How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application
Authors: van der Scheer Jan W. , Woodward Matthew , Ansari Akbar , Draycott Tim , Winter Cathy , Martin Graham , Kuberska Karolina , Richards Natalie , Kern Ruth , Dixon-Woods Mary ,   Thiscovery Authorship Group, Sartori André , Paterson Andy , Unger-Lee Doro , Leeding Joann , Steer Luke ,   Obstetric Emergency Consensus Authorship Group, Andrews Amanda , Arya Rita , Bell Sarah F. , Chaffer Denise , Cooney Andrew , Corry Rachel , Davies Mair G. P. , Duffy Lisa , Everden Caroline , Fitzpatrick Theresa , Grant Courtney , Hellaby Mark , Herlihey Tracey A. , Hignett Sue , Hookes Sarah , Ives Fran R. , Jun Gyuchan T. , Marsh Owen J. , Matthews Tanya R. , McKeown Celine , Merriman Alexandra , Miles Giulia , Millward Susan , Muchatata Neil , Newton David , Noble Valerie G. , Page Pamela , Pargade Vincent , Pickering Sharon P. , Pickup Laura , Richards Dale , Scarr Cerys , Sidhu Jyoti , Stevenson James , Tipney Ben , Tipper Stephen , Wailling Jo , Whalley-Lloyd Susan P. , Wilhelm Christian , Wood Juliet J. 
Published: May 2021

Background

Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements – the changes that need to be made in a healthcare process – remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study.

Methods

Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus.

Results

We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video.

Conclusions

The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.