Exploring how feedback for emergency ambulance service staff promotes workforce wellbeing and patient safety

Extensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital care has been relatively neglected. Exploratory work suggests feedback and follow-up for emergency ambulance staff might provide closure and improve clinical performance. This PhD explored how feedback for emergency ambulance service staff promotes workforce wellbeing and patient safety. Drawing upon evidence from implementation science and organisational psychology, four research studies were conducted: a qualitative interview study (Study 1), a systematic review and meta-analysis (Study 2), a realist evaluation of current practice (Study 3) and a mixed-methods diary study (Study 4). Analysis of the qualitative interviews in Study 1 facilitated the development of a typology of prehospital feedback, including patient outcome feedback (‘follow-up’), on-scene advice, peer-to-peer feedback, post-event debriefing, patient-reported experience feedback, clinical performance feedback (‘audit and feedback’) and feedback from incident reporting. Applying this typology to the systematic review findings in Study 2 revealed that the published prehospital literature included predominantly audit and feedback-type initiatives. Overall, the meta-analysis suggested that prehospital feedback has a moderate positive effect on the quality of care and professional development but did not reveal any studies evaluating the impact of prehospital feedback on staff wellbeing. The realist evaluation of current practice in Study 3 suggested that feedback in clinical practice focused predominantly on patient follow-up initiatives and suggested mechanisms of action by which prehospital feedback works. The analysis of diary entries in Study 4 supported the positive effects from the meta-analysis but also included positive outcomes on staff wellbeing and highlighted a subset of patients and staff for which prehospital feedback should be enhanced to improve clinical decision-making and staff wellbeing. Further research and clinical practice change should draw upon existing theories to support more robust intervention development and evaluation of prehospital feedback.