BMJ Open Quality最新文献

{"title":"Quality improvement in maternity care: insights from system integration simulations.","authors":"Fatemah Qasem","doi":"10.1136/bmjoq-2024-003204","DOIUrl":"10.1136/bmjoq-2024-003204","url":null,"abstract":"<p><p>This report summarises the implementation of system integration simulations conducted prior to the transfer of clinical care at a newly established 789-bed maternity hospital transitioning from a 400-bed facility, highlighting key findings and actionable insights. The simulations focused on critical scenarios involving elective and emergency caesarean sections, aiming to enhance operational readiness and patient safety. Results indicate significant improvements in communication, staffing, logistics and equipment management were required and subsequently implemented prior to transfer of clinical care. These findings serve as a blueprint for establishing best practices in maternity care transitions, setting a new standard for operational excellence and patient safety.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the utility of texting in the ambulatory care of paediatric patients with type 1 diabetes: a quality improvement report.","authors":"Eiko Waida, Susi Wilkinson, Madison Brauer","doi":"10.1136/bmjoq-2024-003114","DOIUrl":"10.1136/bmjoq-2024-003114","url":null,"abstract":"<p><strong>Introduction: </strong>Type 1 diabetes (T1D) is a chronic and costly disease that is often diagnosed in childhood. Achieving excellent glycaemic control during this period requires attention to multiple factors. Advances in technology now allow clients (patients/family members) to fine-tune their insulin delivery, necessitating support from highly skilled nurses, dietitians and physicians (clinicians). Despite quarterly team-based appointments, interim issues and questions often arise, and families may not always reach out for support. The incidence of T1D is rising, and yet barriers exist to expanding the clinical team. Additionally, clinicians are not necessarily colocated, making timely and efficient communication challenging. We postulated that offering texting as a communication modality would increase client interactions by 20%, and that clients and clinicians would find it a desirable tool in the delivery of efficient and timely ambulatory care.</p><p><strong>Methods: </strong>A prospective interventional quality improvement project was conducted between July 2022 and August 2023. Baseline data were obtained for the number of interactions. Parents, caregivers and age-appropriate patients were then registered onto the texting platform (N=125) and received a weekly check-in message. The number of interactions and clinical time spent texting and providing care because of a text interaction were collected.</p><p><strong>Results: </strong>There were approximately 30 interactions per week, an increase of >2300%. The average additional clinical time required was 56 min per week (average of 30 s/interaction). Qualitatively, 100% of our clients expressed a desire to continue texting with the team. 97% of clients felt that texting was an important way for them to contact their diabetes team. Our clinicians also wished to continue texting, valuing the improved efficiency of communication and experiencing a greater degree of connection with their clients.</p><p><strong>Conclusions: </strong>Texting is a welcome modality of communication between clients and their clinical care team in the setting of ambulatory T1D care, resulting in increased engagement.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same-day discharge pathway for elective total hip and knee arthroplasty patients: a quality improvement project at a Canadian community hospital.","authors":"Tim Kostamo, Jennifer Watters, Brittany Spence, Reza Faraji, Janice Eng, Michele Montgomery","doi":"10.1136/bmjoq-2024-003170","DOIUrl":"10.1136/bmjoq-2024-003170","url":null,"abstract":"<p><p>Total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgeries performed annually are increasing, with over $1.26 billion in hospital costs, according to the 2021/2022 Canadian Institute of Health Information report. A trend towards same-day surgery has helped support the rising demand for arthroplasty in an ageing population and has established evidence for patient safety and satisfaction.Burnaby Hospital sought to develop a same-day pathway to increase at-home recovery opportunities and associated recovery benefits. The aim was to increase the same-day discharge (SDD) rate for THA and TKA from 8% to 15% within a 12-month period.The project team used the Model for Improvement framework to guide the team in achieving the project aim. A series of Plan-Do-Study-Act cycles and ramps were conducted on five interventions: screening tool, focused arthroplasty same-day track automatisation, surgical and anaesthesia standardisation and patient education resources.The health authority's electronic health records (MEDITECH) were used to extract 18 months of baseline data. The data analysis software (SQCPack) was used to monitor the data throughout the project to assess its progress. The results of the SDD rate increased from 8% to 20% with a success rate of 82% SDD, while achieving a decrease in readmission rates to 4-7% from a baseline average of 7-8%. There was no increase in emergency room visits and readmission within 30 days for SDD when compared with the standard inpatient cases. Both staff and patients reported high levels of satisfaction.Driven by a working group creates success with clear goals, strong departmental collaboration, and substantial stakeholder and leadership support. The team viewed failures as learning opportunities to adapt new Plan-Do-Study-Act cycles and strategies for developing continuous improvement throughout the project's life cycle. Process automation was key for a sustainable path for improvements; this provided resiliency against changes from external and staffing pressures.