Safety climate in English general practices: workload pressures may compromise safety

Nurses' perceptions about the patient safety climate in Primary Health Care

OBJECTIVE

to evaluate the patient safety climate in Primary Health Care from the perspective of nurses working in the services.

METHOD

a quantitative and cross-sectional study conducted with 148 nurses from a municipality in the state of São Paulo. The Brazilian version of the Primary Care Safety Questionnaire Survey and personal, professional, and organizational performance variables (intention to stay at work, job satisfaction, care quality, and frequency of incidents) were used. Parametric and non-parametric comparison tests and Spearman's correlation coefficient were performed, considering a 5% significance level.

RESULTS

the safety climate was positive, varying from 4.52 to 5.33 and differing across districts for workload (p=0.0214) and leadership (p=0.0129). The safety climate professional variables and dimensions differed in relation to the frequency of incidents. Teamwork and safety and learning system were strongly correlated with job satisfaction and moderately with perceived care quality.

CONCLUSION

teamwork and safety and learning system stood out for their positive correlations with job satisfaction and care quality. A positive safety climate favors the involvement of Primary Care nurses to develop improvement plans aligned with the National Patient Safety Program.

BACKGROUND

(1) The safety climate is perceived differently across health districts. (2) There is a correlation between the climate dimensions and professional satisfaction. (3) Workload and leadership exert an influence on the safety climate perception. (4) There is a relationship between the safety climate and reporting of care-related incidents. (5) The safety climate is perceived differently among nurses regarding their role.

Application of the Primary Care Safety Questionnaire to primary health care professionals: cross-sectional study

OBJECTIVE

To evaluate the perception of the patient safety climate in primary health care associated with professional categories, health centers, and previous experience of participation in the National Program for the Improvement of Access and Quality of Primary Care.

METHOD

Cross-sectional study with 119 health professionals in a city in the interior of the state of São Paulo, between August 2019 and February 2020, using the Brazilian version of the Primary Care Safety Questionnaire.

RESULTS

The safety climate was favorable, with better evaluation for communication and leadership and worse evaluation for workload. There were differences among health centers regarding teamwork (p=0.0010), workload (p=0.0001) and total score (p=0.0185). Professionals with previous experience participating in the improvement program have a better perception of the climate.

CONCLUSION

The perception of climate did not differ between professional categories but differed between health centers.

Viewpoint: Patient safety in primary care - patients are not just a beneficiary but a critical component in its achievement

Promoting and maintaining patient safety in primary care requires different strategies and monitoring than utilized in large healthcare delivery systems. Maintenance of a culture of safety is key to providing patient safety but has been difficult to measure in primary care. This is particularly true in rural settings where practice size is a major barrier to measurement reliability. Primary care evaluates a wide range of patients, including those who are immunocompromised and others who have infectious diseases. Providing a safe environment with proper wearing of N95 masks, clean examination rooms, and adequate ventilation is important. Patients with infectious diseases should be separated from other patient populations. Primary care is often less bureaucratic than hospitals, but also has fewer resources to implement patient safety initiatives, along with detecting safety lapses and adverse events. However, monitoring the practice's safety practices and the culture of safety is of utmost importance and should be performed using both outcome and process measures. Because of the small size of many rural practices, effective monitoring of adverse events and maintenance of safety protocols should include patients. Patients are an important resource for reporting of adverse events and medical treatment outcomes. The aim of this manuscript is to underscore the importance of patient safety in primary care and to stimulate future research in developing a metric for the culture of safety in primary care, which also incorporates the patient perspective. Patients should be viewed not only as beneficiaries of patient safety but also as a critical component of its maintenance.

Exploring and Evaluating Patient Safety Culture in a Community-Based Primary Care Setting

OBJECTIVES

The primary aim was to measure patient safety culture in two home care services in Belgium (Flanders). In addition, variability based on respondents' profession was examined.

