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Thomas T, Hampton D, Butler K, Hudson JL. Assessing the Value of Huddle Implementation in the Perioperative Setting. AORN J 2023; 118:14-23. [PMID: 37368531 DOI: 10.1002/aorn.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 06/29/2023]
Abstract
Communication is essential for safe, effective patient care. In perioperative services, where interdisciplinary teamwork is crucial, communication breakdowns may lead to increased errors, decreased staff member satisfaction, and poor team performance. This process improvement project focused on instituting perioperative huddles for two months and measuring the effect that they had on staff members' satisfaction, engagement, and communication effectiveness. We used validated, Likert-style survey tools to gauge participants' satisfaction, level of engagement, communication practices, and opinions about the value of huddles before and after implementation, in addition to an open-ended descriptive question in the postsurvey. Sixty-one participants completed the presurvey and 24 participants completed the postsurvey. Scores across all categories increased post huddle implementation. Benefits of the huddles noted by participants included timely and consistent messaging, sharing essential information, and increased feelings of connection between perioperative leaders and staff members.
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Auschra C, Asaad E, Sydow J, Hinkelmann J. Interventions Into Reliability-Seeking Health Care Organizations: A Systematic Review of Their Goals and Measuring Methods. J Patient Saf 2022; 18:e1211-e1218. [PMID: 35948320 DOI: 10.1097/pts.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES Within the last 2 decades, numerous interventions making use of high-reliability theory have been implemented to increase reliability in healthcare organizations. This systematic literature review first explores the concrete goals on which such interventions focus. Second, the review captures how the achievement of these goals, or alternatively a change, generally an increase in organizational reliability, is measured across different contexts. METHODS Searches were conducted in PubMed, Academic Search Ultimate, Business SourcePremier, CINAHL, Communication Source, EconLit, ERIC, Medline, Political Science Complete, PsycArticles, APA PsycInfo, PSYNDEX, SocINDEX (via the resource hosterEbscoHost), and Web of Science (through November 22, 2021). Peer-reviewed, English language studies were included, reporting on the implementation of a concrete intervention to increase reliability in a medical context and referring to high-reliability theory. RESULTS The search first yielded 8896 references, from which 75 studies were included in the final sample. Important healthcare goals stated by the seminal report "Crossing the Quality Chasm" guided the analysis of the included studies. Most of the studies originated from the United States and report on interventions to increase reliability of either organizational units or whole organizations when aiming for safety (n = 65). Other goals reported on include effectiveness, and much less frequently timeliness, patient centeredness, and efficiency. Fifty-eight studies use quantitative measurement exclusively to account for the achievement of these goals; 7 studies use qualitative measurement exclusively, and 10 studies use a mixed-method approach. The operationalization of goals, including the operationalization of organizational reliability, and measurement methods do not follow a unified approach, despite claiming to be informed by a coherent theory. Instead, such operationalizations strongly depend on the overall objective of the study and the respective context. CONCLUSIONS Measuring the outcomes of high-reliability interventions into healthcare organizations is challenging for different reasons, including the difficult operationalization of partly overlapping goals, the complex, processual nature of achieving reliability, and the limited ability of organizations striving for more reliability if they are already performing on a high level. This review critically assesses the adoption of the goals stated in the seminal report "Crossing the Quality Chasm" and provides insights for organizations and funding providers that strive to evaluate more reliable service provision.
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Affiliation(s)
- Carolin Auschra
- From the Department of Management, Freie Universität Berlin, Berlin, Germany
| | | | - Jörg Sydow
- From the Department of Management, Freie Universität Berlin, Berlin, Germany
| | - Jürgen Hinkelmann
- Department for Anesthesiology, Intensive Care and Emergency Medicine, St Josefs Hospital, Dortmund, Germany
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Huddles and their effectiveness at the frontlines of clinical care: a scoping review. J Gen Intern Med 2021; 36:2772-2783. [PMID: 33559062 PMCID: PMC8390736 DOI: 10.1007/s11606-021-06632-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research. METHODS A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts. RESULTS Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%). DISCUSSION Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes. STUDY REGISTRATION This scoping review was registered with the Open Science Framework on 18 January 2019 ( https://osf.io/bdj2x/ ).
