Marjon Borgert

68 Chapter 4 Expert team For the development of the owchart, a multidisciplinary expert team was created. The team consisted of two senior researchers (J.B.,F.P.), an intensivist/senior researcher (D.D.) and a junior researcher (M.B.). The junior researcher provided all the information for the consensus meetings. Two senior researchers (J.B.,F.P.) were former ICU nurses who are now involved in quality and patient safety initiatives on the ICU. The intensivist/senior researcher (D.D.) is experienced and trained in quality and safety in healthcare. This multidisciplinary team has a wide experience in the ICU care processes and was familiar with the conditions or requirements of care bundles. Development process The IHI was the founder of the care bundled approach. They described the methods they used to develop the central line bundle and ventilator bundle. 2-5 Their reports were more descriptive in nature. 2-5 These IHI reports formed the basis to structure the owchart. We analyzed the IHI methods on how they have developed the central line bundle and ventilator bundle. 2,5 We analyzed their process in two ways. At rst, we converted their descriptive reports into main process steps. For example, the IHI started the bundle development process by identifying problems by using the results of a systematic review. Therefore, this rst main process step was labelled as: ‘identify problems/risks’. Subsequently, the main steps were identi ed for the whole bundle development process. All steps were structured in a owchart. Secondly, we selected the speci c methods the IHI used for designing the central line bundle or ventilator bundle. For example, the IHI started the bundle development process by identifying problems by using the results of a systematic review. We incorporated the method of a systematic review in process step one: ‘identify problems/risks’. Additionally, the methods identi ed by the literature search were incorporated in one of the main process steps of the owchart. Consensus meetings We used consensus meetings with the expert team to analyze the IHI reports. At rst, we identi ed the main process steps. Secondly, we built the owchart and thirdly, we selected the methods and placed it in one of the process steps. Two meetings were arranged for de ning themainprocess steps and tobuild the owchart and two for lling in the speci c methodologies per process step of the owchart. Di erences between the members were discussed until 100% consensus was reached. The meetings were highly structured by using the nominal group technique. 18 This is a structured meeting with experts about a certain issue and consists of two rounds in which the experts rate, discuss and rerate topics or issues. 17