title: Codifying knowledge to improve patient safety: a qualitative study of practice-based interventions.
abstract: Although it is well established that health care professionals use tacit and codified knowledge to provide front-line care, less is known about how these two forms of knowledge can be combined to support improvement related to patient safety. Patient safety interventions involving the codification of knowledge were co-designed by university and hospital-based staff in two English National Health Service (NHS) hospitals to support the governance of medication safety and mortality and morbidity (M&M) meetings. At hospital A, a structured mortality review process was introduced into three clinical specialities from January to December 2010. A qualitative approach of observing M&M meetings (n = 30) and conducting interviews (n = 40) was used to examine the impact on meetings and on front-line clinicians and hospital managers. At hospital B, a medication safety 'scorecard' was administered on a general medicine and elderly care ward from September to November 2011. Weekly feedback meetings were observed (n = 18) and interviews with front-line staff conducted (n = 10) to examine how knowledge codification influenced behaviour. Codification was shown to support learning related to patient safety at the micro (front-line service) level by structuring the sharing of tacit knowledge, but the presence of professional and managerial boundaries at the organisational level affected the codification initiatives' implementation. The findings suggest that codifying knowledge to support improvement presents distinct challenges at the group and organisational level; translating knowledge across these levels is contingent on the presence of enabling organisational factors, including the alignment of learning from clinical practice with its governance.
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK. Electronic address: simon.j.turner@ucl.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Turner
authors.affiliation: 41 Selsdon Road, London, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: Higginson
authors.affiliation: Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Institute of Pharmaceutical Science, King's College London, London, UK.
authors.forename: C Alice
authors.initials: CA
authors.lastname: Oborne
authors.affiliation: Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Thomas
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Angus I G
authors.initials: AI
authors.lastname: Ramsay
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Fulop
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004739:England; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D019359:Knowledge; D007858:Learning; D008505:Medical Staff, Hospital / Q000523:psychology*; D008508:Medication Errors / Q000517:prevention & control; D061214:Patient Safety / Q000592:standards*; D036301:Qualitative Research; D058996:Quality Improvement; D017751:Safety Management / Q000379:methods*; D013222:State Medicine
keywords: Codification; Organisational learning; Patient safety; Quality improvement; Tacit knowledge; UK