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using quality improvement methodology to reduce Did Not Attends in healthcare within a UK prison.","authors":"Nitish Lakhman, Suzan Harleston, Emma Knight, Charlie Bodnar, Francesca Addis, Vishal Bheenick","doi":"10.1136/bmjoq-2024-003183","DOIUrl":"10.1136/bmjoq-2024-003183","url":null,"abstract":"<p><strong>Background: </strong>His Majesty's Prison East Sutton Park is an open prison and young offender institution for women in Maidstone, England. In 2022, it developed a high Did Not Attend (DNA) rate of 21% per week across all five core healthcare clinics. Services with a high DNA rate increase waiting times for other patients, increase cost wastage and reduce efficiency and resource management. DNAs occur across all parts of the National Health Service with different levels of severity; however, DNAs within a prison create a unique challenge not shared with community services due to the setting. This quality improvement project aimed to reduce and sustain a below 10% DNA rate.</p><p><strong>Methods: </strong>The healthcare team worked in partnership with the prison to develop a quality improvement project using the Model for Improvement, which had a clear aim, measures and change ideas tested using Plan-Do-Study-Act cycles. The outcome measures were plotted using Statistical Process Control charts to highlight and track the improvements.</p><p><strong>Results: </strong>There was an 86% decrease in DNAs across all five core healthcare clinics. The overall DNA rate was reduced from a pre-intervention rate of 21% per week to 3% per week post-intervention. Clinical time wasted decreased by 76% from a pre-intervention of 284 minutes per week to 66 minutes per week post-intervention. Cost wastage for missed appointments decreased by 67% from a pre-intervention of £303 per week to £99 per week post-intervention. These core outcome measures have been sustained for more than 35 weeks (August 2023 to April 2024) and continue to be sustained.</p><p><strong>Conclusions: </strong>Implementing standard processes and systematic change ideas, including developing partnership working with the prison and better engagement with patients, led to a significant and sustained reduction in DNAs. During the project time frame, there was also no change in the number of patient complaints about healthcare.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosing diagnostic error of endometriosis: a secondary analysis of patient experiences from a mixed-methods survey.","authors":"Allyson C Bontempo, Gordon D Schiff","doi":"10.1136/bmjoq-2024-003121","DOIUrl":"10.1136/bmjoq-2024-003121","url":null,"abstract":"<p><strong>Objective: </strong>To analyse endometriosis diagnostic errors made by clinicians as reported by patients with endometriosis.</p><p><strong>Methods: </strong>This study deductively analysed qualitative data as part of a larger mixed-methods research study examining 'invalidating communication' by clinicians concerning patients' symptoms. Data analysed were responses to an open-ended prompt asking participants to describe an interaction with a clinician prior to their diagnosis in which they felt their symptoms were dismissed. We used three validated taxonomies for diagnosing diagnostic error (Diagnosis Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC) and generic diagnostic pitfalls taxonomies).</p><p><strong>Results: </strong>A total of 476 relevant interactions with clinicians were identified from 444 patients to the open-ended prompt, which identified 692 codable units using the DEER taxonomy, 286 codable units using the RDC taxonomy and 602 codable diagnostic pitfalls. Most prevalent subcategories among these three taxonomies were inaccurate/misinterpreted/overlooked critical piece of history data (from DEER Taxonomy; n=291), no specific diagnosis was ever made (from diagnostic pitfalls taxonomy; n=271), and unfamiliar with endometriosis (from RDC Taxonomy; n=144).</p><p><strong>Conclusion: </strong>Examining a series of patient-described diagnostic errors reported by patients with surgically confirmed endometriosis using three validated taxonomies demonstrates numerous areas for improvement. These findings can help patients, clinicians and healthcare organisations better anticipate errors in endometriosis diagnosis and design and implement education efforts and safety to prevent or mitigate such errors.