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van Dijk MD, van Beeck EF, Huis A, van der Gun BT, Polinder S, van Eijsden RA, Burdorf A, Vos MC, Erasmus V. Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before-after study in operating theatres in the Netherlands. BMJ Open 2023; 13:e073137. [PMID: 37085301 PMCID: PMC10124304 DOI: 10.1136/bmjopen-2023-073137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating theatre (OT). DESIGN Multicentre before-after study. SETTING This study was performed in four Dutch hospitals. INTERVENTION The QI team training intervention consisted of four sessions per hospital and stimulated participants to set culture norms and targets, identify barriers, and formulate management activities to improve compliance with four standard operating procedures (SOPs) of a SSI bundle in the OT. Participants were executive board members, top-level managers, leading clinicians and support staff. The four SOPs were: (1) reducing door movements; (2) preoperative antibiotic prophylaxis prescribing; (3) preoperative shaving; and (4) postoperative normothermia. Poisson and logistic regression analyses were performed to analyse the effect of the intervention on compliance with the individual SOPs (primary outcome measure) and on the influence of medical specialty, time of day the procedure took place and time in the OT (secondary outcome measures). RESULTS Not all management layers were successfully involved during all sessions in the hospitals. Top-level managers were best represented in all hospitals, leading clinicians the least. The number of implemented improvement activities was low, ranging between 2 and 14. The team training intervention we developed was not associated with improvements in the compliance with the four SOP of the SSI bundle. Medical specialty, time of day, and time in OT were associated with median number of door movements, and preoperative antibiotic prophylaxis administration. CONCLUSION This study showed that after the QI team training intervention the overall compliance with the four SOPs did not improve. Minimal involvement of leading clinicians and a low number of self-initiated activities after the team training were important barriers for compliance.
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Affiliation(s)
- Manon D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ed F van Beeck
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anita Huis
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bernardina Tf van der Gun
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rianne Am van Eijsden
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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2
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Inayat H, Torti J, Hemmett J, Lingard L, Chau B, Inayat A, Elzinga JL, Sultan N. An Approach to Leadership Development and Patient Safety and Quality Improvement Education in the Context of Professional Identity Formation in Pre-Clinical Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231170522. [PMID: 37187919 PMCID: PMC10176555 DOI: 10.1177/23821205231170522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
Objectives Leadership and patient safety and quality improvement (PSQI) are recognized as essential parts of a physician's role and identity, which are important for residency training. Providing adequate opportunities for undergraduate medical students to learn skills related to these areas, and their importance, is challenging. Methods The Western University Professional Identity Course (WUPIC) was introduced to develop leadership and PSQI skills in second-year medical students while also aiming to instill these topics into their identities. The experiential learning portion was a series of student-led and physician-mentored PSQI projects in clinical settings that synthesized leadership and PSQI principles. Course evaluation was done through pre/post-student surveys and physician mentor semi-structured interviews. Results A total of 108 of 188 medical students (57.4%), and 11 mentors (20.7%), participated in the course evaluation. Student surveys and mentor interviews illustrated improved student ability to work in teams, self-lead, and engage in systems-level thinking through the course. Students improved their PSQI knowledge and comfort levels while also appreciating its importance. Conclusion The findings from our study suggest that undergraduate medical students can be provided with an enriching leadership and PSQI experience through the implementation of faculty-mentored but student-led groups at the core of the curricular intervention. As students enter their clinical years, their first-hand PSQI experience will serve them well in increasing their capacity and confidence to take on leadership roles.
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Affiliation(s)
- Hamza Inayat
- Schulich School of Medicine &
Dentistry at Western University in London, Ontario, Canada
| | - Jacqueline Torti
- Department of Medicine, and Scientist,
Centre for Education Research and Innovation, Schulich School of Medicine and
Dentistry, Western University, London, Canada
| | - Juliya Hemmett
- Division of Nephrology, Department of
Medicine, Cummings School of Medicine, Calgary, Canada
| | - Lorelei Lingard
- Department of Medicine, and Scientist,
Centre for Education Research and Innovation, Schulich School of Medicine and
Dentistry, Western University, London, Canada
| | - Brandon Chau
- Department of Emergency Medicine,
University of British Columbia, Kelowna, Canada
| | - Ali Inayat
- Medical Student at the St. George's
University, Grenada, West Indies, and Northumbria University, Newcastle,
England
| | - Jason L. Elzinga
- Physician for the Department of
Emergency Medicine at the University of Calgary, Calgary, Canada
| | - Nabil Sultan
- Nephrologist and Associate Professor in
the Department of Nephrology, Schulich School of Medicine &
Dentistry, Western University, London, Canada
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Buja A, Damiani G, Manfredi M, Zampieri C, Dentuti E, Grotto G, Sabatelli G. Governance for Patient Safety: A Framework of Strategy Domains for Risk Management. J Patient Saf 2022; 18:e769-e800. [PMID: 35067624 DOI: 10.1097/pts.0000000000000947] [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: 11/26/2022]
Abstract
BACKGROUND Adverse events in healthcare are primarily due to system failures rather than individuals. Risk reduction strategies should therefore focus on strengthening systems, bringing about improvements in governance, and targeting individual practices or products. The purpose of this study was to conduct a scoping review to develop a global framework of management strategies for sustaining a safety-oriented culture in healthcare organizations, focusing on patient safety and the adoption of good safety-related practices. METHODS We conducted a search on safety-related strategies in 2 steps. The first involved a search in the PubMed database to identify effective, broadly framed, cross-sector domains relevant to clinical risk management strategies in healthcare systems. In the second step, we then examined the strategies adopted by running a scoping review for each domain. RESULTS Our search identified 8 strategy domains relevant to patient safety: transformational leadership, patient engagement, human resources management quality, innovation technology, skills certification, education in patient safety, teamwork, and effective communication. CONCLUSIONS This scoping review explores management strategies key to healthcare systems' efforts to create safety-oriented organizations. Improvement efforts should focus particularly on the domains identified: combined together, they would nurture an overall safety-oriented culture and have an impact on preventable adverse events.