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Foo CD, Surendran S, Tam CH, Ho E, Matchar DB, Car J, Koh GCH. Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore: a qualitative study. BMJ Open 2021; 11:e046010. [PMID: 33947737 PMCID: PMC8098912 DOI: 10.1136/bmjopen-2020-046010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) policy was promulgated as a model of care to organise private general practitioners (GPs) into groups to provide GPs with resources to anchor patients with chronic conditions with them in the community. As PCN is still in its embryonic stages, there is a void in research regarding its ability to empower GPs to manage patients with chronic conditions effectively. This qualitative study aims to explore the facilitators and barriers for the management of patients with chronic conditions by GPs enrolled in PCN. DESIGN We conducted 30 semistructured interviews with GPs enrolled in a PCN followed by a thematic analysis of audio transcripts until data saturation was achieved. SETTING Singapore. RESULTS Our results suggest that PCNs facilitated GPs to more effectively manage patients through (1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a 'one-stop-shop', (2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients' health outcomes and (3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions. CONCLUSION PCNs demonstrate great promise in empowering enrolled GPs to manage patients with chronic conditions. However, barriers will need to be addressed to ensure the viability of PCNs in managing more patients in the face of an ageing population.
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Affiliation(s)
- Chuan De Foo
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Shilpa Surendran
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Chen Hee Tam
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Elaine Ho
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - David Bruce Matchar
- Internal Medicine, Duke University, Durham, North Carolina, USA
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gerald Choon Huat Koh
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
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Using the Patient Safety Huddle as a Tool for High Reliability. Jt Comm J Qual Patient Saf 2019; 44:219-226. [PMID: 29579447 DOI: 10.1016/j.jcjq.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/06/2017] [Indexed: 11/24/2022]
Abstract
A Patient Safety Huddle was developed at a community hospital (Providence Little Company of Mary Medical Center, San Pedro, California) through consultation with key stakeholders. The goal was to become a high reliability organization by improving communication across different departments, troubleshooting operational problems, focusing on safety and quality metrics, and reporting unusual occurrences. The Patient Safety Huddle involved executives in development and implementation, respect for employee time, ensuring accountability, and empowering frontline staff to foresee and deal with safety issues. The current template of the Patient Safety Huddle agenda and the Documentation Tools used to address patient safety issues are provided.
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Dogbey GY, Collins K, Russ R, Brannan GD, Mivsek M, Sewell S. Factors Associated With Osteopathic Primary Care Residency Choice Decisions. J Osteopath Med 2019; 118:225-233. [PMID: 29582057 DOI: 10.7556/jaoa.2018.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context The osteopathic medical profession traditionally emphasized the education of primary care physicians. A common thread for both osteopathic and allopathic residency matches, however, has been an increase in the interest in specialties outside of primary care. Objective To determine whether there are critical points in medical school associated with residency selection decision-making, what factors affect residency selection decisions, and whether any identifiable shifts or trends exist. Methods This mixed-methods study sequentially used qualitative and quantitative research approaches. The study population was a convenience sample of osteopathic medical students, interns and residents, and practicing physicians from partner medical schools, associated hospitals, and a regional association of osteopathic physicians. In the first phase, interviews and focus group discussions were analyzed for codes, categories, and themes relating to factors that influence residency selection. In the second phase, a survey was created from the results of the first phase and administered to study participants. Results Of the 3450 potential participants, 282 completed the survey. Ninety-one of 209 participants (43.5%) indicated that the third year of medical school was the time they will or did decide what type of residency program to pursue. There were no significant differences in the mean scores between the respondent groups (ie, students, residents, and physicians) when ranking the importance of the 10 influential factors associated with residency selection decision-making (P>.05 for all). Conclusion The highest percentage of participants indicated the third year of medical school was the time that they made residency selection decisions regarding what specialty they were interested in entering. No shifts regarding the importance of specific primary care residency choice factors were found between training status of respondents.
