Caitlin Wilson (@999_Caitlin) is a final year PhD student at the University of Leeds, United Kingdom, funded by the National Institute for Health Research Yorkshire and Humber Patient Safety Translational Research Centre, and supervised by Dr Jonathan Benn, Professor Rebecca Lawton and Dr Gillian Janes. Caitlin is also a paramedic for North West Ambulance Service NHS Trust and an Associate Editor for the British Paramedic Journal.
Caitlin’s PhD explores how enhancing prehospital feedback can enrich emergency ambulance staff wellbeing, paramedic decision-making and prehospital patient safety. As part of her PhD, Caitlin has conducted several research studies including a systematic review, a qualitative interview study and a mixed-methods diary study. At this conference, Caitlin is presenting on the development of an initial programme theory of prehospital feedback as part of an ongoing mixed-methods study combining a realist evaluation framework with an explanatory case study design.
Evidence exists for the effectiveness of feedback in changing professional behaviour and improving clinical performance across a range of healthcare settings, but this has not yet been explored within the prehospital context (Ivers et al., 2012). The aim of this study was to understand how UK ambulance services are meeting the challenge of providing feedback and generate an initial explanatory programme theory to capture the implicit mechanisms by which prehospital feedback results in desirable outcomes.
This mixed methods study combines a realist evaluation framework with an explanatory case study design. The study consisted of a national cross-sectional survey to identify active and historic feedback initiatives in UK ambulance services, followed by 4 in-depth case studies of these initiatives. Case studies were purposively selected from survey responses using a sampling framework stratified by feedback type and context, and each involved 4-5 semi-structured qualitative interviews and documentary analysis.
An initial programme theory was developed using the survey data and findings from our previously conducted systematic review and exploratory interview study. It was informed by existing theories on audit and feedback, behaviour change and implementation science: Clinical Performance Feedback Intervention Theory (Brown et al., 2019), Theoretical Domains Framework (Michie et al., 2005) and Implementation Outcomes Evaluation Framework (Proctor et al., 2011)).
Fitting the descriptive survey data of prehospital feedback initiatives to the CMO framework gave rise to an initial programme theory for prehospital feedback, which is depicted visually in a logic model.
Our initial programme theory will be further refined during the ongoing case study phase of this study.