METHODS

A cross-sectional study was conducted by administering the SCOPE-Primary Care questionnaire in two home care service organizations.

RESULTS

In total, 1875 valid questionnaires were returned from 2930 employees, representing a response rate of 64%. The highest mean patient safety culture score was found for "organizational learning" (mean [SD] = 3.81 [0.53]), followed by "support and fellowship" (mean [SD] = 3.76 [0.61]), "open communication and learning from error" (mean [SD] = 3.73 [0.64]), and "patient safety management" (mean [SD] = 3.71 [0.60]). The lowest mean scores were found for "handover and teamwork" (mean [SD] = 3.28 [0.58]) and "adequate procedures and working conditions" (mean [SD] = 3.30 [0.56]). Moreover, managers/supervisors scored significantly higher on the dimensions "open communication and learning from error," "adequate procedures and working conditions," "patient safety management," "support and fellowship," and "organizational learning" than clinical and nonclinical staff.

CONCLUSIONS

In conclusion, organizational learning is perceived as most positive. However, large gaps remain in the continuity of care as "handover and teamwork" is perceived as the most negative safety culture dimension. With knowledge of the current patient safety culture, organizations can redesign processes or implement improvement strategies to avoid patient safety incidents and patient harm in the future.

Residents' subjective mental workload during computerized prescription entry

To examine residents' subjective mental workload when they enter prescriptions in a computerized physician order entry (CPOE) system. Twenty-two residents completed six prescribing tasks in which two factors were manipulated: numerical input method and level of urgency. Data on demographic characteristics, familiarity with CPOE, and pretest performance were collected. The subjective mental workload was measured by the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Temporal demand (Mean = 34.48) contributed most to residents' workload on the CPOE task, followed by Performance (Mean = 29.23). No significant associations were found between workload and demographic characteristics, CPOE familiarity, or pretest CPOE performance (p's > .05). A 3 × 2 repeated-measures ANOVA yielded main effects of numerical input method [F (2, 19) = 88.358, p < .001, η² = .900] and level of urgency [F (1, 21) = 169.654, p < .001, η² = .890], and interaction of input method and urgency [F (2, 20) = 87.427, p < .001, η² = .900]. Residents' major sources of workload during the CPOE prescription were temporal demand and performance. Prescriptions entered by the row of numbers exhibited the highest workload. Workload increased with higher level of urgency. It is necessary to emphasize the negative impact of subjective workload, especially in prescription task under urgent situation. Further researches focus on medical staff's workload are encouraged to ensure patient safety.

Improving the culture of safety among healthcare workers: Integration of different instruments to gain major insights and drive effective changes

The Safety Attitude Questionnaire (SAQ) and Manchester Patient Safety Framework (MaPSaF) are known as effective tools to assess patient safety culture and climate and develop targeted strategies. However, they are seldom applied in an integrated way. The aim of this study was to conduct an implementation project through a novel use of both instruments to gain unique insights. The Italian version of MaPSaF and SAQ were administered to 1,759 healthcare workers from three Italian hospitals (response rate: MaPSaF 70.5%, SAQ 61.6%). MaPSaF evaluation proved an overall bureaucratic level of patient safety culture. SAQ scores showed a predominance of neutral scores (75.99%). The dimension perception of management gained the lowest mean score (53.32), while Stress recognition obtained the highest (75.17). Safety climate perception differed significantly among groups: working in a small hospital, in a medical department, and being a physician were associated with the most positive results. The majority (67.1%) of responders to both MaPSaF and SAQ considered the two instruments as providing with different and complementary information. Overall, results showed that an integrated approach in the evaluation of an organisation's safety culture may result useful for an in-depth analysis of the criticalities and the adoption of appropriate improvement strategies.

