from embracing to managing risks - electronic whiteboard cost

Abstract objective to evaluate the development trend of obtaining, managing and using quality and safety information in managing hospital services.
Four National Health Service hospitals have been set up in the UK.
Participant 111.
The observation time of the hospital board of directors and the board meeting was 5 hours, and the Ward observation time was 72 hours.
Conduct 86 interviews with board and middle management, as well as ward managers and staff.
The results began with a low base, and during the period 2013 to 2016 there was a significant improvement in the quantity and quality of data produced for the board and middle management.
All four hospitals have data warehouses deployed to manage data sets from different departmental systems.
Three of them deployed real-
Time ward management system widely used by nurses and other staff.
Conclusion The results of the survey, especially with the actual deployment
The time Ward management system is a correction of many negative descriptions of information technology implementation.
The hospital information infrastructure, which is an element of broader action, is no longer dependent on individual professionals to make judgments, but to turn to teams --based and data-
A driving approach to active risk management.
However, they did not use their fine
Develop fine-grained data for ultra-secure work practices.
Objective to evaluate the time development of obtaining, managing and using quality and safety information in managing hospital services.
Four National Health Service hospitals have been set up in the UK.
Participant 111.
The observation time of the hospital board of directors and the board meeting was 5 hours, and the Ward observation time was 72 hours.
Conduct 86 interviews with board and middle management, as well as ward managers and staff.
The results began with a low base, and during the period 2013 to 2016 there was a significant improvement in the quantity and quality of data produced for the board and middle management.
All four hospitals have data warehouses deployed to manage data sets from different departmental systems.
Three of them deployed real-
Time ward management system widely used by nurses and other staff.
Conclusion The results of the survey, especially with the actual deployment
The time Ward management system is a correction of many negative descriptions of information technology implementation.
The hospital information infrastructure, which is an element of broader action, is no longer dependent on individual professionals to make judgments, but to turn to teams --based and data-
A driving approach to active risk management.
However, they did not use their fine
Develop fine-grained data for ultra-secure work practices.
Background a series of reports published since the millennium junction highlighted the quality and safety of acute hospital services in many countries.
1-3 while there is evidence of improvements in focused initiatives, it is generally believed that there is still considerable room for better quality and safer services in general.
Over the past 15 years, these issues have generated a range of proposed responses.
A recurring theme concerns the need for hospital cultural change, away from "blame culture", and cultural change where employees are confident to report mistakes and be able to learn from them.
Our interest in this article is in another
Long-term proposal for investment in information technology (IT)
Infrastructure to facilitate access, analysis and use of data on the quality and safety of services.
7-9 in any hospital, the implementation of the proposal involves significant changes in work practices.
Staff in wards and departments will obtain data electronically rather than paper.
Hospitals need employees with the skills required to design and deploy IT systems, manage and interpret clinical data, and support data clinical teams
Promote the improvement plan.
This is a considerable challenge in practice.
Many IT investments, including the high-profile HITECH program in the United States and national health services (NHS)
The uk it country program has encountered problems in the implementation and daily use of wards and departments.
10 11 there is also evidence that hospitals may lack the ability to analyze or learn from quality and safety data collected by wards and departments.
For every leading site, there are other sites that still face challenges.
Despite this evidence, hospitals in the NHS continue to invest in IT systems, including real-time systems—
Once the data is captured, the data is widely available
Manage the ward.
They also seek to improve the number and scope of data to support more effective service governance, which has been facilitated by a range of policies and reports since 2008.
14 15 during the 2013-2016 period, we studied the development of data and IT infrastructure in four acute NHS hospitals in the UK.
We are particularly interested in whether and how they affect patient risk management.
Vincent and Amalberti16 describe three main methods.
The first is based on the judgment of individual health professionals to respond when risks arise.
The second is the team change.
The team proactively manages the work of patient risk.
In the third approach that resonates with some quality improvement methods, hospitals use data to analyze their work practices and "design out" risks, creating an ultra-safe environment.
There are two issues involved in this article.
First, how do hospitals develop information infrastructure to obtain and use data on the quality and safety of services?
Second, how do they use the data generated to monitor and manage quality and safety?
We conclude that an effective infrastructure is being developed in acute hospitals
Time management and quality and safety management supervision of the ward.
This is part of a broader transition, no longer relying on the judgment of individual physicians and other professionals, but instead shifting to a model in which the clinical team actively manages risks.
Methods the method of manual biography was adopted.
