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Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for heart failure patients at hospital discharge
Marques, Iuri Ismail, Hanif Armitage, Gerry R. Blenkinsopp, Alison
Marques, Iuri
Ismail, Hanif
Armitage, Gerry R.
Blenkinsopp, Alison
Publication Date
2019-02
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(c) 2019 The Authors. This is an Open Access article distributed under the Creative Commons CC-BY license (https://creativecommons.org/licenses/by/4.0/)
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openAccess
Accepted for publication
24/10/2018
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Abstract
Poor medicines management places patients at risk, particularly during care transitions. For
patients with heart failure (HF), optimal medicines management is crucial to control
symptoms and prevent hospital readmission. This study explored the concept of resilience
using HF as an example condition to understand how the system compensates for known
and unknown weaknesses.
We explored resilience using a mixed-methods approach in four healthcare economies in the
north of England. Data from hospital site observations, healthcare staff and patient
interviews, and documentary analysis were collected between June 2016 and March 2017.
Data were synthesised and analysed using framework analysis.
Interviews were conducted with 45 healthcare professionals, with 20 patients at three timepoints
and 189 hours of observation were undertaken. We identified four primary inter-related themes concerning organisational resilience. These were named as gaps, traps,
bridges and props. Gaps were discontinuities in processes that had the potential to result in
poorly optimised medicines. Traps were features of the system that could produce errors or
unintended adverse medication events. ‘Bridges’ were features of the medicines
management system that promoted safety and continuity which ensured that, despite
varying conditions, care could be delivered successfully. ‘Props’ were informal, temporary or
impromptu actions taken by patients or healthcare staff to avoid potential adverse events.
The numerous opportunities for HF patient safety to be compromised and sub-optimal
medicines management during this common care transition are mitigated by system
resilience. Cross-organisational bridges and temporary fixes or ‘props’ put in place by
patients and carers, healthcare teams and organisations are critical for safe and optimal care
to be delivered in the face of continued system pressures.
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Citation
Fylan B, Marques I, Ismail H et al (2019) Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines
management system for heart failure patients at hospital discharge. BMJ Open. 9(2): e023440.
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