Relationship between patient safety culture and patient experience in hospital settings: a scoping review protocol

INTRODUCTION

Hospitals commonly examine patient safety culture and other quality indicators to evaluate and improve performance in relation to quality and safety. A growing body of research has separately examined relationships between patient safety culture and patient experience on clinical outcomes and other quality indicators. However, there is a knowledge gap regarding the relationship between these two important domains. This article describes the protocol for a scoping review of published literature examining the relationship between patient safety culture and patient experience in hospital settings. The scoping review will provide an overview of research into the relationship between patient safety culture and patient experience in hospital contexts, map key concepts underpinning these domains and identify research gaps for further study.

METHODS AND ANALYSIS

The scoping review will be conducted using the five stages of Arksey and O'Malley's framework: identify the research question; identify relevant studies; study selection; chart data; and collate, summarise and report the results. The inclusion criteria will be applied using the Population, Concept and Context Framework. Searches will be conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, Scopus and SciELO databases, without applying date range limits. Hand-searching of grey literature will also be performed to find relevant, non-indexed literature. Data will be extracted using a standardised data extraction form developed by the Joanna Briggs Institute. Both descriptive and thematic analyses will be undertaken to scope key concepts within the body of reviewed literature.

ETHICS AND DISSEMINATION

This type of study does not require an ethics review. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.

The importance of teamwork climate for preventing burnout in UK general practices

This short report aims to investigate the association between teamwork and burnout among general practitioners (GPs). A two-stage survey was conducted. In stage one, validated self-report measures of burnout and teamwork were completed by 50 GPs across 12 general practices in Greater Manchester, UK. In stage two, staff members across 3 of the 12 general practices (GPs, nursing staff, managers and admin staff) responded to free text questions about teamwork (n = 20). The results of the stage one survey showed that teamwork in GPs was significantly negatively associated with the emotional exhaustion (r = −0.326, P < 0.05) and depersonalization (r = −0.421, P < 0.01) domains of the burnout measure and significantly positively associated with the personal accomplishment (r = 0.296, P < 0.05) domain. Free text responses in stage two were assigned into three themes: (i) addressing organizational barriers which might threaten teamwork, (ii) promoting the view of teamwork as a shared responsibility among all staff members of the general practice and (iii) implementing improvement strategies which can be embedded in the busy environment of general practices. GPs and other staff members of general practices valued the importance of teamwork for boosting their morale and mitigating burnout. Future research should focus on designing and embedding brief teamwork improvement strategies in general practices.

Professional safety constructs in the context of Primary Health Care

OBJECTIVES

to identify scientific production on safety-related aspects/characteristics in the performance of Primary Health Care professionals for professional safety constructs.

METHODS

integrative literature review in the BDENF, IBECS, LILACS, MEDLINE databases.

RESULTS

the corpus of this review refers to 16 articles that highlighted work overload, work process, insufficient human resources, precarious work environment conditions, lack of continuing education, team relationship and with users, evidencing that they are factors that possibly compromise health care and professional safety for best practices.

FINAL CONSIDERATIONS

to know the factors that impact in the scope of professional safety allows to subsidize interventions that guarantee best practices. This study originally contributes to the formulation of Primary Health Care professional safety constructs.

Using safety culture results to guide the merger of four general practices in the UK

BACKGROUND

The rapid merger in a crisis of three GP practices to incorporate the patients from a neighbouring closing surgery, led to the redesign of primary care provision. A deliberate focus on patient safety and staff engagement was maintained throughout this challenging transition to working at scale in an innovative, integrated and collaborative GP model.

METHOD

3 cycles of a staff culture tool (Safety, Communication, Organizational Reliability, Physician & Employee burn-out and Engagement) were performed at intervals of 9-12 months with structured feedback and engagement with staff after each round. The impact of different styles of feedback, the effect of specific interventions, and overall changes in safety climate and culture domains were observed in detail throughout this time period.

RESULTS

Strong themes demonstrated were that: there was a general improvement in all culture domains; specific focus on teams that expressed they were struggling created the most effective outcomes; an initial lack of trust of the management structure improved; adapting and tailoring the styles of feedback was most efficacious; and burn-out scores dropped progressively. A unique observation of the rate at which different modalities of safety climate and culture change with time is demonstrated.