The IT system in the organization has developed for many years, usually piecemeal.
Add new features on a regular basis and link to existing systems for infrastructure-
Combine some systems with the work practices of people who use them
Developed over time.
Adding new systems in increments;
Users can adapt to them for a long time and deeply integrate into daily life. to-
The daily work of the organization.
If we want to know why systems are being used today, then we need to know their history.
In addition, since these infrastructure is developed in different ways in different parts of the organization, it is necessary to study them in multiple places --
Where there may be changes in interests.
In multi-site longitudinal case studies, images of ways in which observations are used to build infrastructure and more widely organize mutual adaptation over time.
A field survey was conducted at four acute NHS hospitals, each with a pseudonym to promote anonymity: solo, duo, Trio and quadruple.
Through a telephone survey of 15 acute hospitals in the fall of 2014, these locations were identified and recruited.
Sampling is both purposeful and pragmatic.
This is for a purpose as we are trying to recruit a real hospital that has been deployed
Or have a formal implementation plan.
This is pragmatic because we can only choose from the sites included in the survey, all of which are within a reasonable travel distance from our research base and are willing to participate.
In accordance with the established ethnographic approach, we attach particular importance to direct observation of participants' work practices.
Between May 2015 and July 2016, 18 board-level quality meetings and board meetings were held at all four locations (see table 1).
At all meetings, a team member took notes of the time and recorded them as soon as practicable.
We also have semi-structuredto-
Interviewed between April 2015 and September 2016 to explore the views of senior managers and board managers and members of the informatics and information team on the development and use of their hospital information infrastructure, including the development of the first two years of 2015 (see table 2).
20-22 view this table: view the opinions of the meeting by location (hours)
View this table: View the inline View pop-up table 2 interviews conducted with live/agent and public participation. The study, which has a patient and public engagement team, provides advice on our field survey methodology and comments on the findings and their interpretation.
They are not involved in recruitment or research.
Monthly Meeting of the hospital board of directors: Analysis of papers every three months (
April, July, October and January)
During the period from April 2013 to 2016, trends in the quantity and content of quality and safety data provided were identified.
Data on mortality, reported incidents and complaints, vital signs, pain management, nutritional status and NHS safety thermometers are used as tracking tools.
21 observations were also conducted in two wards of each hospital.
During field work, regular observation of the morning handover meeting and the use of the electronic whiteboard within 30-60 minutes after the meeting. (
The electronic whiteboard is a large screen, usually mounted on a wall near the nurse station and displays summary details for each patient. )
A detailed simultaneous recording of staff practices, with a particular focus on the use of whiteboards, is an external representation of ward-level information infrastructure.
We are also interested in more common sources of information and use, including the "soft intelligence" discussed during the handover process ".
In addition, observers occasionally ask staff to explain their "on-site" actions when it seems important to study, for example, why the handover meeting took so long to discuss a specific topic.
Conduct semi-structured interviews with Ward clinical managers and staff. Five cross-site accounts—mini-biographies—
Development of the work of the board of directors quality committee, information and Informatics Group, Board of Directors (
Sometimes referred to as a clinical or business unit)
And the ward team (
Focus on nursing staff but include junior doctors and consultants).
The analytical strategy is ethnography.
Data from direct observations are used to develop an initial schedule for each environment in each hospital.
Publicly encode interview records and develop narrative accounts using coding materials.
23 then compare and contrast these accounts and integrate them to provide an overall narrative for each scenario.
Patient and Public Participation in this study there is a patient and public participation Group that advises on all aspects of our field survey methodology and comments on the findings and their interpretation.
They are not involved in recruitment or research.
Monthly Meeting of the hospital board of directors: Analysis of papers every three months (
April, July, October and January)
During the period from April 2013 to 2016, trends in the quantity and content of quality and safety data provided were identified.
Data on mortality, reported incidents and complaints, vital signs, pain management, nutritional status and NHS safety thermometers are used as tracking tools.
21 observations were also conducted in two wards of each hospital.
During field work, regular observation of the morning handover meeting and the use of the electronic whiteboard within 30-60 minutes after the meeting. (
The electronic whiteboard is a large screen, usually mounted on a wall near the nurse station and displays summary details for each patient. )
A detailed simultaneous recording of staff practices, with a particular focus on the use of whiteboards, is an external representation of ward-level information infrastructure.
We are also interested in more common sources of information and use, including the "soft intelligence" discussed during the handover process ".