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Affiliation(s)
- Alessandra Buja
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | | | - Mariagiovanna Manfredi
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | - Chiara Zampieri
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | - Elena Dentuti
- University of Padua School of Nursing Sciences, Padova
| | - Giulia Grotto
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
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4
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Ahmadi S, Haghgoshayie E, Arjmand A, Hajebrahimi S, Hasanpoor E. Patient safety improvement with the patient engagement in Iran: A best practice implementation project. PLoS One 2022; 17:e0267823. [PMID: 35544524 PMCID: PMC9094506 DOI: 10.1371/journal.pone.0267823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Patient engagement in patient safety is aimed at increasing the awareness and participation of patients in error-prevention strategies. The aim of this project was to improve the patient safety with the patient engagement within the local context of a maternity hospital by implementing best practice. Methods A clinical audit was conducted using the JBI Practical Application of Clinical Evidence System tool. The current project was conducted in surgical ward of Shahid-Beheshti maternity hospital, Iran. The sample size was 46 patients and 46 healthcare practitioners for both the baseline and follow-up. In phase 1, four audit criteria were used and a baseline audit was conducted for this project. In phase 2, barriers to compliance were identified, and strategies were adopted to promote best practice. In phase 3, a follow-up audit was conducted. Results The results showed varying levels of compliance with the four criteria used in this project. The criterion 1, which was related to training of healthcare practitioners on how they can support patients, has the highest compliance at 87% in baseline and follow up data collection. Furthermore, compared with the baseline data (criterion 2 = 52%; criterion 3 = 37%; criterion 4 = 61%), compliance with criteria 2, 3, and 4 notably improved at 85, 76, and 92%, respectively. Conclusions The present project successfully implements patient engagement in Iran and reveals varying results on compliance and the increasing knowledge of healthcare practitioners and patients on evidence-based patient engagement in order to improve the patient safety. The used strategies can facilitate implementation of evidence based procedures in clinical practice.
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Affiliation(s)
- Sajjad Ahmadi
- Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elaheh Haghgoshayie
- Department of Healthcare Management, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
- Research Centre for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Allahveirdy Arjmand
- Department of Anesthesiology, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Sakineh Hajebrahimi
- Research Centre for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Hasanpoor
- Department of Healthcare Management, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
- Research Centre for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
- * E-mail:
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5
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Hospital quality-review spending and patient safety: a longitudinal analysis using instrumental variables. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021. [DOI: 10.1007/s10742-021-00251-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6
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Joniaková Z, Jankelová N, Blštáková J, Némethová I. Cognitive Diversity as the Quality of Leadership in Crisis: Team Performance in Health Service during the COVID-19 Pandemic. Healthcare (Basel) 2021; 9:313. [PMID: 33799831 PMCID: PMC8001430 DOI: 10.3390/healthcare9030313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/27/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022] Open
Abstract
The level of leadership skills of healthcare team leaders has long been the subject of interest and many discussions. Several studies have pointed to their inadequacy, which is becoming a serious problem during the global crisis due to the Covid-19 pandemic. There is a direct link between the leadership in the healthcare system and its performance, conditioned by the level of decisions of leaders of medical teams. It is they who determine the performance of healthcare delivery. The study published in this article contains the results from the examination of the dependence between crisis leadership and team performance in healthcare providers. The subject of the research is the impact of cognitive diversity and the quality of crisis-leadership decision-making on the performance of medical teams in the acute crisis phase. The study was conducted on a research sample of 216 healthcare providers after the outbreak of the COVID-19 pandemic in Slovakia (April 2020). The respondents to the research sample involved team leaders in healthcare providers, who have been involved in managing the crisis. The study has justified the positive association between crisis leadership and team performance, which is mediated by cognitive diversity, supporting the quality of decision-making in crisis leadership. The results of the research have proven that the performance of the medical team in the acute crisis phase can be positively influenced through qualified decision-making in crisis leadership amplified by the usage of cognitive diversity.
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Affiliation(s)
- Zuzana Joniaková
- Department of Management, Faculty of Business Management, University of Economics in Bratislava, Dolnozemská Cesta 1, 852 35 Bratislava, Slovakia; (N.J.); (J.B.); (I.N.)
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7
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Garuma M, Woldie M, Kebene FG. Areas of Potential Improvement for Hospitals' Patient-Safety Culture in Western Ethiopia. DRUG HEALTHCARE AND PATIENT SAFETY 2020; 12:113-123. [PMID: 32848480 PMCID: PMC7425101 DOI: 10.2147/dhps.s254949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/14/2020] [Indexed: 11/23/2022]
Abstract
Background Patient-safety culture is an important component of health-care quality and currentlyan issue of high concern globally. In Ethiopia, little is known about patient-safety culture in hospitals. We assessed the patient-safety culture and associated factors among health-care workers in public hospitals of East Wollega Zone, western Ethiopia. Methods This institution-based cross-sectional study was conducted among 421 health-care workers selected using simple random sampling from March 4 to March 29, 2019. A standardized measuring 12 patient safety–culture components was used for data collection. Data were cleaned and entered into EpiData version 3.1 and analysis done using SPSS version 25 (IBM). Bivariate and multivariate linear regression analyses were performed. Significance was set at 95% CI and p<0.05, and unstandardized β-coefficients were used to measure extent of association. Results This study revealed that the level of patient-safety culture was 49.2% and patient safety culture–component scores ranged from 29.2% for nonpunitive responses to error to 77.9% for teamwork within a hospital unit. Age ≥45 years (β=13.642, CI: 5.324–21.959; p=0.001), 1–5 years’ experience at the current hospital (β=5.559, 95% CI 2.075–9.042; p=0.002), and working in general hospitals (β=11.988, 95% CI 7.233–16.743; p<0.001) and primary hospitals (β=6.408, 95% CI 2.192–10.624; p=0.003) were factors associated with better scores on patient-safety culture. Conclusion Overall scores for patient-safety culture were low. Improving the current state of patient safety in public hospitals would require tailored interventions to address low-scoring components, such as nonpunitive responses to error.