CONCLUSION

With limited time, resources and energy, especially at times of crisis or change, the rapid and accurate identification of which domains of 'culture' and which teams required the most input at each stage of the journey is invaluable. Using this tool and prioritising patient safety, enables rapid and effective positive change to the culture and shape of expanding practices. It affirms that new models of working at scale in GP can be positively embraced with improvements in safety culture, if this is deliberately focused on and included in the transition process.

Development of the prototype concise safe systems checklist tool for general practice

BACKGROUND

In the course of producing a patient safety toolkit for primary care, we identified the need for a concise safe-systems checklist designed to address areas of patient safety which are under-represented in mandatory requirements and existing tools. This paper describes the development of a prototype checklist designed to be used in busy general practice environments to provide an overview of key patient safety related processes and prompt practice wide-discussion.

METHODS

An extensive narrative review and a survey of world-wide general practice organisations were used to identify existing primary care patient safety issues and tools. A RAND panel of international experts rated the results, summarising the findings for importance and relevance. The checklist was created to include areas that are not part of established patient safety tools or mandatory and legal requirements. Four main themes were identified: information flow, practice safety information, prescribing, and use of IT systems from which a 13 item checklist was trialled in 16 practices resulting in a nine item prototype checklist, which was tested in eight practices. Qualitative data on the utility and usability of the prototype was collected through a series of semi-structured interviews.

RESULTS

In testing the prototype four of nine items on the checklist were achieved by all eight practices. Three items were achieved by seven of eight practices and two items by six of eight practices. Participants welcomed the brevity and ease of use of the prototype, that it might be used within time scales at their discretion and its ability to engage a range of practice staff in relevant discussions on the safety of existing processes. The items relating to prescribing safety were considered particularly useful.

CONCLUSIONS

As a result of this work the concise patient safety checklist tool, specifically designed for general practice, has now been made available as part of an online Patient Safety Toolkit hosted by the Royal College of General Practitioners. Senior practice staff such as practice managers and GP partners should find it a useful tool to understand the safety of less explored yet important safety processes within the practice.

Safety climate, safety climate strength, and length of stay in the NICU

Background

Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs).

Methods

Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU’s respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (< 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality.

Results

NICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes.

Conclusions

Safety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals.

Variation in staff perceptions of patient safety climate across work sites in Norwegian general practitioner practices and out-of-hour clinics

Introduction

Measuring staff perceptions with safety climate surveys is a promising approach to addressing patient safety. Variation in safety climate scores between work sites may predict variability in risk related to tasks, work environment, staff behavior, and patient outcomes. Safety climate measurements may identify considerable variation in staff perceptions across work sites.

Objective

To explore variation in staff perceptions of patient safety climate across work sites in Norwegian General Practitioner (GP) practices and Out-of-hours clinics.

Methods

The Norwegian Safety Attitudes QuestionnaireAmbulatory Version (SAQ A) was used to survey staff perceptions of patient safety climate across a sample of GP practices and Out-of-hours clinics in Norway. We invited 510 primary health care providers to fill out the questionnaire anonymously online in October and November 2012. Work sites were 17 regular GP practices in Sogn & Fjordane County, and seven Out-of-hours clinics, of which six were designated as “Watchtower Clinics”. Intra–class correlation coefficients were calculated to identify what proportion of the variation in the five factor scores (Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions) were at work site-level.

Results

Of the 510 invited health care providers, 266 (52%) answered the questionnaire. Staff perceptions varied considerably at the work site level: intra–class correlation coefficients (ICCs) were 12.3% or higher for all factors except for Job satisfaction–the highest ICC value was for Perceptions of management: 15.5%.