In addition, observers occasionally ask staff to explain their "on-site" actions when it seems important to study, for example, why the handover meeting took so long to discuss a specific topic.
Conduct semi-structured interviews with Ward clinical managers and staff. Five cross-site accounts—mini-biographies—
Development of the work of the board of directors quality committee, information and Informatics Group, Board of Directors (
Sometimes referred to as a clinical or business unit)
And the ward team (
Focus on nursing staff but include junior doctors and consultants).
The analytical strategy is ethnography.
Data from direct observations are used to develop an initial schedule for each environment in each hospital.
Publicly encode interview records and develop narrative accounts using coding materials.
23 then compare and contrast these accounts and integrate them to provide an overall narrative for each scenario.
Results The overall trend of hospital internal development is the integration of technical infrastructure, or two parallel and loosely coupled infrastructure.
24 The first involves deploying real-
Time ward management system.
These systems are either developed as discrete systems and are then gradually associated with other systems (Trio)
Or an integral part of an electronic health record program (Soloand Duo).
The second development focus is the data warehouse.
These computer servers hold a range of data sets from "real-time" systems, including real-time for new deployments
Use the time system with the patient management system, pathology and other departmental systems.
Warehouse is constantly updated-
According to the system involved, up to 15 minutes per day
But it is separate from the "real-time" system used by wards and departments.
They are used to manage data, including validation of data sets, writing of regular reports, and creation of off-site data
A report of the quality committee and other committees. Real-
The time Ward management system squartet did not deploy the system during the study.
Three other hospitals have been deployed successfully.
Among the three projects, it was mainly designed by the local information team and ward nurses, and the direct participation of medical staff was less.
The design process is iterative.
Some respondents described it as agile
As the informatics team used the production versions for "pilots", Ward employees Fed back the versions, resulting in design modifications until the employees were satisfied with the systems.
Junior doctors, nurses and health care assistants (HCAs)
Capture data by the bed using a tablet or laptop.
The three hospitals have some data in common, especially nursing observations used to calculate national early warning scores (NEWS)
Scoring automatically.
All three were able to plan alerts for future care tasks, following a set of observations or the next risk assessment.
The primary physician uses the device to view clinical data, including test and scan results.
Overall, clinical staff are positive about tablets and laptops.
At Duo, for example, a nurse and a junior doctor told us separately: If we answer a phone call, we can update any information here immediately so that we can see it directly on the whiteboard, the doctor can see right away and all the teams can see that if anyone asks us any questions, we get all the information. (Ward nurse)
I don't have to go to the doctor's office if I need to check something [and]
Take a look at the doctor's notes and have everything here, so I know if they took the test or not. (
Two, junior doctor)
However, some problems have also been noted.
One is that there is too little equipment in some wards.
The other involves the difficulties encountered when the system crashes.
The system is not frequent or lasts for a long time, but there is a problem when it is turned off: if the screen is turned off, you cannot see the patient's obs [observations]
Expired, what they used to be, or what. (
Ward nurse trio)
During the entire observation period, an electronic whiteboard located within or near the Ward station was used to view the ward-
Extensive data from Duo and Trio are "surprising ".
Nurses, HCAs and doctors use them to check the time of the patient's next observation and to check their location when the patient enters the ward.
A sister in the Ward observed that you have such a big thing to tell you . . . . . . You can see people's blood pressure drop . . . . . . We just know better. I just think it's really good. (
Three sisters ward)
During the observation period, there was no substantial change in usage.
In contrast, Solo's clinicians told us that the staff did not look at the whiteboard often because most of the data (
(News, risk and nutrition)
Copy on their laptop and delivery order and use it before the electronic whiteboard arrives.
Square wall-mounted dry-
Wipe the whiteboard in the whole study.
Their use, primarily to identify the key clinical risks of each patient using magnet symbols, has not changed.
Nursing handover and other meetings-
Time systems are designed and deployed in a wider information environment --
Intensive flow of wards.
Work practices, especially in handover and patient safety, are stable in the course of the study: we have found no evidence that these techniques disrupt clinical work.
In four hospitals, similar data were used for handover and crowding throughout the observation period.
For example, in Solo, throughout the course of the study, the nurses who started the shift had a printed paper delivery form that included a summary of the patient's history, dietary information, patient assessment (Risk of fall)
Current drugs and news
The staff also discussed the information that is not available on the delivery order, such as the work that needs to be done (
Change dressing)
Or how the patient feels (
A patient was doing well, but he reported that he was not feeling well. .