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Affiliation(s)
- Melkamu Garuma
- Nekemte Public Health Research and Referral Laboratory, East Wollega Zone, Oromia Region, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Addis Ababa, Ethiopia.,Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Feyera Gebissa Kebene
- Department of Public Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
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8
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Feeser VR, Jackson A, Senn R, Layng T, Santen SA, Creditt AB, Dhindsa HS, Vitto MJ, Savage NM, Hemphill RR. Patient Safety Event Reporting and Opportunities for Emergency Medicine Resident Education. West J Emerg Med 2020; 21:900-905. [PMID: 32726262 PMCID: PMC7390572 DOI: 10.5811/westjem.2020.3.46018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/09/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Healthcare systems often expose patients to significant, preventable harm causing an estimated 44,000 to 98,000 deaths or more annually. This has propelled patient safety to the forefront, with reporting systems allowing for the review of local events to determine their root causes. As residents engage in a substantial amount of patient care in academic emergency departments, it is critical to use these safety event reports for resident-focused interventions and educational initiatives. This study analyzes reports from the Virginia Commonwealth University Health System to understand how the reports are categorized and how it relates to opportunities for resident education. Methods Identifying categories from the literature, three subject matter experts (attending physician, nursing director, registered nurse) categorized an initial 20 reports to resolve category gaps and then 100 reports to determine inter-rater reliability. Given sufficient agreement, the remaining 400 reports were coded individually for type of event and education among other categories. Results After reviewing 513 events, we found that the most common event types were issues related to staff and resident training (25%) and communication (18%), with 31% requiring no education, 46% requiring directed educational feedback to an individual or group, 20% requiring education through monthly safety updates or meetings, 3% requiring urgent communication by email or in-person, and <1% requiring simulation. Conclusion Twenty years after the publication of To Err is Human, gains have been made integrating quality assurance and patient safety within medical education and hospital systems, but there remains extensive work to be done. Through a review and analysis of our patient safety event reporting system, we were able to gain a better understanding of the events that are submitted, including the types of events and their severity, and how these relate to the types of educational interventions provided (eg, feedback, simulation). We also determined that these events can help inform resident education and learning using various types of education. Additionally, incorporating residents in the review process, such as through root cause analyses, can provide residents with high-quality, engaging learning opportunities and useful, lifelong skills, which is invaluable to our learners and future physicians.
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Affiliation(s)
- V Ramana Feeser
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia
| | - Anne Jackson
- Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia
| | - Regina Senn
- Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia
| | - Timothy Layng
- Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia
| | - Sally A Santen
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia
| | - Angela B Creditt
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia
| | - Harinder S Dhindsa
- Virginia Commonwealth University Health System, Department of Emergency Medicine, Division of Emergency Medical Services, Richmond, Virginia
| | - Michael J Vitto
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia
| | - Nastassia M Savage
- Virginia Commonwealth University School of Medicine, Office of Assessment, Evaluation, and Scholarship, Richmond, Virginia
| | - Robin R Hemphill
- Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia
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Abu Awwad D, Lewis SJ, Mackay S, Robinson J. Examining the Relationship between Emotional Intelligence, Leadership Attributes and Workplace Experience of Australian Chief Radiographers. J Med Imaging Radiat Sci 2020; 51:256-263. [DOI: 10.1016/j.jmir.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
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10
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Abuosi AA, Akologo A, Anaba EA. Determinants of patient safety culture among healthcare providers in the Upper East Region of Ghana. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519876756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Aaron A Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | - Alexander Akologo
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | - Emmanuel A Anaba
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
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11
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Gardner R. Office Patient Safety. Obstet Gynecol Clin North Am 2019; 46:339-351. [PMID: 31056135 DOI: 10.1016/j.ogc.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patient safety is inseparable from quality and is a top priority for the United States health care system. This article explores factors that contribute to errors and patient harm in office practice, discusses key ways in which errors in the outpatient setting compare with those occurring in the inpatient setting, and describes strategies for supporting and improving patient safety in office practice.
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Affiliation(s)
- Roxane Gardner
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Center for Medical Simulation, Boston, MA, USA; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Center for Medical Simulation, Boston, MA, USA; Division of Adolescent Gynecology, Boston Children's Hospital, 300 Longwood Avenue, 5th Floor, Boston, MA 02115, USA; Center for Medical Simulation, Boston, MA, USA.
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12
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Sahlström M, Partanen P, Turunen H. Patient-reported experiences of patient safety incidents need to be utilized more systematically in promoting safe care. Int J Qual Health Care 2019; 30:778-785. [PMID: 29668942 DOI: 10.1093/intqhc/mzy074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 04/07/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To analyze patient safety incidents (PSIs) reported by patients and their use in Finnish healthcare organizations. Study Design Cross-sectional study. Setting About 15 Finnish healthcare organizations ranging from specialized hospital care to home care, outpatient and inpatient clinics, and geographically diverse areas of Finland. Participants The study population included all Finnish patients who had voluntarily reported PSI via web-based system in 2009-15. Main Outcome Measure(s) Quantitative analysis of patients' safety reports, inductive content analysis of patients' suggestions to prevent the reoccurrence incidents and how those suggestions were used in healthcare organizations. Results Patients reported 656 PSIs, most of which were classified by the healthcare organizations' analysts as problems associated with information flow (32.6%) and medications (18%). Most of the incidents (65%) did not cause any harm to patients. About 76% of the reports suggested ways to prevent reoccurrence of PSIs, most of which were feasible, system-based amendments of processes for reviewing or administering treatment, anticipating risks or improving diligence in patient care. However, only 6% had led to practical implementation of corrective actions in the healthcare organizations. Conclusions The results indicate that patients report diverse PSIs and suggest practical systems-based solutions to prevent their reoccurrence. However, patients' reports rarely lead to corrective actions documented in the registering system, indicating that there is substantial scope to improve utilization of patients' reports. There is also a need for strong patient safety management, including willingness and commitment of HCPs and leaders to learn from safety incidents.
