User redesign, testing and evaluation of the Monitoring Risk and Improving System Safety (MoRISS) checklist for the general practice work environment

Bowie, P., de Wet, C., Crickett, T., McCulloch, J., Young, P., Freestone, J., Watson, P., Houston, N., Gillies, J. and McNab, D. (2020) User redesign, testing and evaluation of the Monitoring Risk and Improving System Safety (MoRISS) checklist for the general practice work environment. BMJ Open Quality, 9(4), e000977. (doi: 10.1136/bmjoq-2020-000977) (PMID:33184042) (PMCID:PMC7662415)

Abstract

Background: Inadequate checking of safety-critical issues can compromise care quality in general practice (GP) work settings. Adopting a systemic, methodical approach may lead to improved standardisation of processes and reliability of task performance, strengthening the safety systems concerned. This study aimed to revise, modify and test the content and relevance of a previously validated safety checklist to the current GP context. Methods: A multimethod study was undertaken in Scottish GP involving: consensus building workshops with users and ‘experts’ to revise checklist content; regional testing of the modified checklist and follow-up usability evaluation survey of users. Quantitative data underwent descriptive statistical analyses and selected survey free-text comments are presented. Results: A redesigned checklist tool consisting of eight themes (eg, medication safety) and 61 items (eg, out-of-date stock is appropriately disposed) was agreed by 53 users/experts with items reclassified as: mandatory (n=25), essential (n=24) and advisory (n=12). Totally 42/55 GPs tested the tool and submitted checklist data (76.4%). The mean aggregated results demonstrated 92.0% compliance with all 61 checklist items (range: 83.0%–98.0%) and 25/42 GP managers responded to the survey (59.5%) and reported high mean levels of agreement on the usefulness of the checklist (77.0%), ease of use (89.0%), learnability (94.0%) and satisfaction (78.4%). Conclusions: The checklist was comprehensively redesigned as a practical safety monitoring and improvement tool for potential implementation in Scottish GP. Testing and evaluation demonstrated high levels of checklist content compliance and strong usability feedback, but some variation was evident indicating room for improvement in current safety-critical checking processes. The checklist should be of interest in similar GP settings internationally and to other areas of primary care practice.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: De Wet, Carl and Bowie, Dr Paul
• Authors: Bowie, P., de Wet, C., Crickett, T., McCulloch, J., Young, P., Freestone, J., Watson, P., Houston, N., Gillies, J., and McNab, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: BMJ Open Quality
• Publisher: BMJ Publishing Group
• ISSN: 2399-6641
• ISSN (Online): 2399-6641
• Published Online: 12 November 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in BMJ Open Quality 9(4): e000977
• Publisher Policy: Reproduced under a Creative Commons License