title: Management of major trauma: changes required for improvement.
abstract: OBJECTIVE
  To describe the views of key healthcare professionals on the changes they considered to be important in the reduction of major trauma mortality between 1988 and 1995 in Leeds.
  
  
  METHODS
  Qualitative unstructured interviews with a purposive sample of 10 healthcare professionals deemed to be key personnel by an experienced consultant who had provided acute trauma care throughout the relevant period. Each interview was tape recorded and transcribed; each transcript was analysed for important themes by two independent researchers who then discussed their results to resolve any differences in interpretation.
  
  
  RESULTS
  Three categories of change became evident: "policy", "infrastructure", and "philosophy of care". Each of these categories seemed to be equally important. Policy changes identified as important were the Royal College of Surgeons of England's report into trauma care (1988), the setting of standards for paramedic training, and the national audit of major trauma outcomes. Important infrastructure changes identified were training in advanced trauma life support, decreased ambulance response times, reorganisation towards "consultant led" hospital services, and an emphasis on quality monitoring. Changes in philosophy of care were increases in levels of teamwork, commitment, communication, and confidence. Together these facilitated an overall restructuring and refocusing of care.
  
  
  CONCLUSIONS
  No individual change is seen as dominant for improved care, but rather a strategic mixture of facilitating national and regional policy guidance, organisational restructuring, and congruent professional attitudes were integral components leading to the observed changes. Improving outcomes in other areas is likely to involve an integrated series of changes which must be managed as a total system.
authors.affiliation: Centre for Research in Primary Care, Nuffield Institute for Health, Leeds, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dyas
authors.forename: P
authors.initials: P
authors.lastname: Ayres
authors.forename: M
authors.initials: M
authors.lastname: Airey
authors.forename: J
authors.initials: J
authors.lastname: Connelly
mesh_terms: D001291:Attitude of Health Personnel; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D004635:Emergency Medicine / Q000592:standards*; D004739:England / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D012109:Research Support as Topic; D017749:Total Quality Management / Q000379:methods*; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*