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Mamaril M, Card E. Be the Perianesthesia Leadership Voice for the Science of Safety - It's More Than Just a Culture. J Perianesth Nurs 2022; 37:987-988. [DOI: 10.1016/j.jopan.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022]
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Resilient Safety Culture and Safety Performance: Examining the Effect in Malaysian Paramedic Training Institute through Importance-Performance Map Analysis (IPMA). SAFETY 2022. [DOI: 10.3390/safety8020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
An increasing number of studies have shown that safety culture factors have a substantial influence on safety performance in a variety of industrial sectors. These factors’ impact on safety performance are unclear, especially at public service and statutory authorities. On the other hand, the understanding of indicators for safety performance in every working sector in Malaysia is continuing to progress. Hence, this study’s contribution is to explore the influence of safety culture factors (i.e., management commitment and supervision in safety, safety system) and safety competence on safety performance in government paramedic training institutes. Importance-performance map analysis (IPMA) is a technique used in Smart PLS to determine the significance and performance of each of these factors. The study was conducted via an online survey and involved 258 safety and health committee members in the Ministry of Health paramedic training institute. As a matter of relevance, the IPMA’s empirical data study revealed that management commitment and supervision in safety were the predominant factors in determining safety performance. Meanwhile, for performance, the findings showed that worker involvement, safety system, and safety competence perform well in determining safety performance.
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Vázquez-Calatayud M, Oroviogoicoechea C, Pittiglio L, Pumar-Méndez MJ. Nurses' protocol-based care decision-making: a multiple case study. J Clin Nurs 2020; 29:4806-4817. [PMID: 33007122 DOI: 10.1111/jocn.15524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/20/2023]
Abstract
AIM To describe and explain nurses' protocol-based care decision-making. BACKGROUND Protocol-based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol-based care decision-making. Understand this process is key to successful implementation. METHOD A multiple embedded case study was carried out. Nurses' protocol-based care decision-making was studied in three inpatient wards (medical, surgical and medical-surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non-participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting. RESULTS The multiple embedded case study revealed protocol-based care decision-making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost. CONCLUSION This study has allowed progress in protocol-based care decision-making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol-based care. RELEVANCE TO CLINICAL PRACTICE Strategies to promote protocol-based care should address the contexts of practice and the ability of professionals' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost.
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Affiliation(s)
- Mónica Vázquez-Calatayud
- Area of Nursing Professional Development, Clínica Universidad de Navarra, Pamplona, Spain.,Faculty of Nursing, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Cristina Oroviogoicoechea
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Area of Research and Innovation, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - María Jesús Pumar-Méndez
- Faculty of Nursing, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,ImPuLs Research Group, University of Navarra, Pamplona, Spain
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George ER, Hawrusik R, Marx Delaney M, Kara N, Kalita T, Semrau KE. Who's your coach? The relationship between coach characteristics and birth attendants' adherence to the WHO Safe Childbirth Checklist. Gates Open Res 2020; 4:111. [PMID: 32803131 PMCID: PMC7417619 DOI: 10.12688/gatesopenres.13118.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Research demonstrates that coaching is an effective method for promoting behavior change, yet little is known about which attributes of a coach make them more or less effective. This post hoc, sub-analysis of the BetterBirth trial used observational data to explore whether specific coaches' and team leaders' characteristics were associated with improved adherence to essential birth practices listed on the World Health Organization Safe Childbirth Checklist. Methods: A descriptive analysis was conducted on the coach characteristics from the 50 BetterBirth coaches and team leaders. Data on adherence to essential birth practices by birth attendants who received coaching were collected by independent observers. Bivariate linear regression models were constructed, accounting for clustering by site, to examine the association between coach characteristics and attendants' adherence to practices. Results: All of the coaches were female and the majority were nurses. Team leaders were comprised of both males and females; half had clinical backgrounds. There was no association between coaches' or team leaders' characteristics, namely gender, type of degree, or years of clinical training, and attendants' adherence to essential birth practices. However, a significant inverse relationship was detected between the coach or team leader's age and years of experience and the birth attendants' adherence to the checklist. Conclusion: Younger, less experienced coaches were more successful in promoting essential birth practices adherence in this population. More data is needed to fully understand the relationship between coaches and birth attendants.