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing clinical recruitment rate to a single-site observational study: a quality improvement study.","authors":"Hayley Macleod, Nadine Copty, Damien Doherty, Robbie Power, Kate Ahearne, Niamh Ryan, Khalid Saeed, Ellen O'Rourke, Rehman Faryal, Luisa Weiss, Sarah Kelliher, Barry Kevane, Patricia Maguire, Fionnuala Ni Ainle","doi":"10.1136/bmjoq-2024-003091","DOIUrl":"10.1136/bmjoq-2024-003091","url":null,"abstract":"<p><strong>Objective: </strong>Clinical recruitment encompasses a significant challenge in multidisciplinary research, often acting as a bottleneck to timely completion due to slower-than-expected patient enrolment rates. Addressing this, enhanced communication within clinical departments is crucial. A quality improvement (QI) study was initiated in the Mater Misericordiae University Hospital (MMUH) to increase the slow recruitment rate of cancer-associated thrombosis patients to the EXPECT Study.</p><p><strong>Methods: </strong>Process and stakeholder mapping as well as Plan Do Study Act (PDSA) cycles highlighted effective initiatives to increase recruitment rates to the study. The PDSA cycle 1 aimed at increasing clinical communication and study education through implementation of work package-1, which included engaging a clinical project sponsor to drive recruitment and increasing study awareness through educational talks/informative materials. The PDSA cycle 2 aimed to increase process efficiency and paired sample acquisition through implementation of work package-2, which included holding weekly QI meetings, building a strong multidisciplinary QI team and mapping the recruitment process. These efforts aimed to increase recruitment from one to four patients enrolled per month, with recruitment progress tracked with a run/bar chart over a 2 year period.</p><p><strong>Results: </strong>The communication/education work package-1 initiatives increased the recruitment rate from one to two patients per month, with target enrolment met or exceeded 33% of the QI-project duration. Recruitment numbers nearly doubled in roughly half the timeframe, from 10 patients enrolled in the first 16 months to 18 patients enrolled in the 9 months of the QI study. Furthermore, a greater than threefold statistically significant increase in paired sample acquisition from 20% to 66% was documented following the execution of the second PDSA cycle, aimed at improving process efficiency.</p><p><strong>Conclusions: </strong>This QI study highlights the need for a highly engaged study team, specifically the clinical project sponsor driving recruitment from a medical front-line perspective as well as a highly efficient recruitment process.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing an online educational platform to expedite ADHD medication initiation in child and adolescent mental health services: a quality improvement project.","authors":"Noah Stanton, Aadam Aziz, Salim Jakhra, Louise Morganstein, Sandra Bailey, Tami Kramer, Isaac Obeng","doi":"10.1136/bmjoq-2024-003148","DOIUrl":"10.1136/bmjoq-2024-003148","url":null,"abstract":"<p><p>The waiting times for diagnosis of attention deficit hyperactivity disorder (ADHD) and subsequent medication initiation present a growing challenge for Child and Adolescent Mental Health Services (CAMHS) in the UK. Treatment delays can result in adverse outcomes. Innovative digital technologies have the potential to reduce waiting times. This project involved the development of an online platform to educate parents about ADHD medication and serve as a portal to initiate medication in CAMHS. It aimed to reduce the time-to-treatment initiation (TTI) for medication and increase the proportion of patients with ADHD taking up medication for treatment. A quality improvement project was conducted over 11 months, using three Plan-Do-Study-Act cycles for evaluation. The platform integrated psychoeducational videos about ADHD medication, a section for question-and-answers, links to useful websites and a portal to facilitate the medication decision. The mean TTI reduced by 41%, from 86 days to 51 days. The proportion of patients initiated on medication increased from 64% to 70%. Average user satisfaction increased from 4.13/5 to 4.37/5. The platform substantially improved outcomes and has been fully implemented locally, highlighting the potential of digital healthcare in managing ADHD.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supportive supervision visits in a large community hypertension programme in Nigeria: implementation methods and outcomes.","authors":"Gabriel Lamkur Shedul, Nanna Ripiye, Erica L Jamro, Ikechukwu A Orji, Grace Julcit Shedul, Eugenia N Ugwuneji, Emmanuel Okpetu, Boni M Ale, Samuel Osagie, Abigail S Baldridge, Namratha R Kandula, Mark D Huffman, Dike Ojji, Lisa Hirschhorn","doi":"10.1136/bmjoq-2024-003163","DOIUrl":"10.1136/bmjoq-2024-003163","url":null,"abstract":"<p><strong>Background: </strong>The Hypertension Treatment in Nigeria (HTN) Programme established a system for hypertension diagnosis and management in 60 public primary healthcare facilities in the Federal Capital Territory of Nigeria through the implementation of HEARTS, a multi-level strategy bundle including team-based care led by community health extension workers (CHEWs). To improve HEARTS implementation, supportive supervision was added as an implementation strategy in April 2020.