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Affiliation(s)
- Merja Sahlström
- Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Finland.,Ylä-Savo SOTE Joint Municipal Authority, Finland
| | - Pirjo Partanen
- Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Finland.,Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Kuopio University Hospital, Kuopio, Finland
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13
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Al-Mandhari A, Al-Farsi S, Al-Barwani S, Al-Salmani N, Al-Rabhi S, Al-Saidi S, Abulmajd K, Al-Adawi S. Developing patient safety system using WHO tool in hospitals in Oman. Int J Qual Health Care 2018; 30:423-428. [PMID: 29590368 DOI: 10.1093/intqhc/mzy050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/11/2018] [Indexed: 01/15/2023] Open
Abstract
Objective Oman is progressively implementing the Patient Safety Friendly Hospital Initiative (PSFHI), a tool formulated by the World Health Organization (WHO) to achieve optimal patient safety in hospitals. This paper describes its implementation in selected government and private hospitals in Oman and analyses the performance of four hospitals whose implementations of PSFHI were assessed by WHO. Design The PSFHI initiative was launched in 11 hospitals in Oman during 2016. The enrolled hospitals implemented a 1-year plan composed of several steps such as formation of steering committees, working groups, full orientation about the standards, training of staff, documents development and community involvement. One year later, four hospitals which were the earliest to join the initiative were subjected to WHO assessment. Setting Secondary level government and private hospitals. Intervention(s) The WHO-PSFHI standards. Main Outcome Measure Hospitals' adherence to the standards. Results Three of the four hospitals (one government and two private) scored level two. One government hospital scored level three, earning it the distinction of being the first hospital in the Eastern Mediterranean Region to reach level three in the very first assessment. Conclusions Implementation of PSFHI in selected hospitals of Oman had successful outcomes in improving patient's safety.
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Affiliation(s)
- A Al-Mandhari
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman.,Quality Assurance Center, Ministry of Health, Muscat, Oman
| | - S Al-Farsi
- Quality Assurance Center, Ministry of Health, Muscat, Oman
| | - S Al-Barwani
- Quality Assurance Center, Ministry of Health, Muscat, Oman
| | - N Al-Salmani
- Quality Assurance Center, Ministry of Health, Muscat, Oman
| | - S Al-Rabhi
- Quality Assurance Center, Ministry of Health, Muscat, Oman
| | - S Al-Saidi
- Quality Assurance Center, Ministry of Health, Muscat, Oman
| | - K Abulmajd
- Quality Assurance Center, Ministry of Health, Muscat, Oman
| | - S Al-Adawi
- Behavioral Medicine Department, Sultan Qaboos Universality Hospital, Muscat, Oman
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14
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Sfantou DF, Laliotis A, Patelarou AE, Sifaki-Pistolla D, Matalliotakis M, Patelarou E. Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare (Basel) 2017; 5:E73. [PMID: 29036901 PMCID: PMC5746707 DOI: 10.3390/healthcare5040073] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 01/20/2023] Open
Abstract
Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004-2015. The research question that guided this review was posed as: "Is there any relationship between leadership style in healthcare settings and quality of care?" Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals.
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Affiliation(s)
- Danae F Sfantou
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens 12462, Greece.
| | - Aggelos Laliotis
- Department of Upper Gastrointestinal and Bariatric Surgery, St. Georges, NHS Foundation Hospitals, London SE170QT, UK.
| | - Athina E Patelarou
- Department of Anesthesiology, University Hospital of Heraklion, Crete 71500, Greece.
| | - Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete 71500, Greece.
| | - Michail Matalliotakis
- Department of Obstretics and Gynaecology, Venizeleio General Hospital, Heraklion, 71409, Greece.
| | - Evridiki Patelarou
- Florence Nightingale Faculty of Nursing and Midwifery, King's College, London SE18WA, UK.
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Sullivan JL, Rivard PE, Shin MH, Rosen AK. Applying the High Reliability Health Care Maturity Model to Assess Hospital Performance: A VA Case Study. Jt Comm J Qual Patient Saf 2017; 42:389-411. [PMID: 27535456 DOI: 10.1016/s1553-7250(16)42080-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization (HRO)-related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices. Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. The High Reliability Health Care Maturity (HRHCM) model, a model for health care organizations' achievement of high reliability with zero patient harm, incorporates three major domains critical for promoting HROs-Leadership, Safety Culture, and Robust Process Improvement ®. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. METHODS Staff perceptions of patient safety at six US Department of Veterans Affairs (VA) hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity. RESULTS Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components. DISCUSSION The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability.
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Affiliation(s)
- Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, USA
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16
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Collaborating with nurse leaders to develop patient safety practices. Leadersh Health Serv (Bradf Engl) 2017; 30:249-262. [DOI: 10.1108/lhs-05-2016-0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The organisational level and leadership development are crucial elements in advancing patient safety, because patient safety weaknesses are often caused by system failures. However, little is known about how frontline leader and director teams can be supported to develop patient safety practices. The purpose of this study is to describe the patient safety development process carried out by nursing leaders and directors. The research questions were: how the chosen development areas progressed in six months’ time and how nursing leaders view the participatory development process.
Design/methodology/approach
Participatory action research was used to engage frontline nursing leaders and directors into developing patient safety practices. Semi-structured group interviews (N = 10) were used in data collection at the end of a six-month action cycle, and data were analysed using content analysis.
Findings
The participatory development process enhanced collaboration and gave leaders insights into patient safety as a part of the hospital system and their role in advancing it. The chosen development areas advanced to different extents, with the greatest improvements in those areas with simple guidelines to follow and in which the leaders were most participative. The features of high-reliability organisation were moderately identified in the nursing leaders’ actions and views. For example, acting as a change agent to implement patient safety practices was challenging. Participatory methods can be used to support leaders into advancing patient safety. However, it is important that the participants are familiar with the method, and there are enough facilitators to steer development processes.
Originality/value
Research brings more knowledge of how leaders can increase their effectiveness in advancing patient safety and promoting high-reliability organisation features in the healthcare organisation.
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17
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Critical Access Hospital Use of TeamSTEPPS to Implement Shift-Change Handoff Communication. J Nurs Care Qual 2017; 32:77-86. [PMID: 27270844 DOI: 10.1097/ncq.0000000000000203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Implementation of handoff as part of TeamSTEPPS initiatives for improving shift-change communication is examined via qualitative analysis of on-site interviews and process observations in 8 critical access hospitals. Comparing implementation attributes and handoff performance across hospitals shows that the purpose of implementation did not differentiate between high and low performance, but facilitators and barriers did. Staff involvement and being part of the "big picture" were important facilitators to change management and buy-in.