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Affiliation(s)
- Emily R. George
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
| | - Rebecca Hawrusik
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
| | - Megan Marx Delaney
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
| | - Nabihah Kara
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
| | - Tapan Kalita
- Population Services International, Lucknow, India
| | - Katherine E.A. Semrau
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
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Evaluation of nurses' experiences of a post education program promoting recognition and response to patient deterioration: Phase 2, clinical coach support in practice. Nurse Educ Pract 2020; 46:102835. [PMID: 32778370 DOI: 10.1016/j.nepr.2020.102835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 11/19/2019] [Accepted: 07/02/2020] [Indexed: 11/23/2022]
Abstract
Front-line nurses providing around the clock care are pivotal to the identification, recognition, and response to patient deterioration. However, there is growing evidence that patient deterioration indicators are poorly managed and not escalated to rapid response teams (RRTs), contributing to adverse outcomes. Access to effective educational programs has been cited as vital in optimising nurses' recognition and response to deteriorating patients. Several studies evaluated educational programs, but have not explored nurses' experiences of engaging in patient deterioration events post attendance. Participants in a multimodal education program (DeTER) were invited to attend a series of focus groups three months post workshop as phase two of an overall study. A convenience sample of 22 acute care nurses was recruited. A qualitative descriptive design incorporating focus groups and thematic analysis was used to evaluate participants' experiences of engaging with the RRT during patient deterioration events and whether clinical coach support in practice influenced their recognition and response. Four themes were identified within the data, categorised as enhanced confidence, effective communication, supportive culture, and early response. The importance of an educational model using multimodal strategies, underpinned by coach support and guidance post workshop, was clearly demonstrated to optimise nurses' management of patient deterioration events.
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Abstract
Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.
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Affiliation(s)
- Shilpa J Patel
- John A. Burns School of Medicine, Kapi`olani Medical Center for Women & Children, Hawaii Pacific Health, 1319 Punahou Street, 7th Floor, Honolulu, HI 96826, USA.
| | - Christopher P Landrigan
- Boston Children's Hospital, Brigham & Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA
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Martell R, Macartney JT, Portnik D. New technology and the chain of safety. Healthc Manage Forum 2019; 30:4-9. [PMID: 28929897 DOI: 10.1177/0840470416679044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare is currently experiencing an exponential growth in medical technology but it has not kept pace with similar industries such as the airline industry. New technology has the potential to improve patient safety, but if the introduction of new technology into the healthcare setting is not coordinated in a thoughtful, proactive manner, there may be weak links in the chain of safety that may expose risks for patients. We describe three concepts that represent this chain of safety. We suggest that these are shared among all leadership and frontline staff and that these concepts require their full attention and investment in order to keep the chain of safety intact and avoid a single weak link in implementing new technology.
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Martell R, Macartney JT, Portnik D. Les nouvelles technologies et la chaîne de la sécurité. Healthc Manage Forum 2019; 30:10-15. [PMID: 28929895 DOI: 10.1177/0840470416684206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La technologie médicale connaît une croissance exponentielle dans le milieu de la santé, mais elle n'a toutefois pas suivi le rythme observé dans des industries similaires, telles que l'aéronautique. Les nouvelles technologies ont le potentiel d'accroître la sécurité des patients, mais si leur introduction dans le milieu de la santé n'est pas coordonnée de manière réfléchie et proactive, la chaîne de la sécurité risque de s'en trouver affaiblie, ce qui exposera les patients à des risques. Trois concepts qui représentent la chaîne de la sécurité sont décrits. Les équipes de direction et le personnel de première ligne devraient tous les connaître, les étudier et s'y investir afin de maintenir la chaîne de la sécurité intacte et d'éviter qu'un seul maillon soit affaibli par l'adoption d'une nouvelle technologie.
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We don't miter the sheets on the bed: Understanding the preceptor role in the enculturation of nursing students. Nurse Educ Pract 2018; 32:21-27. [DOI: 10.1016/j.nepr.2018.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/13/2018] [Accepted: 06/28/2018] [Indexed: 11/23/2022]
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The impact of a multimodal education strategy (the DeTER program) on nurses' recognition and response to deteriorating patients. Nurse Educ Pract 2018; 31:130-135. [PMID: 29879637 DOI: 10.1016/j.nepr.2018.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 01/22/2018] [Accepted: 05/21/2018] [Indexed: 11/21/2022]
Abstract
Nurses are ideally positioned to recognise and respond to patient deterioration. However, premonitory signs of patient deterioration are often overlooked, not managed, or not communicated in a timely fashion. Education programs aimed at improving nurses' technical and non-technical skills have been developed, however, the outcomes of these educational strategies remain unclear. A quasi-experimental time series design was used in this study to evaluate the impact of a multi-modal education program (DeTER) on acute care nurses' technical and non-technical skill development and recognition and response to patient deterioration. Participants were asked to complete a survey on four occasions: one month prior to commencement of the DeTER program, immediately prior and post workshop attendance and two-three months' post workshop completion. Pre-intervention, data were collected on participants' demographic profile and their responses to the Clinical Emergency Recognition and Response Survey designed by (Buckley and Gordon, 2011). Post intervention these data were collected again and, in addition, respondents were asked to report on their recent experiences of deteriorating patients and report on their confidence in managing these incidents. Sixty staff consented to participate in the study and all completed the surveys at time 2 and 3. In total 32 staff (45%) responded at all time points. Participants included registered nurses (n = 51; 85%), and enrolled nurses (n = 9; 15%), on average they had worked for 10.4 years (sd = 11.1). Participants rated patient advocacy and assertiveness skills as the most useful aspects of the workshop. Recognition and response to deteriorating patients by ward nurses is a multifaceted process influenced by many factors. Our study supports the importance of multimodal educational strategies in sustaining changes to ward nurses' technical and non-technical skills over time.