The development of conventional data infrastructure has substantially developed in the infrastructure of all four hospitals dealing with conventional data, and they report that these infrastructure began in 2011 or 2012.
Respondents noted that the hospital has collected and submitted a large amount of data to national institutions since 1980;
They re-used some of these data for internal management reports.
These changes are reflected in the development of the data size and scope of the board quality committee reported.
Three of the four boards in April 2013
Reports received by the first-level quality committee show a trend towards a limited number of regular data items on 1-2 pages of paper.
Trio's report is longer, more than 30 pages long, showing a trend of more indicators.
By October 2016, all four hospitals had submitted detailed reports showing a large number of indicators, usually on pages 60-100, with dozens of charts, charts and tables.
The reasons for these changes include the hope to solve long-term problems.
Long-term issues of data credibility
By creating a "single source of truth"
And the board's recognition of the importance of monitoring quality and safety.
The data in the report is managed by the hospital information team.
Several of our respondents commented that many indicators are important.
Number of incidents, hospital deaths, etc.
It was argued that this was largely due to the long-term focus on activity data by state agencies, and that the data was available to hospitals.
At the same time, in the course of the study, the number of "narrative reports" that combine regular data on specific topics with text comments has increased.
For example, the monitoring of complaints :. . . . . . Before we really measure the speed at which complaints are reversed . . . . . . [now]
We reported the turnaround time and theme . . . . . . Are we responding correctly?
If not, why not?
. . . . . . So this is a huge shift for us in terms of reducing complaints and how our team manages complaint responses. (
Members of the quartet quality Committee)
These developments are not without cost.
There are some comments about the time the information team has to spend on validating the data and making the report.
For example, a significant amount of effort must be put into each month to collect and collate NHS security thermometer data authorized by the state, although most of the data has been recorded in patient notes and Datix (
Systems widely used to record event information).
One respondent pointed out :. . . . . . 20 days in a month of one person's work . . . . . . The current 18 days are about data verification . . . . . . We must reduce this day to three or four days. (
Joint lead)
Board of Directors Committee: detailed "information package" in committee documents and use and value of data in documents on specific topics (
Trends in mortality and initiatives to reduce the incidence of pressure sore)
It was widely used throughout the observation period.
The quality committee uses data for performance management, assurance, identifying organizational risks and identifying opportunities for service improvement.
When non--, the value of the data is highlighted
It is used by executive directors to challenge executives.
At Solo, for example, they question the value of receiving data from serious events that occurred months ago, and question the statement "What will we do", wondering how improvements can be achieved and measured.
The data in the report is not the only source of information for senior management.
The respondents told us that during the period from 2014 to 2016, many introduced additional strategies for gathering intelligence.
These measures include a weekly meeting where staff can ask any questions or concerns to the chief nurse and the medical director. Non-
Executives also often "walk" in the ward: you do a triangle measurement of what you receive [
In the report of the board of directors]
What people actually say and talk about. (
Members of the quartet quality Committee)
Members of the board's quality committee said they believe that governance of service quality and safety has improved over time.
In Solo: compared to our previous situation, it is now a kind of trust.
Francis, in terms of the quality and quantity of the information we get, our position is much higher.
You can always ask for more. (
Member of the personal quality Committee)
Again, in Trio :. . . . . . Because we have access to this information, for example, to be able to detect the location of deterioration in the ward . . . . . . Faster . . . . . . We can respond and take steps to restore this position. (
Senior nurse manager)Real-
The time Ward management system squartet did not deploy the system during the study.
Three other hospitals have been deployed successfully.
Among the three projects, it was mainly designed by the local information team and ward nurses, and the direct participation of medical staff was less.
The design process is iterative.
Some respondents described it as agile
As the informatics team used the production versions for "pilots", Ward employees Fed back the versions, resulting in design modifications until the employees were satisfied with the systems.
Junior doctors, nurses and health care assistants (HCAs)
Capture data by the bed using a tablet or laptop.
The three hospitals have some data in common, especially nursing observations used to calculate national early warning scores (NEWS)
Scoring automatically.
All three were able to plan alerts for future care tasks, following a set of observations or the next risk assessment.
The primary physician uses the device to view clinical data, including test and scan results.
Overall, clinical staff are positive about tablets and laptops.
At Duo, for example, a nurse and a junior doctor told us separately: If we answer a phone call, we can update any information here immediately so that we can see it directly on the whiteboard, the doctor can see right away and all the teams can see that if anyone asks us any questions, we get all the information. (Ward nurse)
I don't have to go to the doctor's office if I need to check something [and]
Take a look at the doctor's notes and have everything here, so I know if they took the test or not. (
Two, junior doctor)
However, some problems have also been noted.