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Sinclair A, Guérin A, Robin C, Dey P. Investigating the cost and efficiency of incident reporting in a specialist paediatric NHS hospital and impact on patient safety. Eur J Hosp Pharm 2017; 24:91-95. [PMID: 31156911 DOI: 10.1136/ejhpharm-2016-000926] [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: 02/22/2016] [Revised: 04/18/2016] [Accepted: 04/26/2016] [Indexed: 11/04/2022] Open
Abstract
Objectives The aim of this study was to investigate the incident reporting process (IR1s), to calculate the costs of reporting incidents in this context and to gain an indication of how economic the process was and whether it could be improved to yield better outcomes. Methods A retrospective analysis of a sample, 10.47% (n=150) selected from 1432 medication incident report summaries, generated at Birmingham Children's Hospital, a specialist tertiary referral paediatric centre, during 2014 and collated through the national Datix incident reporting system software was analysed and the associated staff time required to complete each step of the incident reporting process was costed. The staff costs for various grades of staff were averaged across the staff actually involved, using data calculated by the Personal Social Services Research Unit. Results The analysis showed that the incident reporting process involved 262 staff on 2942 occasions (19.16 staff episodes per incident form completed) at a cost of £337.16 per incident form completed. Conclusions The study showed that the incident reporting system was a labour intensive process. The numbers of staff involved in the process particularly as a result of the email distribution activity did appear to have room for efficiencies. However, it proved to be relatively inexpensive from a cost perspective. With redesign, arguably the emphasis could be moved away from the recording process to learning in order to gain improved patient safety outcomes.
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Affiliation(s)
- Anthony Sinclair
- Pharmacy Department, Birmingham Children's Hospital, Birmingham, UK
| | - Aurélie Guérin
- Pharmacy Department, Birmingham Children's Hospital, Birmingham, UK
| | | | - Prasanta Dey
- Business School Aston University, Birmingham, UK
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Responding to Emotional Stress in Pediatric Hospitals: Results From a National Survey of Chief Nursing Officers. J Nurs Adm 2017; 46:385-92. [PMID: 27379910 DOI: 10.1097/nna.0000000000000363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to identify leadership awareness of emotional stress and employee support efforts in pediatric hospitals. BACKGROUND The current pediatric environment has seen increases in treatment intensity, care duration, and acuity of patients resulting in increased likelihood of being exposed to emotional events. METHODS Mail survey was sent to chief nursing officers at 87 pediatric hospitals. RESULTS A total of 49 responses (56%) were received. Hospitals with less than 250 beds were significantly more likely to rate emotional stress as a large to very large problem, whereas ANCC Magnet® hospitals felt better about support efforts after patient deaths. Most commonly used support offerings focused on staff recovery after a traumatic event as opposed to training for prevention of emotional stress. CONCLUSIONS Emotional stress is a well-recognized issue in pediatric hospitals with comparatively large resource commitment. Further focus on caregiver prevention training and unit leadership recognition of stress may be needed.
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20
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Vaismoradi M, Griffiths P, Turunen H, Jordan S. Transformational leadership in nursing and medication safety education: a discussion paper. J Nurs Manag 2016; 24:970-980. [DOI: 10.1111/jonm.12387] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Pauline Griffiths
- College of Human and Health Sciences; Swansea University; Swansea UK
| | - Hannele Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio University Hospital; Kuopio Finland
| | - Sue Jordan
- College of Human and Health Sciences; Swansea University; Swansea UK
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21
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Kanerva A, Lammintakanen J, Kivinen T. Nursing Staff's Perceptions of Patient Safety in Psychiatric Inpatient Care. Perspect Psychiatr Care 2016; 52:25-31. [PMID: 25623953 DOI: 10.1111/ppc.12098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 10/02/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to explore nursing staff's perceptions of patient safety in psychiatric inpatient care. DESIGN AND METHODS Nurses were asked to describe their perceptions in semi-structured interviews, and their responses were analyzed by inductive content analysis. FINDINGS Nurses addressed two sets of factors: one related to the experiences of safety and the other related to the implementation of safe care. PRACTICE IMPLICATIONS The views of the nurses contribute to formalization of organizational policies and strategies. In particular, they highlight the importance of continual training for the staff and management, considering patients' views, and treating patients as collaborators in their care.
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Affiliation(s)
- Anne Kanerva
- Central Finland Health Care District, Jyväskylä, Finland
| | - Johanna Lammintakanen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Tuula Kivinen
- Central Finland Health Care District, Jyväskylä, Finland
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Jordan S, Gabe-Walters ME, Watkins A, Humphreys I, Newson L, Snelgrove S, Dennis MS. Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. PLoS One 2015; 10:e0140203. [PMID: 26461064 PMCID: PMC4603896 DOI: 10.1371/journal.pone.0140203] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/21/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring. DESIGN Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care. SETTING Five UK private sector care homes. PARTICIPANTS 41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine. INTERVENTION Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step. OUTCOMES Problems addressed and changes in medicines prescribed. DATA COLLECTION AND ANALYSIS Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site. RESULTS Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22). CONCLUSION The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines. TRIAL REGISTRATION ISRCTN 48133332.
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Affiliation(s)
- Susan Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | | | - Alan Watkins
- College of Medicine, Swansea University, Swansea, Wales
| | - Ioan Humphreys
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Louise Newson
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales
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23
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Castel ES, Ginsburg LR, Zaheer S, Tamim H. Understanding nurses' and physicians' fear of repercussions for reporting errors: clinician characteristics, organization demographics, or leadership factors? BMC Health Serv Res 2015; 15:326. [PMID: 26272228 PMCID: PMC4542128 DOI: 10.1186/s12913-015-0987-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 08/05/2015] [Indexed: 11/15/2022] Open
Abstract
Background Identifying and understanding factors influencing fear of repercussions for reporting and discussing medical errors in nurses and physicians remains an important area of inquiry. Work is needed to disentangle the role of clinician characteristics from those of the organization-level and unit-level safety environments in which these clinicians work and learn, as well as probing the differing reporting behaviours of nurses and physicians. This study examines the influence of clinician demographics (age, gender, and tenure), organization demographics (teaching status, location of care, and province) and leadership factors (organization and unit leadership support for safety) on fear of repercussions, and does so for nurses and physicians separately. Methods A cross-sectional analysis of 2319 nurse and 386 physician responders from three Canadian provinces to the Modified Stanford patient safety climate survey (MSI-06). Data were analyzed using exploratory factor analysis, multiple linear regression, and hierarchical linear regression. Results Age, gender, tenure, teaching status, and province were not significantly associated with fear of repercussions for nurses or physicians. Mental health nurses had poorer fear responses than their peers outside of these areas, as did community physicians. Strong organization and unit leadership support for safety explained the most variance in fear for both nurses and physicians. Conclusions The absence of associations between several plausible factors including age, tenure and teaching status suggests that fear is a complex construct requiring more study. Substantially differing fear responses across locations of care indicate areas where interventions may be needed. In addition, since factors affecting fear of repercussions appear to be different for nurses and physicians, tailoring patient safety initiatives to each group may, in some instances, be fruitful. Although further investigation is needed to examine these and other factors in detail, supportive safety leadership appears to be central to reducing fear of reporting errors for both nurses and physicians. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0987-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Evan S Castel
- Department of Geography and Planning / Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Shahram Zaheer
- Health Policy & Management, York University, Toronto, Canada.