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Saleh U, O'Connor T, Afaneh T, Moore Z, Patton D, Derwin R. The use of a Competence Fair to validate nursing competence. NURSE EDUCATION TODAY 2017; 57:1-7. [PMID: 28675822 DOI: 10.1016/j.nedt.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/15/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
Strategies to ensure that nursing competence is maintained and validated are of increasing importance and are much discussed in the nursing literature. Professional bodies, employers, nurses themselves and most importantly patients need to have reassurance that competence across the profession is uniform and is maintained. This is of particular concern in the increasingly globalised and multinational workforces which exist in many health care institutions. This paper describes an educational initiative, and the evaluation thereof, which aimed to validate and enhance nurse competency in a multinational workforce in a medical city in the Kingdom of Saudi Arabia. Results indicate that there was variability in competencies across the organisation which allowed for targeted educational interventions. The initiative was well received by the nurses in the organisation and the evaluation points to the need for ongoing strategies to ensure that competence in maintained.
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Affiliation(s)
| | | | | | - Zena Moore
- King Abdullah Medical City, Saudi Arabia
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Jessee MA, Tanner CA. Pursuing Improvement in Clinical Reasoning: Development of the Clinical Coaching Interactions Inventory. J Nurs Educ 2017; 55:495-504. [PMID: 27560117 DOI: 10.3928/01484834-20160816-03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/18/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Clinical coaching has been identified as a signature pedagogy in nursing education. Recent findings indicate that clinical coaching interactions in the clinical learning environment fail to engage students in the higher order thinking skills believed to promote clinical reasoning. METHOD The Clinical Coaching Interactions Inventory (CCII) was based on evidence of supervisor questioning techniques, the Tanner clinical judgment model, Bloom's Taxonomy, and simulation evaluation tools. Content validity was established with expert assessment, student testing for clarity, and calculation of scale-content validity index/average (S-CVI/Ave). Reliability was established with Kuder-Richardson Formula 20 (KR-20). RESULTS CVI (S-CVI/Ave) was .91, and KR-20 was .70. The CCII identified differences in clinical coaching behaviors in university faculty supervisors and staff nurse preceptor supervisors. CONCLUSION The CCII advances the measurement of clinical coaching interactions from qualitative to quantitative. Ultimately, results from use of this inventory may facilitate the design of prelicensure clinical coaching strategies that promote the improvement of students' clinical reasoning skill. [J Nurs Educ. 2016;55(9):495-504.].
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Faithfull-Byrne A, Thompson L, Schafer KW, Elks M, Jaspers J, Welch A, Williamson M, Cross W, Moss C. Clinical coaches in nursing and midwifery practice: Facilitating point of care workplace learning and development. Collegian 2017. [DOI: 10.1016/j.colegn.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nielsen K, Finderup J, Brahe L, Elgaard R, Elsborg AM, Engell-Soerensen V, Holm L, Juul H, Sommer I. The art of preceptorship. A qualitative study. Nurse Educ Pract 2017; 26:39-45. [PMID: 28668586 DOI: 10.1016/j.nepr.2017.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 11/01/2016] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
In the clinical nursing practice preceptorship is a widespread method to improve patient care by assisting nurses in developing the right clinical skills. However, little is known about how preceptorship should be practiced to achieve a positive learning outcome. The aim of the study was to investigate how preceptorship can be used in clinical practice to create learning and facilitate competence development. A qualitative study guided by a hermeneutic phenomenological approach and inspired by ethnographic fieldwork included 28 participant observations and 58 interviews. Data were analysed according to Steinar Kvale's three interpretation contexts. The findings showed three themes: Being together: Preceptee and preceptor were physically present in the same room optimising the learning situation with focus on complexity, use of senses and patient safety. Doing together: Preceptee and preceptor performed nursing together to obtain skills focusing on independence, practical skills and communication. Getting along together: Preceptee and preceptor together focused on the patient, relation, comfort and managing how to keep the balance between a professional and a personal relation. Precepetorship is situated learning where knowledge and skills are generated through participation in clinical practice. In this way, nurses develop clinical judgement and independence.
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Affiliation(s)
- Karina Nielsen
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Lotte Brahe
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
| | - Randi Elgaard
- Department of Urology, Aarhus University Hospital, Denmark
| | - Anne Marie Elsborg
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | | | - Laila Holm
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark
| | - Hanne Juul
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Irene Sommer
- Department of Cardiology, Aarhus University Hospital, Denmark
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Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrea Herepath
- Sir Roland Smith Centre for Strategic Management, Department of Entrepreneurship, Strategy and Innovation, Lancaster University Management School, Lancaster University, Lancaster, UK
- Cardiff Business School, Cardiff University, Cardiff, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
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