Do Networked Information Technologies Improve Patient Safety? A Realist Synthesis

The aim of this study is to establish how and why networked, inter-organisational Health Information Technology (HIT) services improve patient safety, do not do so, or increase safety risks.

The objectives of the study are to:

1. Identify initial programme theories, and prioritise theories to review;

2. Search systematically for evidence to test the theories;

3. Undertake quality appraisal, and use included texts to support, refine or reject programme theories;

4. Synthesise the findings;

5. Disseminate the findings to a range of audiences.

We will undertake a realist synthesis, in 5 Stages, corresponding to the objectives.

Stage 1 focuses on the identification of programme theories. Searches will be designed and conducted to identify relevant government policies and official reports, and articles by opinion leaders. Documents will be reviewed, to identify relevant statements about HITs and patient safety. Leading theories (in key texts) of patient safety will be identified, and statements relevant to the review identified. The findings will be summarised, for presentation to 4 nominal groups - policy makers, NHS implementation leads, frontline clinicians, and our patient and public involvement group. The groups will meet separately, in the order listed. The meetings will be structured, so as to identify leading programme theories for detailed evaluation. Following the first meeting, each subsequent meeting will also be presented with the outputs of the preceding group(s).

Stages 2 and 3 involve a series of literature searches, designed to identify and assess evidence for each link (or a series of links) in a chain of reasoning in the programme theories. We will design searches for Ovid databases, including Medline, Embase and HMIC, and also ASSIA, Sociological Abstracts and IEEE Explore. Evidence will be assessed for rigour and relevance, and then used to evaluate the selected programme theories. The theories will be supported, refined or rejected. We will also identify evidence that sheds light on the reasons why the intended effects of programme theories are - or are not - realised in practice. The nominal groups will be re-convened (by email or web-based service) towards the end of Stage 3, to comment on the emerging findings. The groups may lead us to conduct further literature searches.

Stage 4 is the synthesis phase of the review, where the findings are interpreted. The nominal groups will be convened again, by email or web-based service, at the end of this Stage, and will comment on our interpretations and provide their own.

In Stage 5 we will prepare a number of outputs for dissemination.

The review will add value in two ways. First, the underlying mechanisms that link HITs and patient safety are poorly understood. Identifying the chains of reasoning will help us and practitioners and policy makers - to understand the underlying logic linking the implementation of networked, inter-organisational HITs and their subsequent effects. We will also identify cultural, economic and other reasons why intended effects represented by the chains of reasoning - are not achieved in practice. Second, we will produce evidence-based guidance for NHS organisations. We will ensure that the guidance is useful to practitioners. Policy makers and practitioners will be involved in the review and will also be involved in the development of the guidance.

Read more here.

Publications and outputs

Keen, J., Greenhalgh, J., Randell, R. et al. Networked information technologies and patient safety: a protocol for a realist synthesis. Systematic Reviews 8, 307 (2019). https://doi.org/10.1186/s13643-019-1223-1 

Keen J, Abdulwahid MA, King N, Wright J, Randell R, Gardner P, Waring J, Longo R, Nikolova S, Sloan C and Greenhalgh J (2020) Effects of interorganisational information technology networks on patient safety: a realist synthesis, BMJ Open https://doi.org/10.1136/bmjopen-2019-036608