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BACKGROUND Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). METHODS Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies,(More)
BACKGROUND Quality improvement collaboratives (QICs) continue to be widely used, yet evidence for their effectiveness is equivocal. We sought to explain what happened in Stroke 90:10, a QIC designed to improve stroke care in 24 hospitals in the North West of England. Our study drew in part on the literature on collective action and inter-organizational(More)
BACKGROUND Walkrounds, introduced as Leadership (or Executive) WalkRounds, are a widely advocated model for increasing leadership engagement in patient safety to improve safety culture, but evidence for their effectiveness is mixed. In the English National Health Service (NHS), hospitals have been strongly encouraged to make use of methods closely based on(More)
OBJECTIVES We aimed to evaluate whether a large-scale two-phase quality improvement programme achieved its aims and to characterise the influences on achievement. SETTING National Health Service (NHS) in England. PARTICIPANTS NHS staff. INTERVENTIONS The programme sought to (1) develop a shared national, regional and locally aligned safety focus for 4(More)
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