information: | © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10170662 |
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