How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application
Creators: name: Van Der Scheer, Jan W.
name: Woodward, Matthew
name: Ansari, Akbar
name: Draycott, Tim
name: Winter, Cathy
name: Martin, Graham
name: Kuberska, Karolina
name: Richards, Natalie
name: Kern, Ruth
name: Dixon-Woods, Mary
name: Sartori, André
name: Paterson, Andy
name: Unger-Lee, Doro
name: Leeding, Joann
name: Steer, Luke
name: Andrews, Amanda
name: Arya, Rita
name: Bell, Sarah F.
name: Chaffer, Denise
name: Cooney, Andrew
name: Davies, Mair G. P.
name: Duffy, Lisa
name: Everden, Caroline
name: Fitzpatrick, Theresa
name: Grant, Courtney
name: Hellaby, Mark
name: Herlihey, Tracey A.
name: Hignett, Sue
name: Hookes, Sarah
name: Ives, Fran R.
name: Jun, Gyuchan T.
name: Marsh, Owen J.
name: Matthews, Tanya R.
name: Merriman, Alexandra
name: Miles, Giulia
name: Millward, Susan
name: Muchatata, Neil
name: Newton, David
name: Noble, Valerie G.
name: Page, Pamela
name: Pargade, Vincent
name: Pickering, Sharon P.
name: Pickup, Laura
name: Richards, Dale
name: Scarr, Cerys
name: Sidhu, Jyoti
name: Stevenson, James
name: Tipney, Ben
name: Tipper, Stephen
name: Wailling, Jo
name: Whalley-Lloyd, Susan P.
name: Wilhelm, Christian
name: Wood, Juliet J.
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: Technical Advance
Study design
Consensus-building
Consensus development
Delphi technique
Best practices
Professional practice
Obstetrics
Postpartum haemorrhage
COVID-19

description: Abstract: 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.