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LINK Research Institute

From Policy to Practice: An International Comparison of Approaches to Systemic Quality and Safety

Project Summary

This research, which is funded by the Health Research Board, will undertake an international comparison of the national systems and policy for patient safety, in Scotland and Ireland. In addition the research will consider the route from policy to practice in both contexts. This project will utilize a systems focus rather than concentrating on individual errors in an effort to gain a more thorough and fundamental understanding of the overarching processes involved in patient safety and quality care. It will also illuminate the common challenges and facilitators of quality and safety at system and organisational levels, as well as those unique to each context. It aims to promote cross-learning about the merits and disadvantages of particular policy approaches and supports. Integrating a system and organisational level focus will highlight where support is needed to ensure that policies are effective on-the-ground.

To begin, the study will benchmark the Irish system of quality and safety against the Scottish, and explore the enablers and barriers to implementing national safety. Various system and organisational level supports will be explored to determine their effectiveness in ensuring policy implementation. In addition, several factors that have been shown to influence quality and safety will also be assessed. These include: employee-involvement, quality of working relationships, inter-professional coordination, the extent to which staff feel comfortable reporting errors and near misses (psychological safety), team work and communication. The aim of these assessments is to identify key system and organisational enablers and barriers to achieving quality and safety.

Overall, the project aims to evaluate how system and organisational structures and processes affect quality and safety with the ultimate aim of informing how systemic quality and safety can be created and embedded.


Initially, a review and comparison of institutions, structures, policies, systems and approaches to health care quality and safety improvements adopted in each country will be conducted. Of particular interest will be who is involved in creating the policies; the governance/research plans; the timelines the policies are functioning under and, the monitoring and evaluation mechanisms in place. This primary stage will lay a foundation of understanding and comparison which will inform the subsequent steps of this study.

Second, national case studies of the systems factors facilitating or hindering policy implementation and impact in each country will be explored through interviews with key policy makers and implementers in each country.

Third, two matched organisational case studies will be conducted in each country. These will be based on interviews with senior management, clinical directors, clinical governance mangers, consultants, nurses, managers, allied health professionals, and others involved in implementing quality and safety initiatives. The interviews will be used to identify the organizational factors facilitating or hindering policy enactment in each context (e.g. employee involvement, quality of working relationships, inter-professional coordination, psychological safety, team work, and communication). These case studies will be focused in one area of clinical care that is yet to be determined.

Fourth, a quantitative assessment of the system and organisational initiatives which support employee involvement, psychological safety, relational coordination, team work, and communication will be carried out. This will identify how these factors influence policy implementation.

Last, a future programme of research for comparative research between Scotland and Ireland in the domain of safety and quality improvement will be identified.

Project Team

Prof. Patrick Flood and Dr. Lauren Hamel – Dublin City University

Prof. Lorna McKee – University of Aberdeen

Dr. Aoife McDermott – Cardiff University