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This paper describes a quality improvement project to improve oversight of quality at national board level using statistical process control (SPC) methods, complimented by a qualitative experience of patients and frontline staff. It demonstrates the application of the “Picture-Understanding-Action” approach and shares the lessons learnt.

Using co-design and applying the “Picture-Understanding-Action” approach, the project team supported the directors of the Irish health system to identify and test a qualitative and quantitative picture of the quality of care across the health system. A “Quality Profile” consisting of quantitative indicators, analysed using SPC methods was used to provide an overview of the “critical few” indicators across health and social care. Patient and front-line staff experiences added depth and context to the data. These methods were tested and evolved over the course of six meetings, leading to quality of care being prioritised and interrogated at board level.

This project resulted in the integration of quality as a substantive and prioritised agenda item. Using best practice SPC methods with associated training produced better understanding of performance of the system. In addition, bringing patient and staff experiences of quality to the forefront “people-ised” the data.

The application of the “Picture-Understanding-Action” approach facilitated the development of a co-designed quality agenda item. This is a novel process that shifted the focus from “providing” information to co-designing fit-for-purpose information at board level.

The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction between formal “imposed accountability” and front-line “felt accountability”. From these insights, the paper introduces an emergent concept, “grounded accountability”.

Interviews are conducted with 41 clinicians, managers and governors in two large academic hospitals. The authors ask interviewees to recall a critical clinical incident as a focus for elucidating their experiences of and observation on the practice of accountability.

Accountability emerges from the front-line, on-the-ground. Together, clinicians, managers and governors co-construct accountability. Less attention is paid to cost, blame, legal processes or personal reputation. Money and other accountability assumptions in business do not always apply in a hospital setting.

The authors propose the concept of co-constructed “grounded accountability” comprising interrelationships between the concept’s three constituent themes of front-line staff’s felt accountability, along with grounded engagement by managers/governors, supported by a culture of openness.

While digital technologies have led to many important social and cultural advances worldwide, they also facilitate the perpetration of violence, abuse and harassment, known as technology-facilitated violence and abuse (TFVA). TFVA includes a spectrum of behaviors perpetrated online, offline, and through a range of technologies, including artificial intelligence, livestreaming, GPS tracking, and social media. This chapter provides an overview of TFVA, including a brief snapshot of existing quantitative and qualitative research relating to various forms of TFVA. It then discusses the aims and contributions of this book as a whole, before outlining five overarching themes arising from the contributions. The chapter concludes by mapping out the structure of the book.

Rape culture, described as when “violence is seen as sexy and sexuality as violent” (Buchwald, Fletcher, & Roth, 1993, p. vii), exists online and offline (Henry & Powell, 2014). Much of the research on rape culture focuses on the experiences of heterosexual women, and few studies have explored rape culture in the context of dating apps. This chapter explores how men who have sex with men (MSM) understand and experience rape culture through their use of Grindr and similar dating apps. A thematic analysis of interviews with 25 MSM dating app users revealed problematic user behavior as well as unwanted sexual messages and images as common manifestations of rape culture on dating apps. Participants explained that rape culture extends beyond in-app interactions to in-person encounters, as evident by incidents of sexual violence that several participants had experienced and one participant had committed. Participants were unsure about the extent to which MSM dating apps facilitate rape culture but asserted that some apps enable rape culture more than others. This chapter demonstrates the importance of investigating sexual violence against people of diverse gender and sexual identities to ensure their experiences are not minimized, ignored, or rendered invisible.