Developing Healthcare Team Observations for Patient Safety (HTOPS): Senior Medical Students Capture Everyday Clinical Moments

Abstract Background Aviation has used a real-time observation method to advance anonymised feedback to the front-line and improve safe practice. Seeking a patient-safety experiential learning method for final year medical students we embarked on a pilot study for similarly observing real-time clinical practice in context. Methods Using Participatory Action Research, we collected data on medical students’ observations of real time clinical practice. The observation data was analysed thematically and shared with a steering group of experts to agree a framework for recording observations. A sample of students (observers) and front-line clinical staff (observed) completed on-to-one interviews on their experiences. The interviews were analysed using thematic analysis. Results Thirty-seven medical students identified 917 issues in wards, theatres and clinics in an acute hospital Trust. They formed the themes of human factors, systems and environment. Aviation approaches were adapted to form an app capable of recording real time positive and negative clinical incidents. Five students and eleven clinical staff were interviewed and shared their agreement of the value of a process that helped them learn and has the potential to advance the quality of practice. Concerns were shared about how the observational process is managed. Conclusion The final product, an app called Healthcare Team Observations for Patient Safety (HTOPS), used by observing senior medical students can record both positive and negative clinical individual and team behaviours in acute-care practice. Early findings are promising as they highlight the totality of patient safety practice and can illuminate good and poor practice. The findings have been positively received and welcomed by the observed Hospital Trust. The next steps will further refine the app for use in all clinical areas for capturing light noise. HTOPS offers the opportunity for collective ownership of safety concerns without blame and has been positively received by staff and medical students.