One is that there is too little equipment in some wards.
The other involves the difficulties encountered when the system crashes.
The system is not frequent or lasts for a long time, but there is a problem when it is turned off: if the screen is turned off, you cannot see the patient's obs [observations]
Expired, what they used to be, or what. (
Ward nurse trio)
During the entire observation period, an electronic whiteboard located within or near the Ward station was used to view the ward-
Extensive data from Duo and Trio are "surprising ".
Nurses, HCAs and doctors use them to check the time of the patient's next observation and to check their location when the patient enters the ward.
A sister in the Ward observed that you have such a big thing to tell you . . . . . . You can see people's blood pressure drop . . . . . . We just know better. I just think it's really good. (
Three sisters ward)
During the observation period, there was no substantial change in usage.
In contrast, Solo's clinicians told us that the staff did not look at the whiteboard often because most of the data (
(News, risk and nutrition)
Copy on their laptop and delivery order and use it before the electronic whiteboard arrives.
Square wall-mounted dry-
Wipe the whiteboard in the whole study.
Their use, primarily to identify the key clinical risks of each patient using magnet symbols, has not changed.
Nursing handover and other meetings-
Time systems are designed and deployed in a wider information environment --
Intensive flow of wards.
Work practices, especially in handover and patient safety, are stable in the course of the study: we have found no evidence that these techniques disrupt clinical work.
In four hospitals, similar data were used for handover and crowding throughout the observation period.
For example, in Solo, throughout the course of the study, the nurses who started the shift had a printed paper delivery form that included a summary of the patient's history, dietary information, patient assessment (Risk of fall)
Current drugs and news
The staff also discussed the information that is not available on the delivery order, such as the work that needs to be done (
Change dressing)
Or how the patient feels (
A patient was doing well, but he reported that he was not feeling well. .
The development of conventional data infrastructure has substantially developed in the infrastructure of all four hospitals dealing with conventional data, and they report that these infrastructure began in 2011 or 2012.
Respondents noted that the hospital has collected and submitted a large amount of data to national institutions since 1980;
They re-used some of these data for internal management reports.
These changes are reflected in the development of the data size and scope of the board quality committee reported.
Three of the four boards in April 2013
Reports received by the first-level quality committee show a trend towards a limited number of regular data items on 1-2 pages of paper.
Trio's report is longer, more than 30 pages long, showing a trend of more indicators.
By October 2016, all four hospitals had submitted detailed reports showing a large number of indicators, usually on pages 60-100, with dozens of charts, charts and tables.
The reasons for these changes include the hope to solve long-term problems.
Long-term issues of data credibility
By creating a "single source of truth"
And the board's recognition of the importance of monitoring quality and safety.
The data in the report is managed by the hospital information team.
Several of our respondents commented that many indicators are important.
Number of incidents, hospital deaths, etc.
It was argued that this was largely due to the long-term focus on activity data by state agencies, and that the data was available to hospitals.
At the same time, in the course of the study, the number of "narrative reports" that combine regular data on specific topics with text comments has increased.
For example, the monitoring of complaints :. . . . . . Before we really measure the speed at which complaints are reversed . . . . . . [now]
We reported the turnaround time and theme . . . . . . Are we responding correctly?
If not, why not?
. . . . . . So this is a huge shift for us in terms of reducing complaints and how our team manages complaint responses. (
Members of the quartet quality Committee)
These developments are not without cost.
There are some comments about the time the information team has to spend on validating the data and making the report.
For example, a significant amount of effort must be put into each month to collect and collate NHS security thermometer data authorized by the state, although most of the data has been recorded in patient notes and Datix (
Systems widely used to record event information).
One respondent pointed out :. . . . . . 20 days in a month of one person's work . . . . . . The current 18 days are about data verification . . . . . . We must reduce this day to three or four days. (
Joint lead)
Board of Directors Committee: detailed "information package" in committee documents and use and value of data in documents on specific topics (
Trends in mortality and initiatives to reduce the incidence of pressure sore)
It was widely used throughout the observation period.
The quality committee uses data for performance management, assurance, identifying organizational risks and identifying opportunities for service improvement.
When non--, the value of the data is highlighted
It is used by executive directors to challenge executives.