Conclusion

Although most of the score variation was at the individual level, there was considerable response clustering within the GP practices and OOH clinics. This implies that the Norwegian SAQ A is able to identify GP practices and OOH clinics with high and low patient safety climate scores. Patient safety climate scores produced by the Norwegian version of the SAQ A may, thus, guide improvement and learning efforts to work sites according to the level of their scores.

Safety in primary care (SAP-C): a randomised, controlled feasibility study in two different healthcare systems

BACKGROUND

Patient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2% of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice.

METHODS

A randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention's perceived usefulness and feasibility were explored via an end-of-study questionnaire and semi-structured interviews.

RESULTS

Thirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8% of intervention practice staff (39/46) and 77.8% (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3% (36/46) of intervention practice staff and 68.5% (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19.1% (36/188). Overall, 59% of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention's usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback.

CONCLUSION

This feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention.

TRIAL REGISTRATION

The trial registration number is: ISRCTN11426121 (retrospectively registered 12th June 2018).

Perceived safety climate in Irish primary care settings-a comparison with Scotland and England

Background: Safety climate (SC) measurement is a key component of quality and safety initiatives in primary healthcare.

Objectives: To (1) measure perceived SC in Irish primary care; (2) examine whether perceptions of safety varied according to respondent characteristics; and (3) compare responses from our Irish sample to data from England and Scotland.

Methods: PC-SafeQuest Survey was administered to all practice staff in Irish general practices between March and May 2016. This survey consists of 30 items across five safety domains (workload, communication, leadership, teamwork, and safety systems). Multiple regression analysis was used to identify predictor variables of perceived safety. The effect size of the difference between the Irish sample’s scores and published English and Scottish data were calculated.

Results: A total of 231 questionnaires (38.5%) were returned. Generally, positive perceptions of perceived safety were identified among Irish respondents, but workload had the lowest overall mean score (M = 4.3, SD = 1.2) of the five domains. Comparisons across the Irish, English and Scottish samples identified a medium size effect difference in workload; Scottish respondents perceived workload to have less of a negative impact on safety than Irish or English counterparts (Cohen’s d = 0.602, 0.67 respectively). Analyses indicated that Irish GP principals perceived a more negative impact of workload on safety than administrative staff (β = 0.28, P = 0.03).

Conclusion: Irish SC data are largely similar to those of England and Scotland. The perceived potential for workload to negatively impact upon safety emerged within each country. In Ireland, GP principals perceive this as a greater threat than practice administrators do.

Differences in Safety Climate Perception by Health Care Worker, Work Schedule, and Workplace Characteristics

Safety climate has been associated with patient and health care worker safety and outcomes. However, few studies have examined how perceptions of workplace safety differ by worker, work schedule, and workplace characteristics. Data from 10 168 participants in the National Institute for Occupational Safety and Health's Health and Safety Practices Survey of Healthcare Workers were analyzed. Multivariable regression analyses examined associations among worker and workplace characteristics and items measuring 5 areas of workplace safety perception. Safety climate perception scores were higher (more positive) for dentists and for health care workers who were salaried, were self-employed, worked day shifts and shifts ⩽11 hours, and spent <76% of their time in patient care. A wide range of health care worker, work schedule, and workplace characteristics should be considered in analyses designed to evaluate safety climate and identify potential interventions to improve downstream safety outcomes.

Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives

Background

Primary care is changing rapidly to meet the needs of an ageing and chronically ill population. New ways of working are called for yet the introduction of innovative service interventions is complicated by organisational challenges arising from its scale and diversity and the growing complexity of patients and their care. One such intervention is the multi-strand, single platform, Patient Safety Toolkit developed to help practices provide safer care in this dynamic and pressured environment where the likelihood of adverse incidents is increasing. Here we describe the attitudes of staff toward these tools and how their implementation was shaped by a number of contextual factors specific to each practice.

