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Data quality and data use in primary health care: A case study from Iran. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Unal A, Intepeler SS. Medical error reporting software program development and its impact on pediatric units' reporting medical errors. Pak J Med Sci 2019; 36:10-15. [PMID: 32063923 PMCID: PMC6994913 DOI: 10.12669/pjms.36.2.732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: The purpose of this quasi-experimental study was to developing web-based, anonymous reporting system to increase reporting of medication errors, blood transfusion errors and patient falls in pediatric units and to compare the computerized system with the written system already in use at the institution. Methods: This study was conducted in all pediatric units of a research hospital. All physicians and nurses working in these units agreed to participate in the study. All units were visited to introduce the new reporting system. The number and quality of the reports sent on the new system in years 2014 and 2015 were compared to the reports sent the previous year using the written system. Results: There was considerable increase in rates of reporting: 234% increase in medication error reporting rate, and 100% increase in the reports of blood transfusion errors. One of the most important results of this study that near-miss errors were not reported at all while the written system of the study institution was being used, whereas it was the most commonly reported type of errors in the electronic error reporting system. Conclusion: The web-based reporting system, which makes reporting easy, promoted the development of safety culture among doctors and nurses in common language.
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Affiliation(s)
- Aysun Unal
- Dr. Aysun Unal, PhD, RN. Assistant Professor, Nursing Management Department, Akdeniz University Kumluca, Faculty of Health Sciences, Antalya, Turkey
| | - Seyda Seren Intepeler
- Prof. Dr. Seyda Seren Intepeler, BSN, PhD. Nursing Management Department, Dokuz Eylul University, Nursing Faculty, Izmir, Turkey
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Ling L, Gomersall CD, Samy W, Joynt GM, Leung CC, Wong WT, Lee A. The Effect of a Freely Available Flipped Classroom Course on Health Care Worker Patient Safety Culture: A Prospective Controlled Study. J Med Internet Res 2016; 18:e180. [PMID: 27381876 PMCID: PMC4951630 DOI: 10.2196/jmir.5378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/22/2016] [Accepted: 06/04/2016] [Indexed: 11/21/2022] Open
Abstract
Background Patient safety culture is an integral aspect of good standard of care. A good patient safety culture is believed to be a prerequisite for safe medical care. However, there is little evidence on whether general education can enhance patient safety culture. Objective Our aim was to assess the impact of a standardized patient safety course on health care worker patient safety culture. Methods Health care workers from Intensive Care Units (ICU) at two hospitals (A and B) in Hong Kong were recruited to compare the changes in safety culture before and after a patient safety course. The BASIC Patient Safety course was administered only to staff from Hospital A ICU. Safety culture was assessed in both units at two time points, one before and one after the course, by using the Hospital Survey on Patient Safety Culture questionnaire. Responses were coded according to the Survey User’s Guide, and positive response percentages for each patient safety domain were compared to the 2012 Agency for Healthcare Research and Quality ICU sample of 36,120 respondents. Results We distributed 127 questionnaires across the two hospitals with an overall response rate of 74.8% (95 respondents). After the safety course, ICU A significantly improved on teamwork within hospital units (P=.008) and hospital management support for patient safety (P<.001), but decreased in the frequency of reporting mistakes compared to the initial survey (P=.006). Overall, ICU A staff showed significantly greater enhancement in positive responses in five domains than staff from ICU B. Pooled data indicated that patient safety culture was poorer in the two ICUs than the average ICU in the Agency for Healthcare Research and Quality database, both overall and in every individual domain except hospital management support for patient safety and hospital handoffs and transitions. Conclusions Our study demonstrates that a structured, reproducible short course on patient safety may be associated with an enhancement in several domains in ICU patient safety culture.