At Solo, for example, they question the value of receiving data from serious events that occurred months ago, and question the statement "What will we do", wondering how improvements can be achieved and measured.
The data in the report is not the only source of information for senior management.
The respondents told us that during the period from 2014 to 2016, many introduced additional strategies for gathering intelligence.
These measures include a weekly meeting where staff can ask any questions or concerns to the chief nurse and the medical director. Non-
Executives also often "walk" in the ward: you do a triangle measurement of what you receive [
In the report of the board of directors]
What people actually say and talk about. (
Members of the quartet quality Committee)
Members of the board's quality committee said they believe that governance of service quality and safety has improved over time.
In Solo: compared to our previous situation, it is now a kind of trust.
Francis, in terms of the quality and quantity of the information we get, our position is much higher.
You can always ask for more. (
Member of the personal quality Committee)
Again, in Trio :. . . . . . Because we have access to this information, for example, to be able to detect the location of deterioration in the ward . . . . . . Faster . . . . . . We can respond and take steps to restore this position. (
Senior nurse manager)
The focus of this study is big-
Over time, the information infrastructure has been expanded to provide the basis for its implementation and use.
We found that two different information structures are developing: one is to use real information.
Time data and other review data.
Summarize review data into management reports for routine review of quality and safety;
This helps rationalize the management and use of the different data sets generated so far across the hospital.
Difficulties faced by the Quartet --
The time system reminds us that these developments are far from simple.
The main advantages of this study come from the scope of field work and the use of evidence from three different sources --
Observation, interview and document analysis of work practice.
These findings complement findings from sociological studies of board members and clinicians responsible for quality and safety.
26 27 they usually have nothing to say about the information used by clinicians and managers, how the information is generated, or how they use it to provide information for their deliberations.
The main weakness of this study is the weakness usually associated with the design of this study;
We were unable to assess the outcome of the patient, the observation time was limited and therefore the subsequent development could not be captured.
The availability of board data has changed significantly --
Between 2013 and 2016, committees and middle-level managers at all levels.
Our findings suggest that data on the quality and safety of services are used in all four hospitals.
Routine data were rarely received in 2013, so committees that had to rely on the oral report of the meeting and informal communication were making extensive use of the data to review performance in 2015 and 2016.
This did not lead to the abandonment of less formal management strategies: in fact, they also increased during the study, reflecting the hospital's increased emphasis on quality and safety.
28 The findings are a correction to many negative descriptions of IT --
The basic deployment of the hospital indicates that the hospital is undergoing two major changes.
First, NHS hospital managers have long had to rely on financial and activity data.
Since 2013, managers have increasingly been provided with retrospective reports on a range of quality and safety measures and have used them to monitor performance.
Three of the four hospitals also have a wide range of entities
Time data system to provide effective daysto-
Daily control of quality and safety.
Some respondents stressed that they had problems managing the credibility of the data in the past.
Therefore, it is generally accepted that the accuracy of routine quality and safety data indicates that people's attitudes and ways of working have changed dramatically.
Second, all four hospitals are transforming their clinical risk and hazard management methods.
From the security framework of Vincent and Amalberti, hospitals are moving away from risk --
In the case of relying on the judgment and response strategies of individual health professionals --
Move forward to the model of ward team actively managing risks.
We believe that an effective information system is a prerequisite for active management.
Less optimistic, there is limited evidence that the hospital is moving towards the third approach by Vincent and amberti, in which the hospital uses data to "design" risks,
Environmental safety.
The last question arises: why is the hospital not using data to create an ultra-secure environment?
The findings suggest a possible explanation that data collection is essentially determined by the regulator pursuing its purpose, and that hospitals have limited resources to access and use data for their own purposes.
If the latter is the key data for quality improvement, hospital efforts will be hampered by limited resources.
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Football contributors JK, AL, RR, EM, CG, SW and JW conceived the study and worked out an agreement.
Field surveys were conducted by JK, EN, northwest and AL, and they were analyzed with RR.
All authors have contributed to the drafting of this article.
The study was funded by research on NIHR health services and delivery (HS&DR)
Project Programme 13/07/68.
The points and opinions expressed in the disclaimer are the author's views and opinions and do not necessarily reflect the views and opinions of the HS & DR program, the National Institutes of Health, the National Health Service or the Ministry of Health.
No one declared a competitive interest.
Patient consent is not required.
The Medical and Health Ethics Committee of the University of Leeds received ethical approval.
Uncommissioned source and peer review;
External peer review.
There is no other data available for the data sharing statement.