Methods

The Patient Safety Toolkit comprised six tools; a system of rapid note review, an online staff survey, a patient safety questionnaire, prescribing safety indicators, a medicines reconciliation tool, and a safe systems checklist. We implemented these tools at practices across the Midlands, the North West, and the South Coast of England and conducted semi-structured interviews to determine staff perspectives on their effectiveness and applicability.

Results

The Toolkit was used in 46 practices and a total of 39 follow-up interviews were conducted. Three key influences emerged on the implementation of the Toolkit these related to their ease of use and the novelty of the information they provide; whether their implementation required additional staff training or practice resource; and finally factors specific to the practice’s local environment such as overlapping initiatives orchestrated by their CCG.

Conclusions

The concept of a balanced toolkit to address a range of safety issues proved popular. A number of barriers and facilitators emerged in particular those tools that provided relevant information with a minimum impact on practice resource were favoured. Individual practice circumstances also played a role. Practices with IT aware staff were at an advantage and those previously utilising patient safety initiatives were less likely to adopt additional tools with overlapping outputs. By acknowledging these influences we can better interpret reaction to and adoption of individual elements of the toolkit and optimise future implementation.

Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge

BACKGROUND

Pharmacists' completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload.

METHODS

This is a systematic literature review and meta-analysis of extracted data. Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Allied and Complementary Medicine Database (AMED),Education Resources Information Center (ERIC), Scopus, NHS Evidence and the Cochrane databases were searched using a combination of medical subject heading terms and free-text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using the Critical Appraisal Skills Programme. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively.

RESULTS

Fourteen studies were included, comprising five randomised controlled trials, six cohort studies and three pre-post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload.

CONCLUSIONS

Pharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge, but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload.

The SCOPE-PC instrument for assessing patient safety culture in primary care: a psychometric evaluation

INTRODUCTION

Primary healthcare differs from hospitals in terms of - inter alia - organisational structure. Therefore, patient safety culture could differ between these settings. Various instruments have been developed to measure collective attitudes of personnel within a primary healthcare organisation. However, the number of valid and reliable instruments is limited.

OBJECTIVES

Psychometric properties of the SCOPE-Primary Care instrument were tested to examine the instrument's applicability in home care services in Belgium.

METHODS

A cross-sectional study was conducted by administering the SCOPE-PC questionnaire in a single home care organisation with more than 1000 employees, including nurses, midwives, healthcare assistants, diabetes educators and nursing supervisors. First, a confirmatory factor analysis was performed to test whether the observed dataset fitted to the proposed seven-factor model of the SCOPE-PC instrument. Second, Cronbach's alphas were calculated to examine internal consistency reliability. Finally, the instrument's validity was also examined.

RESULTS

In total, 603 questionnaires were retained for further analysis, representing an overall response rate of 43.9%. Most respondents were nursing staff, followed by healthcare assistants and nursing supervisors. The results of the confirmatory factor analyses satisfied the chosen cut-offs, indicating an acceptable to good model fit. With the exception of the dimension 'organizational learning' (0.58), Cronbach's alpha scores of the SCOPE-PC scales indicated a good level of internal consistency: 'open communication and learning from error' (0.86), 'handover and teamwork' (0.78), 'adequate procedures and working conditions' (0.73), 'patient safety management' (0.81), 'support and fellowship' (0.75), and 'intention to report events (0.85). Moreover, inter-correlations between the seven dimensions as well as with the patient safety grade were moderate to good.

CONCLUSIONS

The present study indicated that the SCOPE-Primary Care instrument has good psychometric properties for home care services in Belgium. No modifications are required to the original questionnaire in order to allow benchmarking between primary healthcare settings.

GPs' perceptions of resilience training: a qualitative study

BACKGROUND

GPs are reporting increasing levels of burnout, stress, and job dissatisfaction, and there is a looming GP shortage. Promoting resilience is a key strategy for enhancing the sustainability of the healthcare workforce and improving patient care.

