Table 1

Key participant quotes corresponding to feasibility measures

Feasibility measureThemeSubthemeParticipant quote
AcceptabilityAttitude towards patient feedback on safetyValue patient feedback on safety‘It's always, the valuable ones are always the awful ones, aren't they? You know… it's really precious. Ain't often people are honest like that…’ (GP, Practice D, APM)
‘It’s better to be informed about it so that you can make that change…it makes it more positive for everybody then’…(Administration Staff, Practice E, APM)
Patient feedback on safety aligned with staff awareness of issues‘the bits that were flagged that were in there [feedback report] were probably what we expected …’ (PN, Practice D, APM).
Believability of the feedback‘And I accept the [safety incident] one, because, perception is truth.’ (GP, Practice B, APM).
Concern and empathy towards patient feedback‘… there's one [safety incident] I was actually concerned, there's a patient who obviously feels that we haven't done our best by them.’ (PM, Practice A, APM).
‘So someone had a blocked airway. That sounds really terrible, doesn't it? It's (an) emergency.’ (PN, Practice A, APM).
Surprised or unsure how to respond when feedback differed to staff perceptions‘I thought we have got some more negative feedback from people, which surprised me.’ (PN1, Practice C, APM).
‘But I'm not quite sure about that [safety incident] one… I found that one very odd, because… probably some of the best staff we have are down that end of the building, without being horrible to others, but the doctors even say that. I just find that really odd.’ (PM, Practice B, APM).
Dismissive towards patient feedback‘I think sometimes it’s that lack of understanding, that they [GP] can’t come and fix the world in fifteen minutes’ (PN1, Practice C, APM).
‘when you get that: ‘I can’t see the doctor that I want to see’ [patient comment]. Well we’ve been working on this for five years trying to improve things!’ (PM, Practice D, Final Interview)
Using patient feedback to make changesCautious about using patient feedback for safety improvement‘But we need to… you know, decide on what, what we think's important to change… and what's changeable. And I don't think we can do anything about this [safety incident].’ (GP, Practice A, APM)
Largely positive feedback limited staff response‘We didn’t have too many negatives [feedback] which is a good thing but also, it was sort of, well do we need to change that much?’ (PM, Practice A, Final interview)
Using staff identified areas of service improvement rather than patient feedback‘…even though it's not, it's not showing up as negative as I thought it might've, so I was really happy about that, but I think the appointment system will still [need to be addressed]… And I think that will assist the, there's less likely to be an error. So there's less likely to be a, ah, negative outcome for the patient’ (PM, Practice A, APM).
Barriers and enablers to intervention development and implementationDeveloping interventionsIntuitive problem-solving process‘We're probably doing it anyway, but we don't realize it's a model for improvement.’ (PN2, Practice C, Final interview)
‘So we [other administration staff] we probably collaborate a lot. We throw ideas around. You know how to do different things. So we're probably the thinkers.’ (Admin, Practice F, Final interview)
Disconnect between staff problem-solving process and MfI framework‘It was a good framework. Initially, what we found was when barriers kind of ah developed, we had trouble readjusting to that [MfI framework].’ (GP, Practice F, Final interview)
‘I didn't ever use a model I was just sort of like, ‘This is what I'm trying to achieve. This is how I'm going to do it’… Did it work? Didn’t it work? Which is probably the same model, but I just didn't actually outline it or ever document it. It was just in my head.’ (PN, Practice D, Final Interview)
‘We are not very keen of formally doing that [sic.] things [MFI]. The simple the better.’ (GP, Practice E, Final Interview)
‘…we probably were never really good at documenting that stuff. Document … as I said, in here you're kind of doing things on the run, do you know what I mean? You go, ‘Oh yeah, we'll do that.’ (PM, Practice E, Final Interview)
Integrating and adapting problem-solving approaches‘[The model for improvement) is a good process and it's simple but sometimes we complicate it by making it bigger than what it is’ (PN1, Practice C, Final Interview).
‘ … [we] do the PDSA cycle, not necessarily super formally but we just, we identify what needs to be done and we try to make our changes small not big and then we introduce those to the practice or to specific members of the practice team who might need to know about it.’ (GP, Practice A, Final Interview)
Implementing interventionsMultidisciplinary team‘I just figured that it would end up falling probably on the three of us(PM, PN, Admin). Because I knew [GP] was going to be time poor… So he was there if we needed him and we would bug him.’ (PM, Practice B, Final Interview)
Staff responsibility and ownership for intervention linked to type of improvement activity‘I like data. I like playing with data [laughter]. I enjoyed doing a lot of the collection and stuff and seeing what you can do to make it happen…’ (PM, Practice C, Final Interview)
Difficulty in measuring change in safety outcomes‘It is difficult to measure outcome because if you prevent a complication, it [is] what it is’ (GP, Practice E, Workshop 2)
Use of soft measures‘…because there were things that we couldn't really kind of quantify. I mean, how do you quantify [staff member] stress level based on one particular aspect and you know separate it from…? That was what we had trouble with, more than anything.’ (GP, Practice F, Final Interview)
Staff support and engagement‘Nobody wanted to be part of the safety improvement team, like, as soon as [you] mention anything like this, everyone’s just like [pause] ‘Not again’.’ (PM, Practice D, Workshop 2).
Time and resources‘I felt as though we could have actually used a, ‘Alright, what's going wrong? Let's troubleshoot this and see.’ I don't think as a team, we were able to devote the time or the resources or energy to actually do that when we hit those barriers.’ (GP, Practice F, Final Interview)
‘A lot's changed in the practice since we [started the trial]. A lot of fairly massive things. We've taken on 50% more students, we've got a few more extra learners, we've got a few other things going on plus we've had just some stuff, health issues, which have had a huge impact.’ (GP, Practice A, Final Interview)
Trail scalabilityIncreased facilitation and support from research team‘I think the workshops were valuable. I don't know whether we can just blame the [intervention barriers], I suppose our lack of engagement with [the intervention]. Maybe if we had to engage a little bit more, it probably would have kept us on track a bit more I think… even if it was just on the phone or something.’ (PM, Practice D, Final Interview)
‘I think you need somebody that's there as the overseer to keep us on track.’ (PM, Practice B, Final interview).
Real-time electronic patient feedback processes‘Something electronic I think we’d definitely be interested in. Even things, like the emails and text messages and stuff to people after they've been to their appointment, people don't have to do them then and there. They can sit on their couch at home and do it at night when they've actually got time… I would imagine we would get different feedback if patients were being surveyed after their appointment.’ (PM, Practice D, Final interview).
  • MFI, model for improvement.