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From embracing to managing risks
  1. Justin Keen1,
  2. Emma Nicklin2,
  3. Nyantara Wickramasekera3,
  4. Andrew Long2,
  5. Rebecca Randell2,
  6. Claire Ginn4,
  7. Elizabeth McGinnis2,
  8. Sean Willis5,
  9. Jackie Whittle5
  1. 1Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  2. 2University of Leeds, Leeds, UK
  3. 3University of Sheffield, Sheffield, UK
  4. 4NHS England, Leeds, UK
  5. 5Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Justin Keen; J.Keen{at}


Objective To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services.

Setting Four acute National Health Service hospitals in England.

Participants 111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff.

Results There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff.

Conclusions The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.

  • information technology
  • risk management
  • information management
  • clinical governance
  • organisation of health services

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  • Contributors JK, AL, RR, EM, CG, SW and JW conceived the study and developed the protocol. JK, EN, NW and AL undertook fieldwork, and they and RR undertook analysis. All authors contributed to drafting the article.

  • Funding This study was funded by the NIHR Health Service and Delivery Research (HS&DR) programme, project 13/07/68.

  • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR programme, National Institute for Health Research, National Health Service or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from the University of Leeds Faculty of Medicine and Health ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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