Contextualising risk, reducing harm. How do quality dashboards influence care delivery within hospital wards? A realist evaluation

In response to patient safety concerns, a number of NHS hospitals have developed and implemented quality dashboards. The aim of this research was to examine how quality dashboards influence care delivery within hospital wards. Methods: A literature and scoping review were used to develop the initial theories to explain how quality dashboard influence care. These theories were refined using a realist interview technique with 11 stakeholders. Three case study sites were selected according to their dashboard performance and a mixed method approach was used to gather data to test the refined theories. In total 30 staff and 6 visitors were interviewed, 18 hours of non-participant observation of a patient safety board, safety huddles and handovers were undertaken and a review of 3 years outcome data were used to test the theories. Findings: The evaluation found ward leaders play an important role in promoting staff engagement with quality dashboards and are responsible for developing strategies to improve performance. Staff were more likely to change practice if the information from the dashboard was seen as important, meaningful and given with a specific focus for change. While staff enjoyed receiving positive performance information, change was more likely in response to performance data that caused dissonance. During the periods of observation a total of 123 staff and 72 visitors were observed walking past a patient safety board displaying information from a QD. During this time 0 staff and 9 visitors were seen interacting with the board. Conclusion: The three interrelated programme theories of Importance, Disruption and Avoidance could be used to explain why and how quality dashboards influence care delivery within hospital wards. The evidence suggests, best practice guidance to support ward managers to use QD information should be developed, information from QD should be incorporated into daily team discussions, auditors should engage with staff during the audit visit as outcomes are triggered by disruption rather than compliance, regular updates to the standards and metrics is needed and where possible QD data should be automatically generated to remove the risk of auditor bias. In conclusion, contextualising QD data has the potential to reduce harm.