| | - Hala Tamim
- School of Kinesiology & Health Science, York University, Toronto, Canada.
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Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership. Health Care Manage Rev 2015; 40:13-23. [PMID: 24378403 DOI: 10.1097/hmr.0000000000000005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased awareness regarding the importance of patient safety issues has led to the proliferation of theoretical conceptualizations, frameworks, and articles that apply safety experiences from high-reliability industries to medical settings. However, empirical research on patient safety and patient safety climate in medical settings still lags far behind the theoretical literature on these topics. PURPOSE The broader organizational literature suggests that ease of reporting, unit norms of openness, and participative leadership might be important variables for improving patient safety. The aim of this empirical study is to examine in detail how these three variables influence frontline staff perceptions of patient safety climate within health care organizations. METHODOLOGY A cross-sectional study design was used. Data were collected using a questionnaire composed of previously validated scales. FINDINGS The results of the study show that ease of reporting, unit norms of openness, and participative leadership are positively related to staff perceptions of patient safety climate. PRACTICE IMPLICATIONS Health care management needs to involve frontline staff during the development and implementation stages of an error reporting system to ensure staff perceive error reporting to be easy and efficient. Senior and supervisory leaders at health care organizations must be provided with learning opportunities to improve their participative leadership skills so they can better integrate frontline staff ideas and concerns while making safety-related decisions. Finally, health care management must ensure that frontline staff are able to freely communicate safety concerns without fear of being punished or ridiculed by others.
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25
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Shin MH, Sullivan JL, Rosen AK, Solomon JL, Dunn EJ, Shimada SL, Hayes J, Rivard PE. Examining the validity of AHRQ's patient safety indicators (PSIs): is variation in PSI composite score related to hospital organizational factors? Med Care Res Rev 2014; 71:599-618. [PMID: 25380608 DOI: 10.1177/1077558714556894] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Increasing use of Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) for hospital performance measurement intensifies the need to critically assess their validity. Our study examined the extent to which variation in PSI composite score is related to differences in hospital organizational structures or processes (i.e., criterion validity). In site visits to three Veterans Health Administration hospitals with high and three with low PSI composite scores ("low performers" and "high performers," respectively), we interviewed a cross-section of hospital staff. We then coded interview transcripts for evidence in 13 safety-related domains and assessed variation across high and low performers. Evidence of leadership and coordination of work/communication (organizational process domains) was predominantly favorable for high performers only. Evidence in the other domains was either mixed, or there were insufficient data to rate the domains. While we found some evidence of criterion validity, the extent to which variation in PSI rates is related to differences in hospitals' organizational structures/processes needs further study.
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Affiliation(s)
| | - Jennifer L Sullivan
- VA Boston Healthcare System, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA
| | - Amy K Rosen
- VA Boston Healthcare System, Boston, MA, USA Boston University School of Medicine, Boston, MA, USA
| | | | | | - Stephanie L Shimada
- Boston University School of Public Health, Boston, MA, USA Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA VA eHealth Quality Enhancement Research Initiative, Bedford, MA, USA University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer Hayes
- VA Boston Healthcare System, Boston, MA, USA VA Office of Academic Affiliations, Evaluation & Analytics, San Francisco, CA, USA
| | - Peter E Rivard
- VA Boston Healthcare System, Boston, MA, USA Suffolk University, Sawyer Business School, Boston, MA, USA
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26
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Resnick B, Galik E, Vigne E. Translation of function-focused care to assisted living facilities. FAMILY & COMMUNITY HEALTH 2014; 37:155-165. [PMID: 24569161 DOI: 10.1097/fch.0000000000000021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Assisted livings settings are residential settings that provide housing and supportive services for older and disabled adults. Although individuals in assisted living settings are less functionally impaired than those in nursing home settings, they engage in limited amounts of physical activity and decline functionally more rapidly than their peers in nursing homes. Function-focused care for assisted living (FFC-AL) was developed to prevent decline, improve function, and increase physical activity among residents living in these settings. The purpose of this study was to translate the previously established, effective FFC-AL intervention to 20 assisted living facilities. Evidence of our ability to successfully translate function-focused care into these 20 assisted living facilities was determined using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) model. Our findings supported our ability to translate FFC-AL effectively into 18 of these 20 settings, using our dissemination and implementation approach.
