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The Safer Delivery of Surgical Services (S3) research was a programme of studies to identify how human factors approaches may be used to reduce errors and harm in surgery. It consisted of an interconnected programme of observational studies, observational tool development programmes, and controlled before-after interventional studies with integrated economic, statistical, and knowledge management analyses. 

The programme was funded by the National Institute of Health Research, under the Programme Grants for Applied Research. The study was three years, four months in length and will involve up to 600 staff across four NHS Trusts. 

This was a programme of linked studies of human factors interventions to improve safety in a variety of clinical settings.There were also two non-interventional studies that involved measure development and validation. The interventional studies planned are illustrated in Figure 1:

Venn Diagram

Figure 1 – Study Designs

The interventional studies all follow a controlled interrupted time series design: This implies a three-month pre-intervention phase, and intervention phase (usually also three months), and a post-intervention phase (at least three months). 

All observations were done in teams of two observers; one observer had a clinical background and the other had a Human Factors background. 

In addition to the studies described above, a series of evaluative approaches were applied. Health economic data was collected throughout the programme, and was used to provide an indication of the cost-benefit ratio of the interventions. A statistical model was developed to describe the effects of the interventions on the specified outcome measures. Current methodological approaches were evaluated, and new ones were proposed and evaluated if this was considered appropriate. In addition, to ensure the lessons learned from the research was disseminated effectively to the wider scientific community, a knowledge translation manual was developed, focussing specifically on translating the research outcomes to NHS practice.