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Mr Dominic Roche 

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PhD student Dominic Roche
Position:PhD student

Telephone:02920 917819
Location:Room 702a, EastGate House, 35-43 Newport Road, Cardiff CF24 0AB


A realist evaluation of patient involvement in a safer surgery initiative


Dr Aled Jones and Professor Davina Allen


Research has shown that healthcare systems can cause harm to patients, much of which is avoidable, and there is reliable evidence to suggest that this avoidable harm is a widespread and recurring phenomenon (Kohn et al 1999; Department of Health 2000; Leape et al 2002; de Vries et al 2008; W.H.O. 2009; Longtin et al 2010; Jha et al 2010). One particular healthcare improvement strategy aimed at increasing patient safety in hospitals is to involve patients in helping to reduce the risk of this avoidable harm.

This study will focus on attempts to improve patient safety through promoting the involvement of patients in the planning and delivery of surgical care through the Enhanced Recovery After Surgery (ERAS) programme. The broad aim of this study is to explore the extent to which patients are involved in attempts to improve their own healthcare safety, specifically considering the mechanism of effect and investigating the conditions and circumstances that are required for patients’ to adopt safety roles. Following the logic of realist evaluation, the researcher will be asking questions relating to the contextual factors that influence ERAS (or its components) effectiveness in encouraging patient involvement in safety. The analytical challenge of this research is not only to determine whether patient involvement has “worked” or not, but also to find out how attempts at patient involvement are shaped, enabled and constrained by interaction between the context of the programme and the chosen mechanisms of change (Greenhalgh et al 2009).

This research will provide answers to questions regarding how the theories of a programme designed at a national level are interpreted as the programme interventions diffuse within an organisation. The results of the research will add to current understanding of the workings of patient safety and quality improvement policy.