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27
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El-Jardali F, Sheikh F, Garcia NA, Jamal D, Abdo A. Patient safety culture in a large teaching hospital in Riyadh: baseline assessment, comparative analysis and opportunities for improvement. BMC Health Serv Res 2014; 14:122. [PMID: 24621339 PMCID: PMC3975247 DOI: 10.1186/1472-6963-14-122] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/21/2014] [Indexed: 11/30/2022] Open
Abstract
Background In light of the immense attention given to patient safety, this paper details the findings of a baseline assessment of the patient safety culture in a large hospital in Riyadh and compares results with regional and international studies that utilized the Hospital Survey on Patient Safety Culture. This study also aims to explore the association between patient safety culture predictors and outcomes, considering respondent characteristics and facility size. Methods This cross sectional study adopted a customized version of the HSOPSC and targeted hospital staff fitting sampling criteria (physicians, nurses, clinical and non-clinical staff, pharmacy and laboratory staff, dietary and radiology staff, supervisors, and hospital managers). Results 3000 questionnaires were sent and 2572 were returned (response rate of 85.7%). Areas of strength were Organizational Learning and Continuous Improvement and Teamwork within units whereas areas requiring improvement were hospital non-punitive response to error, staffing, and Communication Openness. The comparative analysis noted several areas requiring improvement when results on survey composites were compared with results from Lebanon, and the United States. Regression analysis showed associations between higher patient safety aggregate score and greater age (46 years and above), longer work experience, having a Baccalaureate degree, and being a physician or other health professional. Conclusions Patient safety practices are crucial toward improving overall performance and quality of services in healthcare organizations. Much can be done in the sampled organizations and in the context of KSA in general to improve areas of weakness and further enhance areas of strength.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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28
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Tregunno D, Ginsburg L, Clarke B, Norton P. Integrating patient safety into health professionals' curricula: a qualitative study of medical, nursing and pharmacy faculty perspectives. BMJ Qual Saf 2014; 23:257-64. [PMID: 24299734 PMCID: PMC3932978 DOI: 10.1136/bmjqs-2013-001900] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 09/25/2013] [Accepted: 10/09/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND As efforts to integrate patient safety into health professional curricula increase, there is growing recognition that the rate of curricular change is very slow, and there is a shortage of research that addresses critical perspectives of faculty who are on the 'front-lines' of curricular innovation. This study reports on medical, nursing and pharmacy teaching faculty perspectives about factors that influence curricular integration and the preparation of safe practitioners. METHODS Qualitative methods were used to collect data from 20 faculty members (n=6 medical from three universities; n=6 pharmacy from two universities; n=8 nursing from four universities) engaged in medical, nursing and pharmacy education. Thematic analysis generated a comprehensive account of faculty perspectives. RESULTS Faculty perspectives on key challenges to safe practice vary across the three disciplines, and these different perspectives lead to different priorities for curricular innovation. Additionally, accreditation and regulatory requirements are driving curricular change in medicine and pharmacy. Key challenges exist for health professional students in clinical teaching environments where the culture of patient safety may thwart the preparation of safe practitioners. CONCLUSIONS Patient safety curricular innovation depends on the interests of individual faculty members and the leveraging of accreditation and regulatory requirements. Building on existing curricular frameworks, opportunities now need to be created for faculty members to act as champions of curricular change, and patient safety educational opportunities need to be harmonises across all health professional training programmes. Faculty champions and practice setting leaders can collaborate to improve the culture of patient safety in clinical teaching and learning settings.
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Affiliation(s)
- Deborah Tregunno
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Beth Clarke
- Bridgepoint Health, Toronto, Ontario, Canada
| | - Peter Norton
- Department of Family Medicine (Emeritus), University of Calgary, Calgary, Canada
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Jordan S, Gabe M, Newson L, Snelgrove S, Panes G, Picek A, Russell IT, Dennis M. Medication monitoring for people with dementia in care homes: the feasibility and clinical impact of nurse-led monitoring. ScientificWorldJournal 2014; 2014:843621. [PMID: 24707218 PMCID: PMC3951004 DOI: 10.1155/2014/843621] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. DESIGN Feasibility "before-and-after" intervention study. SETTING Three care homes in Wales. PARTICIPANTS Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. INTERVENTION West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. OUTCOME MEASURES (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later. RESULTS Nurses recruited and retained 11 of 29 eligible service users. The profile took 20-25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. CONCLUSIONS Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.
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Affiliation(s)
- Sue Jordan
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Marie Gabe
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Louise Newson
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Sherrill Snelgrove
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Gerwyn Panes
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Aldo Picek
- Fieldbay Ltd., Chestnut House, Tawe Business Village, Swansea Enterprise Park, Swansea SA7 9LA, UK
| | - Ian T. Russell
- The College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Michael Dennis
- The College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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de Feijter JM, de Grave WS, Koopmans RP, Scherpbier AJJA. Informal learning from error in hospitals: what do we learn, how do we learn and how can informal learning be enhanced? A narrative review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2013; 18:787-805. [PMID: 22948951 DOI: 10.1007/s10459-012-9400-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/16/2012] [Indexed: 06/01/2023]
Abstract
Learning from error is not just an individual endeavour. Organisations also learn from error. Hospitals provide many learning opportunities, which can be formal or informal. Informal learning from error in hospitals has not been researched in much depth so this narrative review focuses on five learning opportunities: morbidity and mortality conferences, incident reporting systems, patient claims and complaints, chart review and prospective risk analysis. For each of them we describe: (1) what can be learnt, categorised according to the seven CanMEDS competencies; (2) how it is possible to learn from them, analysed against a model of informal and incidental learning; and (3) how this learning can be enhanced. All CanMEDS competencies could be enhanced, but there was a particular focus on the roles of medical expert and manager. Informal learning occurred mostly through reflection and action and was often linked to the learning of others. Most important to enhance informal learning from these learning opportunities was the realisation of a climate of collaboration and trust. Possible new directions for future research on informal learning from error in hospitals might focus on ways to measure informal learning and the balance between formal and informal learning. Finally, 12 recommendations about how hospitals could enhance informal learning within their organisation are given.
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Affiliation(s)
- Jeantine M de Feijter
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands,
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Jeffs L, Hayes C, Smith O, Mamdani M, Nisenbaum R, Bell CM, McKernan P, Ferris E. The Effect of an Organizational Network for Patient Safety on Safety Event Reporting. Eval Health Prof 2013; 37:366-78. [DOI: 10.1177/0163278713491267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health care organizations continue to implement organization-wide educational approaches to enhance patient safety with less attention on evaluating the impact of these approaches. In this context, a study was conducted to measure the impact of an organization-wide patient safety network approach on patient safety event reporting. A time-series analysis with reported rates of adverse events (major and moderate), near misses, sentinel events, and incidents from 2 years prior through 13 months following implementation was conducted. Study findings include a significant increase in reporting of patient safety events (an approximately 50% increase in overall reporting of safety events was observed; p < .001), especially near misses (an approximately 100% increase following implementation; p = .002). Study findings suggest that a multifaceted networked approach does contribute to improving patient safety event reporting.
