In the name of safety : identifying, understanding and stopping low-value safety practices

Low-value healthcare is a widely recognised problem that detracts from the quality of patient care and places additional pressure on an already over-stretched system. The majority of efforts to identify and remove low-value healthcare practices have focused on clinical practices such as unnecessary tests, treatments and procedures. There is a lack of research that has identified and de-implemented low-value non-clinical practices such as patient safety practices (PSPs) that contribute to the problem of 'safety clutter'. Eliminating PSPs that drain resources and increase the administrative burden on healthcare staff could release time to carry out practices that enhance patient safety. This PhD therefore aimed to understand how to identify and remove low-value PSPs in healthcare settings. An exploratory survey study (Study 1) was carried out, asking healthcare staff to identify practices they perceived to be of low-value for safety. To identify potential practices for de-implementation, the most frequently mentioned PSPs from Study 1 were taken forward to a consultation exercise, during which healthcare professionals rated the practices to determine candidates for de-implementation. A systematic review and meta-analysis (Study 2) was also conducted to understand what types of interventions have been used in the past to de-implement low-value practices in healthcare and what effect they have had on patient safety measures. To explore the potential barriers and facilitators associated with de-implementation, an interview study (Study 3) was carried out, focusing on two PSPs: intentional rounding and double-checking medicines. The final stage of this PhD involved co-designing a de-implementation intervention with stakeholders targeting a specific form of double-checking medicines. Evidence from this thesis provides a novel way of involving healthcare staff in the identification and prioritisation of low-value PSPs for de-implementation. The findings have also contributed to understanding how theory can be applied to develop strategies to overcome challenges to de-implementation.