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Title: Risk perceptions, decision-making and patient safety in the NHS : a qualitative study
Author: Bennett, Chris
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2019
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Background: Insufficient is known about how individuals perceive, assess, select and act upon specific threats from amongst the multiple hazards in their environments. This study explored these issues through an empirical study of healthcare staff who have a key role to play in recognising, and ameliorating or avoiding risk to their patients' wellbeing. It was hoped that examination of the findings would allow some conclusions to be drawn about the possible impact of the perception of multiple threats on patient safety, improvement of which is a key objective for the NHS. Objectives: The objectives of this study were to explore how healthcare staff perceive and prioritise multiple threats in their working lives, to identify the possible impact of their responses on patient safety, and to increase theoretical understanding of links between multiple risk perception, decision-making and behaviour. Methods: The research involved a qualitative case study of healthcare staff in a single NHS acute hospital trust. Data was collected using participant observation, in depth interviews and a focus group. Preliminary observations took place on 19 wards. Three of these wards were chosen for further observations and 40 ward based healthcare staff were interviewed. In addition 27 other staff who had recorded staff shortages as an adverse event on the hospital database were interviewed retrospectively about the incident and the choices they had made. Finally, a focus group of 19 senior managers was held at the end of a regular meeting to access their views about staffing on wards. Results: Participant healthcare staff identified multiple threats in their working environment, both to others and to themselves. All participants identified reductions in quality of care because of staff shortages as the major threat to patient safety and this threatened participants' self concepts as 'good' nurses. Most saw themselves as unable to change this situation and appeared to tolerate the stress this caused by revising their self concept to see themselves as 'doing their best'. Unexpectedly, those participants who responded to staff shortages by recording an adverse event, did not do so because of a changed assessment of the degree of risk involved but as a sudden emotional reaction to a previously tolerated situation. Conclusions: The findings led to the development of a novel process model of decision-making under risk which may be more widely generalizable.
Supervisor: Lofstedt, Ragnar Ernst Vilhelm ; Rothstein, Henry Frederick Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available