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Affiliation(s)
- Lowell Ling
- Prince of Wales Hospital, Department of Anaesthesia and Intensive Care, Shatin, China (Hong Kong)
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Masoudi Asl I, Iezadi S, Akhavan Behbahani A, Rahbari Bonab M. The Association Between Management of the Board of Trustees and Its Effectiveness at Hospitals in Tabriz; 2011 to 2013. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e28265. [PMID: 26328068 PMCID: PMC4552964 DOI: 10.5812/ircmj.28265v2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/18/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
Background: Reforming the structure and improving care and service system, particularly at hospitals, are the main priorities of the health system. The board of trustees of the hospitals is the main proposed strategy in this field. Hospitals with board of trustees were created with the aim of improving accountability to the community and guaranteeing efficient management and attracting public support in running the hospital. Objectives: The aim of this study was to investigate the association between hospital effectiveness and the board of trustee’s management method. Materials and Methods: This cross-sectional study was conducted in Tabriz City, Iran, during the years 2011 to 2013. To assess the effectiveness of board of trustees’ management, two hospitals in Tabriz City were compared. Hospitals selected through purposive typical case sampling method. Two hospitals had equal structure, same doctors, and both were gynecology hospitals of Tabriz City, but one of them was a gynecology hospital managed by the board of trustees and the other was managed by the chairman. The information about the five variables of hospital effectiveness was collected during the years 2011 to 2013 using standard lists and questionnaires, which were available in the hospitals; these variables included quality management, safety, medical equipment management, and patients and staff satisfaction. Then, each variable was weighted through the technique of hierarchical analysis and finally they were analyzed using SPSS 17 and Expert Choice 11. Results: Among the five variables related to the effectiveness, safety showed to have the highest weight and medical equipment management had the lowest weight. According to the statistical analyses, the score of the effectiveness of the hospital with the board of trustees was 33.08 (on the scale of 0 - 100) and the score of the hospital with the chairperson was 29.52. No significant association was found between the effectiveness of hospital and the board of trustees management (P = 0.81). Conclusions: Because there was no significant difference in the effectiveness between hospitals with and without board of trustees, decision-makers must monitor how the commands are carried out to make board of trustees for hospitals and make sure its success in achieving its objectives.
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Affiliation(s)
- Irvan Masoudi Asl
- Health Services Management Department, School of Management and Economics, Science and Research Branch, Islamic Azad University, Tehran, IR Iran
| | - Shabnam Iezadi
- Centre of Excellence in Health Management, Student Research Committee, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | | | - Maryam Rahbari Bonab
- Health Department, Islamic Parliament Research Center, Tehran, IR Iran
- Corresponding Author: Maryam Rahbari Bonab, Health Department, Islamic Parliament Research Center, Tehran, IR Iran. Tel: +98-2183357511, Fax: +98-2183357508, E-mail:
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McLean TR. Why the distribution of medical errors matters. Am J Surg 2015; 210:188-92. [PMID: 25952613 DOI: 10.1016/j.amjsurg.2014.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 09/30/2014] [Accepted: 10/19/2014] [Indexed: 10/23/2022]
Abstract
During the last decade, interventions to reduce the number of medical errors have been largely ineffective. Although it is widely assumed that medical errors follow a Gaussian distribution, they may actually follow a Power Rule distribution. This article presents the evidence in favor of a Power Rule distribution for medical errors and then examines the consequences of such a distribution for medical errors. As the distribution of medical errors has real-world implications, further research is needed to determine whether medical errors follow a Gaussian or Power Rule distribution.
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Affiliation(s)
- Thomas R McLean
- Third Millennium Consultants, LLC, 4970 Park, Shawnee, KS 66216, USA.
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Goh SC, Chan C, Kuziemsky C. Teamwork, organizational learning, patient safety and job outcomes. Int J Health Care Qual Assur 2013; 26:420-32. [PMID: 23905302 DOI: 10.1108/ijhcqa-05-2011-0032] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This article aims to encourage healthcare administrators to consider the learning organization concept and foster collaborative learning among teams in their attempt to improve patient safety. DESIGN/METHODOLOGY/APPROACH Relevant healthcare, organizational behavior and human resource management literature was reviewed. FINDINGS A patient safety culture, fostered by healthcare leaders, should include an organizational culture that encourages collaborative learning, replaces the blame culture, prioritizes patient safety and rewards individuals who identify serious mistakes. PRACTICAL IMPLICATIONS As healthcare institution staffs are being asked to deliver more complex medical services with fewer resources, there is a need to understand how hospital staff can learn from other organizational settings, especially the non-healthcare sectors. ORIGINALITY/VALUE The paper provides suggestions for improving patient safety which are drawn from the health and business management literature.
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Affiliation(s)
- Swee C Goh
- Telfer School of Management, University of Ottawa, Ottawa, Canada.
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Mazur L, McCreery J, Chen SJ. Quality Improvement in Hospitals: Identifying and Understanding Behaviors. JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.4.621] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tariq A, Georgiou A, Westbrook J. Medication incident reporting in residential aged care facilities: limitations and risks to residents' safety. BMC Geriatr 2012; 12:67. [PMID: 23122411 PMCID: PMC3547703 DOI: 10.1186/1471-2318-12-67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 09/04/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents' safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs' devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. METHODS The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. RESULTS The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. CONCLUSIONS This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.