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Jennings BM, Yeager KA, Feistritzer NR, Gullatte MM, Martyn KK. Enacting high reliability principles while caring for people with Ebola Virus Disease. Am J Infect Control 2018; 46:1167-1173. [PMID: 29784444 DOI: 10.1016/j.ajic.2018.04.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fear surrounds Ebola Virus Disease (EVD) because it is highly infectious. Yet members of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) had to overcome that fear when caring for patients with EVD. PURPOSE The analysis reported here illustrates how the members of EUH's SCDU tacitly enacted high reliability (HR) principles while caring for patients with EVD. METHODS A qualitative study was conducted to describe the experience of members of the EUH SCDU who worked with EVD patients in 2014. We completed 17 semi-structured interviews involving registered nurses, physicians, and support personnel (eg, laboratory technicians). Interview recordings were transcribed and analyzed using conventional content analysis. Exploring HR principles was not among the questions guiding this exploration, but the participants repeatedly described concepts related to HR. RESULTS The goal of the SCDU team was to save patients' lives while protecting their own lives. Rigorous training and meeting high standards were required to make the team. The fear surrounding EVD set in motion the enactment of HR principles. HR principles served to alleviate failures or breakdowns in infection prevention and control, thus keeping patients and staff safe. CONCLUSIONS These findings illustrate that it is possible to move HR principles from theory to practice in high-risk situations. HR principles were essential to safety and to infection prevention and control.
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Affiliation(s)
| | | | | | - Mary M Gullatte
- Nursing Innovation and Research, Emory Healthcare, Inc., Atlanta, GA
| | - Kristy K Martyn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Weaver RR. Reconciling evidence-based medicine and patient-centred care: defining evidence-based inputs to patient-centred decisions. J Eval Clin Pract 2015; 21:1076-80. [PMID: 26456314 PMCID: PMC5057360 DOI: 10.1111/jep.12465] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 01/06/2023]
Abstract
Evidence-based and patient-centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards 'cookbook' medicine undermine the view of patients as unique particulars, and diminish what might be considered patient-centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence-based and person-centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients' uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner-patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence-based and patient-centred approaches.
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Affiliation(s)
- Robert R Weaver
- Health Sciences, University of Ontario, Institute of Technology, Oshawa, Ontario, Canada
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Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, Abramson DH, Shields CL, Chantada GL, Njuguna F, Gallie BL. Retinoblastoma. Nat Rev Dis Primers 2015; 1:15021. [PMID: 27189421 PMCID: PMC5744255 DOI: 10.1038/nrdp.2015.21] [Citation(s) in RCA: 339] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retinoblastoma is a rare cancer of the infant retina that is diagnosed in approximately 8,000 children each year worldwide. It forms when both retinoblastoma gene (RB1) alleles are mutated in a susceptible retinal cell, probably a cone photoreceptor precursor. Loss of the tumour-suppressive functions of the retinoblastoma protein (pRB) leads to uncontrolled cell division and recurrent genomic changes during tumour progression. Although pRB is expressed in almost all tissues, cone precursors have biochemical and molecular features that may sensitize them to RB1 loss and enable tumorigenesis. Patient survival is >95% in high-income countries but <30% globally. However, outcomes are improving owing to increased disease awareness for earlier diagnosis, application of new guidelines and sharing of expertise. Intra-arterial and intravitreal chemotherapy have emerged as promising methods to salvage eyes that with conventional treatment might have been lost. Ongoing international collaborations will replace the multiple different classifications of eye involvement with standardized definitions to consistently assess the eligibility, efficacy and safety of treatment options. Life-long follow-up is warranted, as survivors of heritable retinoblastoma are at risk for developing second cancers. Defining the molecular consequences of RB1 loss in diverse tissues may open new avenues for treatment and prevention of retinoblastoma, as well as second cancers, in patients with germline RB1 mutations.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, Toronto, Canada
| | - Timothy W. Corson
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Cobrinik
- The Vision Center, Children’s Hospital Los Angeles & USC Eye Institute, University of Southern California, Los Angeles, CA USA
| | | | - Junyang Zhao
- Department of Ophthalmology, Beijing Children’s Hospital, Capital Medial University, Beijing, China
| | - Francis L. Munier
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - David H. Abramson
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | - Festus Njuguna
- Department of Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Brenda L. Gallie
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, 555 University Ave, Toronto, Ontario M5G1X8, Canada
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