Medical engagement in organisation-wide safety and quality-improvement programmes: experience in the UK Safer Patients Initiative.

OBJECTIVES To identify factors affecting doctors' engagement with the Safer Patients Initiative (SPI). DESIGN Qualitative interview study. SETTING Four organisations participating in phase 1 of the SPI programme, from four different geographical locations in the UK. PARTICIPANTS 34 staff members, comprising senior executive/management leads involved in the SPI programme, the principal SPI programme coordinator and the operational leads in each of the SPI clinical work areas. MAIN OUTCOME MEASURES Staff perceptions of issues affecting medical engagement with SPI, identified in the interviews. RESULTS Qualitative analysis identified seven factors that were reported to affect medical engagement with the SPI programme: (1) Organisation Track Record in QSI, (2) Resource Availability & Allocation, (3) Perceptions of the purpose of SPI, (4) Evidence of Efficacy of Programme, (5) External Expertise, (6) Local Programme Champions and (7) Managers Involvement. Specific barriers and general enabling strategies were identified and described for each factor, based upon participants' experiences. CONCLUSIONS Medical engagement is a complex technical, socio-political and motivational issue that is underpinned by a series of inter-related factors associated with the organisational context, the design of improvement programmes and how they are implemented and promoted. Healthcare organisations planning to embark on safety and quality-improvement programmes may benefit from systematically addressing the core themes identified by this study, in order to promote optimal medical engagement.