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Affiliation(s)
- Amina Tariq
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
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Adibi H, Khalesi N, Ravaghi H, Jafari M, Jeddian AR. Development of an effective risk management system in a teaching hospital. J Diabetes Metab Disord 2012; 11:15. [PMID: 23497710 PMCID: PMC3598162 DOI: 10.1186/2251-6581-11-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/06/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Unsafe health care provision is a main cause of increased mortality rate amongst hospitalized patients all over the world. A system approach to medical error and its reduction is crucial that is defined by clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury. The aim of this study was to develop and implement a risk management system in a large teaching hospital in Iran, especially of the basis of WHO guidelines and patient safety context. METHODS WHO draft guideline and patient safety reports from different countries were reviewed for defining acceptable framework of risk management system. Also current situation of mentioned hospital in safety matter and dimensions of patient safety culture was evaluated using HSOPSC questionnaire of AHRQ. With adjustment of guidelines and hospital status, the conceptual framework was developed and next it was validated in expert panel. The members of expert panel were selected according to their role and functions and also their experiences in risk management and patient safety issues. The validated framework consisted of designating a leader and coordinator core, defining communications, and preparing the infrastructure for patient safety education and culture-building. That was developed on the basis of some values and commitments and included reactive and proactive approaches. RESULTS The findings of reporting activities demonstrated that at least 3.6 percent of hospitalized patients have experienced adverse events and 5.3 percent of all deaths in the hospital related with patient safety problems. Beside the average score of 12 dimensions of patient safety culture was 46.2 percent that was considerably low. The "non-punitive responses to error" had lowest positive score with 21.2 percent. CONCLUSION It is of paramount importance for all health organizations to lay necessary foundations in order to identify safety risks and improve the quality of care. Inadequate participation of staff in education, reporting and analyzing, underreporting and uselessness of aggregated data, limitation of human and financial resources, punitive directions and management challenges for solutions were the main executive problems which could affect the effectiveness of system.
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Affiliation(s)
- Hossein Adibi
- Department of Health Services Management, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Khalesi
- Department of Health Services Management, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ravaghi
- Department of Health Services Management, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Jafari
- Department of Health Services Management, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Jeddian
- Shariaty Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Lin CC, Shih CL, Liao HH, Wung CHY. Learning from Taiwan patient-safety reporting system. Int J Med Inform 2012; 81:834-41. [PMID: 22999224 DOI: 10.1016/j.ijmedinf.2012.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 07/25/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study is to create a national database to record incidents that endanger patient safety. We try to identify systemic problems in hospitals in order to avoid safety incidents in the future and improve the quality of healthcare. METHOD The Taiwan Patient Safety Reporting System employs a voluntary notification model. We define 13 types of patient safety incidents, and the reports of different types of incidents are recorded using common terminology. Statistical analysis is used to identify the incident type, time of occurrence, location, person who reported the incident, and possible reasons for frequently occurring incidents. RESULTS There were 340 hospitals that joined this program from 2005 to 2010. Over 128,271 incident events were reported and analyzed. The three most common incidents were drug-related incidents, falls, and endo tube related incidents. By analyzing the time of occurrence of incidents, we found that drug-related incidents usually occurred between 8 and 10 am. Falls and endo tube incidents usually occurred between 4 and 6 am. The most common location was wards (57.6%), followed by intensive care areas (13.5%), and pharmacies (9.1%). Among hospital staff, nurses reported the highest number of incidents (68.9%), followed by pharmacists (14.5%) and administrative staff (5.5%). The number of incidents reported by doctors was much lower (1.2%). Most staff members who reported incidents had been working for less than five years (58.1%). CONCLUSION The unified reporting system was found to improve the recording and analysis of patient safety incidents. To encourage hospital staff to report incidents, hospitals need to be assisted in establishing an internal report and management system for safety incidents. Hospitals also need a protection mechanism to allow staff members to report incidents without the fear of punishment. By identifying the root causes of safety incidents and sharing the lessons learned across hospitals is the only way such incidents can be stopped from happening again.
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Affiliation(s)
- Chung-Chih Lin
- Department of Computer Science and Information Engineering, Healthy Aging Research Center, Chang Gung University, Taiwan.
