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The Safer Delivery of Surgical Services (S3) research is programme of studies to identify how human factors approaches may be used to reduce errors and harm in surgery. It consists 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 is funded by the National Institute of Health Research, under the Programme Grants for Applied Research. The study is 3 years 4 months in length and will involve up to 600 staff across 4 NHS Trusts. 

This is a programme of linked studies of human factors interventions to improve safety in a variety of clinical settings.  There are also two non-interventional studies that involve 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 will be done in teams of two observers; one observer will have a Clinical background and the other will have a Human Factors background. 

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