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Remediating doctors’ performance to restore patient safety: a realist review protocol
  1. Tristan Price1,
  2. Nicola Brennan1,
  3. Jennifer Cleland2,
  4. Linda Prescott-Clements3,
  5. Amanda Wanner4,
  6. Lyndsey Withers5,
  7. Geoff Wong6,
  8. Julian Archer1
  1. 1 Medicine and Dentistry, University of Plymouth, Plymouth, UK
  2. 2 Institute of Education for Medical and Dental Sciences, School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
  3. 3 Education, Royal College of Veterinary Surgeons, London, UK
  4. 4 NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Plymouth, Plymouth, UK
  5. 5 Patient Partner, University of Plymouth, Plymouth, UK
  6. 6 Nuffield Department of Primary Care, Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Prof. Julian Archer; julian.archer{at}


Introduction Underperformance by doctors poses a risk to patient safety. Remediation is an intervention designed to remedy underperformance and return a doctor to safe practice. Remediation is widely used across healthcare systems globally, and has clear implications for both patient safety and doctor retention. Yet, there is a poor evidence base to inform remediation programmes. In particular, there is a lack of understanding as to why and how a remedial intervention may work to change a doctor’s practice. The aim of this research is to identify why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to support patient safety.

Methods and analysis Realist review is an approach to evidence synthesis that seeks to develop programme theories about how an intervention works to produce its effects. The initial search strategy will involve: database and grey literature searching, citation searching and contacting authors. The evidence search will be extended as the review progresses and becomes more focused on the development of specific aspects of the programme theory. The development of the programme theory will involve input from a stakeholder group consisting of professional experts in the remediation process and patient representatives. Evidence synthesis will use a realist logic of analysis to interrogate data in order to develop and refine the initial programme theory into a more definitive realist programme theory of how remediation works. The study will follow and be reported according to Realist And Meta-narrative Evidence Syntheses—Evolving Standards (RAMESES).

Ethics and dissemination Ethical approval is not required. Our dissemination strategy will include input from our stakeholder group. Customised outputs will be developed using the knowledge-to-action cycle framework, and will be targeted to: policy-makers; education providers and regulators, the National Health Service, doctors and academics.

PROSPERO registration number CRD42018088779.

  • remediation
  • medical performance
  • patient safety

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  • Contributors JA conceptualised the study with input from TP. NB led the development of the protocol with input from JA, TP, GW, LP-C, JC, AW and LW. AW scoped and designed the search strategy. Methodological advice was given by GW and NB. TP wrote the first draft of this manuscript. JA, NB, GW, LP-C, JC, AW and LW critically reviewed it and provided comments for improvement. The authors would like to thank their PPI partners for their input into the original funding application for this study and for their continued support for this research.

  • Funding This project was funded by the NIHR Health Services and Delivery Research Programme (HS&DR 1 7/06/04). This research is also supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula). GW’s salary is partly supported by The Evidence Synthesis Working Group of the National Institute for Health Research School for Primary Care Research (NIHR SPCR) (Project Number 390).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.