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Nascimento A. Sécurité des patients et culture de sécurité: une revue de la littérature. CIENCIA & SAUDE COLETIVA 2011; 16:3591-602. [DOI: 10.1590/s1413-81232011000900027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 09/03/2009] [Indexed: 11/22/2022] Open
Abstract
Depuis la publication du rapport "To err is human" par l'Institut de Médecine américain, la sécurité des patients est devenu un sujet incontournable des politiques publiques en santé: entre 44 000 et 98 000 personnes décèdent tous les ans aux Etats-Unis suite à des événements indésirables. En plus de mettre en évidence la nécessité de placer la sécurité des patients comme une priorité des autorités médicales, ce rapport centre ses recommandations sur le changement de culture à l'hôpital. C'est ainsi que le terme "culture de sécurité", utilisé dans le nucléaire depuis 30 ans, fait son apparition en milieu médical à partir des années 2000. L'objectif de cet article est de proposer une revue de littérature sur la culture de sécurité dans le domaine de la sécurité des patients. La recherche bibliographique a été réalisée sur la base de données ScienceDirect. Au total, 74 références ont été sélectionnées dont 48 ont été retenues pour la rédaction de cet article. L'analyse du matériel retenu a guidé la rédaction de cet article par thématique, à savoir: l'historique de la notion de culture de sécurité et ses approches classiques; et l'apparition de la notion de culture de sécurité en milieu médical, les méthodes d'évaluation existants et les moyens de son développement durable.
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Dunn AG, Ong MS, Westbrook JI, Magrabi F, Coiera E, Wobcke W. A simulation framework for mapping risks in clinical processes: the case of in-patient transfers. J Am Med Inform Assoc 2011; 18:259-66. [PMID: 21486883 PMCID: PMC3078660 DOI: 10.1136/amiajnl-2010-000075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 02/24/2011] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. DESIGN An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. RESULTS The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. CONCLUSIONS The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols.
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Affiliation(s)
- Adam G Dunn
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia.
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Korst LM, Aydin CE, Signer JMK, Fink A. Hospital readiness for health information exchange: development of metrics associated with successful collaboration for quality improvement. Int J Med Inform 2011; 80:e178-88. [PMID: 21330191 DOI: 10.1016/j.ijmedinf.2011.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 10/26/2010] [Accepted: 01/09/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The development of readiness metrics for organizational participation in health information exchange is critical for monitoring progress toward, and achievement of, successful inter-organizational collaboration. In preparation for the development of a tool to measure readiness for data-sharing, we tested whether organizational capacities known to be related to readiness were associated with successful participation in an American data-sharing collaborative for quality improvement. DESIGN Cross-sectional design, using an on-line survey of hospitals in a large, mature data-sharing collaborative organized for benchmarking and improvement in nursing care quality. MEASUREMENTS Factor analysis was used to identify salient constructs, and identified factors were analyzed with respect to "successful" participation. "Success" was defined as the incorporation of comparative performance data into the hospital dashboard. RESULTS The most important factor in predicting success included survey items measuring the strength of organizational leadership in fostering a culture of quality improvement (QI Leadership): (1) presence of a supportive hospital executive; (2) the extent to which a hospital values data; (3) the presence of leaders' vision for how the collaborative advances the hospital's strategic goals; (4) hospital use of the collaborative data to track quality outcomes; and (5) staff recognition of a strong mandate for collaborative participation (α=0.84, correlation with Success 0.68 [P<0.0001]). CONCLUSION The data emphasize the importance of hospital QI Leadership in collaboratives that aim to share data for QI or safety purposes. Such metrics should prove useful in the planning and development of this complex form of inter-organizational collaboration.
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Affiliation(s)
- Lisa M Korst
- University of Southern California, Department of Obstetrics & Gynecology, Keck School of Medicine, Los Angeles, CA 90033, United States.