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Affiliation(s)
- Lianne Jeffs
- St. Michael’s Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - Orla Smith
- St. Michael’s Hospital, Toronto, ON, Canada
| | - Muhammad Mamdani
- St. Michael’s Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES) of Ontario, Toronto, ON, Canada
| | - Rosane Nisenbaum
- St. Michael’s Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Chaim M. Bell
- University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES) of Ontario, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety. Clin Orthop Relat Res 2013; 471:1792-800. [PMID: 23224770 PMCID: PMC3706678 DOI: 10.1007/s11999-012-2719-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. QUESTIONS/PURPOSES We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. METHODS We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. RESULTS Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. CONCLUSIONS Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.
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Abstract
In health care, reliability is the measurable capability of a process, procedure, or health service to perform its intended function in the required time under actual or existing conditions (as opposed to the ideal circumstances under which they are often studied). This article outlines the current state of reliability in a clinical context, discusses general principles of reliability, and explores the characteristics of high-reliability organizations as a desirable future state for pediatric critical care.
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Affiliation(s)
- Matthew F Niedner
- Pediatric Intensive Care Unit, Division of Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI 48109-0243, USA.
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Van Dyck C, Dimitrova NG, de Korne DF, Hiddema F. Walk the talk: leaders' enacted priority of safety, incident reporting, and error management. Adv Health Care Manag 2013; 14:95-117. [PMID: 24772884 DOI: 10.1108/s1474-8231(2013)0000014009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by "walking the safety talk" (enacted priority of safety). DESIGN/METHODOLOGY/APPROACH Open interviews (N = 26) and a cross-sectional questionnaire (N = 183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherlands. FINDINGS As hypothesized, leaders' enacted priority of safety was positively related to incident reporting and error management, and the relation between leaders' enacted priority of safety and error management was mediated by incident reporting. The interviews yielded rich data on (near) incidents, the leaders' role in (non)reporting, and error management, grounding quantitative findings in concrete case descriptions. RESEARCH IMPLICATIONS We support previous theorizing by providing empirical evidence showing that (1) enacted priority of safety has a stronger relationship with incident reporting than espoused priority of safety and (2) the previously implied positive link between incident reporting and error management indeed exists. Moreover, our findings extend our understanding of behavioral integrity for safety and the mechanisms through which it operates in medical settings. PRACTICAL IMPLICATIONS Our findings indicate that for the promotion of incident reporting and error management, active reinforcement of priority of safety by leaders is crucial. VALUE/ORIGINALITY Social sciences researchers, health care researchers and health care practitioners can utilize the findings of the current paper in order to help leaders create health care systems characterized by higher incident reporting and more constructive error handling.
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Castle NG, Wagner LM, Sonon K, Ferguson-Rome JC. Measuring administrators' and direct care workers' perceptions of the safety culture in assisted living facilities. Jt Comm J Qual Patient Saf 2012; 38:375-82. [PMID: 22946255 DOI: 10.1016/s1553-7250(12)38048-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Further understanding of patient safety in health care is still needed. This is particularly evident in long term care settings, where relatively little information exists. Safety culture has emerged as a critical component of efforts to improve patient safety; it is strongly associated with iniatatives that influence patient safety and quality of care. The safety culture of a large sample of assisted living (AL) facilities was examined. METHODS The Nursing Home Survey on Patient Safety Culture (NHPSC) was modified and used to examine safety culture. A random sample of AL settings from all 50 states was selected to participate. Respondents were AL administrators and direct care workers (DCWs) who completed the modified safety culture survey. The applied properties of the instrument are examined. A summary score for administrators and DCWs for each NHPSC item is also presented. These summary scores have a range from 0 to 100, with low scores representing a poor safety culture (and vice versa). RESULTS Information was received from 572 administrators (response rate = 57%) and 3,620 DCWs (response rate = 51%). The scores, using the 0-100 scale, fell into the 48-72 range for administrators and the 40-68 range for DCWs. Many of the scores were similar to those previously found in nursing homes. CONCLUSIONS AL is recognized as one of the fastest-growing institutional components of the long term care industry. The modified NHPSC performed well. Some areas of safety culture were perceived less favorably than in nursing homes. As such, some further attention to safety culture in AL is warranted. This study provides a first step toward assessing safety culture in this underexamined setting.
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Affiliation(s)
- Nicholas G Castle
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, USA.
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Clarke S. Safety leadership: A meta-analytic review of transformational and transactional leadership styles as antecedents of safety behaviours. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2012. [DOI: 10.1111/j.2044-8325.2012.02064.x] [Citation(s) in RCA: 291] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sharon Clarke
- Manchester Business School; University of Manchester; UK
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Sirriyeh R, Lawton R, Armitage G, Gardner P, Ferguson S. Safety subcultures in health-care organizations and managing medical error. Health Serv Manage Res 2012; 25:16-23. [PMID: 22323667 DOI: 10.1258/hsmr.2011.011018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Leadership has been proposed as a key latent factor influencing the safety culture of an organization, the likelihood of errors occurring and the way in which these are managed. Therefore, when an error occurs, managers have an integral role to ensure that the most desirable outcomes are achieved for patients, health-care staff and their organization. Semistructured interviews were conducted in a large UK teaching hospital to explore the perspectives of staff who are tasked in some way with managing patient safety. Data from 26 transcripts were analysed using an adapted version of Spencer's (2003) qualitative framework, which revealed five primary themes. This paper reports findings from two overarching primary themes, described as being management and safety subcultures. These themes describe experiences of managing medical errors and the subgroup variations between professions, ranks and specialties in attitudes and behaviours towards error, and its management in a large National Health Service Trust. We discuss implications for health-care managers and health professionals in developing a stronger and more unified safety culture in their organizations, along with considerations for academic researchers when undertaking health services research.
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Affiliation(s)
- Reema Sirriyeh
- Institute of Psychological Sciences, University of Leeds, Leeds, UK.
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Gabe ME, Davies GA, Murphy F, Davies M, Johnstone L, Jordan S. Adverse drug reactions: treatment burdens and nurse-led medication monitoring. J Nurs Manag 2011; 19:377-92. [PMID: 21507109 DOI: 10.1111/j.1365-2834.2011.01204.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marie E Gabe
- Research Capacity Building Collaboration (RCBC) Wales, College of Human and Health Sciences, Swansea University, Swansea, UK.
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