title: Rapid response systems and collective (in)competence: An exploratory analysis of intraprofessional and interprofessional activation factors.
abstract: The rapid response system (RRS) is a patient safety initiative instituted to enable healthcare professionals to promptly access help when a patient's status deteriorates. Despite patients meeting the criteria, up to one-third of the RRS cases that should be activated are not called, constituting a "missed RRS call". Using a case study approach, 10 focus groups of senior and junior nurses and physicians across four hospitals in Australia were conducted to gain greater insight into the social, professional and cultural factors that mediate the usage of the RRS. Participants' experiences with the RRS were explored from an interprofessional and collective competence perspective. Health professionals' reasons for not activating the RRS included: distinct intraprofessional clinical decision-making pathways; a highly hierarchical pathway in nursing, and a more autonomous pathway in medicine; and interprofessional communication barriers between nursing and medicine when deciding to make and actually making a RRS call. Participants also characterized the RRS as a work-around tool that is utilized when health professionals encounter problematic interprofessional communication. The results can be conceptualized as a form of collective incompetence that have important implications for the design and implementation of interprofessional patient safety initiatives, such as the RRS.
authors.affiliation: Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa , Ottawa , Canada .
authors.forename: Simon
authors.initials: S
authors.lastname: Kitto
authors.forename: Stuart Duncan
authors.initials: SD
authors.lastname: Marshall
authors.forename: Sarah E
authors.initials: SE
authors.lastname: McMillan
authors.forename: Bill
authors.initials: B
authors.lastname: Shearer
authors.forename: Michael
authors.initials: M
authors.lastname: Buist
authors.forename: Rachel
authors.initials: R
authors.lastname: Grant
authors.forename: Monica
authors.initials: M
authors.lastname: Finnigan
authors.forename: Stuart
authors.initials: S
authors.lastname: Wilson
mesh_terms: D001315:Australia; D002983:Clinical Competence; D003142:Communication; D003299:Cooperative Behavior; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration*
keywords: Case study; collective competence; focus groups; interprofessional collaboration; rapid response system; socio-cultural factors