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Hansen RA, Cornell PY, Ryan PB, Williams CE, Pierson S, Greene SB. Patterns in nursing home medication errors: disproportionality analysis as a novel method to identify quality improvement opportunities. Pharmacoepidemiol Drug Saf 2010; 19:1087-94. [DOI: 10.1002/pds.2024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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An empirical study for medication delivery improvement based on healthcare professionals’ perceptions of medication delivery system. Health Care Manag Sci 2008; 12:56-66. [DOI: 10.1007/s10729-008-9076-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Technology and pediatric patient safety: what to target is the dilemma. J Pediatr 2008; 152:153-5. [PMID: 18206678 DOI: 10.1016/j.jpeds.2007.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 11/01/2007] [Indexed: 11/23/2022]
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Sittig DF, Ash JS, Guappone KP, Campbell EM, Dykstra RH. Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument. Int J Med Inform 2007; 77:440-7. [PMID: 17931963 DOI: 10.1016/j.ijmedinf.2007.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 07/19/2007] [Accepted: 08/16/2007] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an open-ended, semi-structured survey at three community hospitals. METHODS We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately 5 min to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to. RESULTS Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. CONCLUSIONS The results of such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur.
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Affiliation(s)
- Dean F Sittig
- Medical Informatics Department, Northwest Permanente, Portland, OR 97227, USA.
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Coelli FC, Ferreira RB, Almeida RMVR, Pereira WCA. Computer simulation and discrete-event models in the analysis of a mammography clinic patient flow. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2007; 87:201-7. [PMID: 17606308 DOI: 10.1016/j.cmpb.2007.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 05/16/2007] [Accepted: 05/16/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This work develops a discrete-event computer simulation model for the analysis of a mammography clinic performance. MATERIAL AND METHODS Two mammography clinic computer simulation models were developed, based on an existing public sector clinic of the Brazilian Cancer Institute, located in Rio de Janeiro city, Brazil. Two clinics in a total of seven configurations (number of equipment units and working personnel) were studied. Models tried to simulate changes in patient arrival rates, number of equipment units, available personnel (technicians and physicians), equipment maintenance scheduling schemes and exam repeat rates. Model parameters were obtained by direct measurements and literature reviews. A commercially-available simulation software was used for model building. RESULTS The best patient scheduling (patient arrival rate) for the studied configurations had an average of 29 min for Clinic 1 (consisting of one mammography equipment, one to three technicians and one physician) and 21 min for Clinic 2 (two mammography equipment units, one to four technicians and one physician). The exam repeat rates and equipment maintenance scheduling simulations indicated that a large impact over patient waiting time would appear in the smaller capacity configurations. CONCLUSIONS Discrete-event simulation was a useful tool for defining optimal operating conditions for the studied clinics, indicating the most adequate capacity configurations and equipment maintenance schedules.
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Affiliation(s)
- Fernando C Coelli
- Program of Biomedical Engineering, Luiz Alberto Coimbra Institute - Coppe, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Hakimzada AF, Green RA, Sayan OR, Zhang J, Patel VL. The nature and occurrence of registration errors in the emergency department. Int J Med Inform 2007; 77:169-75. [PMID: 17560165 PMCID: PMC2259219 DOI: 10.1016/j.ijmedinf.2007.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 03/11/2007] [Accepted: 04/29/2007] [Indexed: 11/16/2022]
Abstract
Research into the nature and occurrence of medical errors has shown that these often result from a combination of factors that lead to the breakdown of workflow. Nowhere is this more critical than in the emergency department (ED), where the focus of clinical decisions is on the timely evaluation and stabilization of patients. This paper reports on the nature of errors and their implications for patient safety in an adult ED, using methods of ethnographic observation, interviews, and think-aloud protocols. Data were analyzed using modified "grounded theory," which refers to a theory developed inductively from a body of data. Analysis revealed four classes of errors, relating to errors of misidentification, ranging from multiple medical record numbers, wrong patient identification or address, and in one case, switching of one patient's identification information with those of another. Further analysis traced the root of the errors to ED registration. These results indicate that the nature of errors in the emergency department are complex, multi-layered and result from an intertwined web of activity, in which stress in the work environment, high patient volume and the tendency to adopt shortcuts play a significant role. The need for information technology (IT) solutions to these problems as well as the impact of alternative policies is discussed.
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Affiliation(s)
- A. Forogh Hakimzada
- Laboratory of Decision Making and Cognition, Department of Biomedical Informatics, Columbia University, New York, NY
| | - Robert A. Green
- New York-Presbyterian Hospital/Columbia University Medical Center, Department of Emergency Medicine, New York, NY
| | - Osman R. Sayan
- New York-Presbyterian Hospital/Columbia University Medical Center, Department of Emergency Medicine, New York, NY
| | - Jiajie Zhang
- School of Health Information Sciences, University of Texas Health Science Center at Houston
| | - Vimla L. Patel
- Laboratory of Decision Making and Cognition, Department of Biomedical Informatics, Columbia University, New York, NY
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