</p><p><strong>Methods: </strong>A multidisciplinary supportive supervision team and data collection forms were developed and implemented at HTN-supported sites. Data from April 2020 to December 2023 from supportive supervision visits were used to measure supportive supervision implementation outcomes, including reach, fidelity, adoption and feasibility and effectiveness of quality of care, data reporting and facility readiness. Descriptive analyses were performed to summarise outcomes. Jonckheere-Terpstra or Cochran-Armitage trend test was used to measure change over time for medians or proportions, respectively.</p><p><strong>Results: </strong>The programme successfully designed and performed quarterly supportive supervision visits. There was high reach (100% sites with visits each year), fidelity (median 100% (IQR 89%-100%) of core components completed), adoption (100% teams provided quarterly visits) and increase in feasibility (planned visits completed) (90.8% to 97.8%, p=0.002). Effectiveness outcomes included an increase in patients with blood pressure (BP) checked in the last 3 days (78.4% to 84.4%, p=0.009), treatment cards without errors (71.5% to 85%. p<0.001), but a slight drop in CHEW fidelity to BP measurement technique (91.5% to 86.5%, p=0.02). Facility readiness increased in adequate staffing (56.7% to 98.3%, p<0.001), but decreased for equipment availability (98.3% to 90.0%, p=0.03). Overall, the proportion of facilities with all readiness components present increased from 0% to 63.3% (p<0.001).</p><p><strong>Conclusions: </strong>We designed and implemented a supportive supervision strategy with strong implementation outcomes and most effectiveness outcomes including facility readiness to provide quality hypertension care in Nigeria. This approach can be modelled for supporting HEARTS implementation in other settings.</p><p><strong>Trial registration number: </strong>The trial was prospectively registered at www.</p><p><strong>Clinicaltrials: </strong>gov under NCT04158154 on 8 November 2019; https://clinicaltrials.gov/ct2/show/NCT04158154.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising pharmacy processes in medication delivery service through digitalisation and automation.","authors":"Kian Hong Hong Ng, Wen Jun Tiew, Yook Ting Amanda Woo, Wei Xiong Nathaniel Lim, Tou Teik George Lim, Arleen Susan Baskaran","doi":"10.1136/bmjoq-2024-003150","DOIUrl":"10.1136/bmjoq-2024-003150","url":null,"abstract":"<p><p>The rapid expansion of medication delivery service (MDS) during COVID-19 created many new roles in the pharmacy which are manpower intensive and not sustainable as pharmacy resumes counter collection services. To keep MDS operations sustainable, we identified the need to streamline and automate processes which are manual and repetitive. We seek to determine if the Plan, Do, Study, Act (PDSA) cycles would effectively reduce the man-hours required for the MDS over two phases in 1 year. Phase 1 involved digitalisation of order taking and automation of the data entry process. Phase 2 involved automating the order generation and accounting process to replicate the patient information matching task which was performed manually during bagging and dispatch of delivery orders. The baseline period for this study was from December 2020 to January 2021. The results following implementation of PDSA cycles in the respective phases were collected between January 2021 to June 2021 and July 2021 to December 2021. The average time taken for data entry per delivery order reduced from a range of 0.5 to 2.15 min to 0.08 to 0.1 min depending on the ordering method (p<0.05). The average time taken for bagging and dispatch per delivery order shortened from 2.7 min to 0.28 min (p<0.05). The improvements were sustained and cumulatively contributed to 11.8-man-hour savings. The impact of the interventions was discussed. As MDS gains prominence as an important alternative for medication collection due to its rapid expansion due to COVID-19, it is crucial for the pharmacy to expand its capacity and information technology capabilities to cope with higher workload from both MDS and walk-in patients.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feedback from bereaved relatives via Medical Examiners: what kinds of concerns are raised?","authors":"Saskie Dorman, Becky Protopsaltis, Ryan Barter, Andy Brogan","doi":"10.1136/bmjoq-2024-003152","DOIUrl":"10.1136/bmjoq-2024-003152","url":null,"abstract":"<p><p>Relatives can offer important insights into the quality of care. In England, the Medical Examiner (ME) system has been introduced to identify if there are any causes for concern relating to the cause of death or the person's care in their final illness. We reviewed feedback from bereaved relatives to identify opportunities for improvement. Routinely collected data (date and place of death, demographics, relationship to the person who had died, concerns raised via the ME system) were collated over 12 months (March 2023 to February 2024, East Dorset, UK). Each comment recorded in the ME records was read by one of the authors and issues identified were coded as themes. Concerns were recorded in 8% and appreciative comments in 12%. The most frequent concerns raised related to family/carer communication (56% of concerns raised). Feedback also reported issues relating to access, delays and care which did not attend to what mattered. Effective feedback loops and meaningful action are important elements of generative governance.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}