AIM

To explore GPs' perspectives on the content, context, and acceptability of resilience training programmes in general practice, in order to build more effective GP resilience programmes.

DESIGN AND SETTING

This was a qualitative study of the perspectives of GPs currently practising in England.

METHOD

GPs were recruited through convenience sampling, and data were collected from two focus groups (n = 15) and one-to-one telephone interviews (n = 7). A semi-structured interview approach was used and data were analysed using thematic analysis.

RESULTS

Participants perceived resilience training to be potentially of value in ameliorating workplace stresses. Nevertheless, uncertainty was expressed regarding how best to provide training for stressed GPs who have limited time. Participants suspected that GPs most likely to benefit from resilience training were the least likely to engage, as stress and being busy worked against engagement. Conflicting views were expressed about the most suitable training delivery method for promoting better engagement. Participants also emphasised that training should not only place the focus on the individual, but also focus on organisation issues.

CONCLUSION

A multimodal, flexible approach based on individual needs and learning aims, including resilience workshops within undergraduate training and in individual practices, is likely to be the optimal way to promote resilience.

Influences on GP coping and resilience: a qualitative study in primary care

BACKGROUND

'Neoliberal' work policies, austerity, NHS restructuring, and increased GP consultation rates provide the backdrop against increasing reports of GP burnout and an impending shortage of GPs.

AIM

To explore GPs' experiences of workplace challenges and stresses, and their coping strategies, particularly focusing on understanding the impact of recent NHS workplace change.

DESIGN AND SETTING

Study design was qualitative, with data collected from two focus groups and seven one-to-one telephone interviews.

METHOD

Focus groups and one-to-one telephone interviews explored the experiences of GPs currently practising in England, recruited through convenience sampling. Data were collected using a semi-structured interview approach and analysed using thematic analysis.

RESULTS

There were 22 GP participants recruited: focus groups (n = 15) and interviews (n = 7). Interviewees understood GPs to be under intense and historically unprecedented pressures, which were tied to the contexts in which they work, with important moral implications for 'good' doctoring. Many reported that being a full-time GP was too stressful: work-related stress led to mood changes, sleep disruption, increases in anxiety, and tensions with loved ones. Some had subsequently sought ways to downsize their clinical workload. Workplace change resulted in little time for the things that helped GP resilience: a good work-life balance and better contact with colleagues. Although some GPs were coping better than others, GPs acknowledged that there was only so much an individual GP could do to manage their stress, given the external work issues they faced.

CONCLUSION

GPs experience their emotional lives and stresses as being meaningfully shaped by NHS factors. To support GPs to provide effective care, resilience building should move beyond the individual to include systemic work issues.

Safety climate in English general practices: workload pressures may compromise safety

OBJECTIVES

Although most health care interactions in the developed world occur in general practice, most of the literature on patient safety has focused on secondary care services. To address this issue, we have constructed a patient safety toolkit for English general practices. We report how practice and respondent characteristics affect scores on our safety climate measure, the PC-Safequest, and address recent concerns with high levels of workload in English general practices.

METHODS

We administered the PC-Safequest, a 30-item tool that was designed to measure safety climate in primary care practices, to 335 primary care staff members in 31 practices in England. Practice characteristics, such as list size and deprivation in the area the practice served, and respondent characteristics, such as whether the respondent was a manager, were also collected and used in a multilevel analysis to predict PC-Safequest scores.

RESULTS

Managers gave their practices significantly higher safety climate scores than did non-managers. Respondents with more years of experience had a more negative perception of the level of workload in their practice. Practices with more registered patients and in areas of higher deprivation provided lower safety climate scores.

CONCLUSIONS

Managers rated their practices more positively on our safety climate measure, so the differences between the perceptions of managers and other staff may need to be reduced in order to build a strong safety culture. Excessive workload for more experienced staff and lower safety climate scores for larger practices may reflect 'burnout'. Concerns that pressures in primary care could affect patient safety are discussed.