Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system

BACKGROUND

Incident reporting systems (IRS) can improve care quality and patient safety, yet their impact is limited by clinician engagement. Our objective was to assess barriers to reporting in a hospital-wide IRS and use data to inform ongoing improvement of a specialty-specific IRS embedded in the electronic health record targeting anaesthesiologists.

METHODS

This quality improvement (QI) evaluation used mixed methods, including qualitative interviews, faculty surveys and user data from the specialty-specific IRS. We conducted 24 semi-structured interviews from January to May 2023 in a large academic health system in Northern California. Participants included adult and paediatric anaesthesiologists, operating room nurses, surgeons and QI operators, recruited through convenience and snowball sampling. We identified key themes and factors influencing engagement, which were classified using the Systems Engineering Initiative for Patient Safety framework. We surveyed hospital anaesthesiologists in January and May 2023, and characterised the quantity and type of reports submitted to the new system.

RESULTS

Participants shared organisation and technology-related barriers to engagement in traditional system-wide IRSs, many of which the specialty-specific IRS addressed-specifically those related to technological access to the system. Barriers related to building psychological safety for those who report remain. Survey results showed that most barriers to reporting improved following the specialty-specific IRS launch, but limited time remained an ongoing barrier (25 respondents out of 44, 56.8%). A total of 964 reports with quality/safety concerns were submitted over the first 8 months of implementation; 47-76 unique anaesthesiologists engaged per month. The top safety quality categories of concern were equipment and technology (25.9%), clinical complications (25.3%) and communication and scheduling (19.9%).

CONCLUSIONS

These findings suggest that a specialty-specific IRS can facilitate increased physician engagement in quality and safety reporting and complement existing system-wide IRSs.

How does communication affect patient safety? Protocol for a systematic review and logic model

INTRODUCTION

One in 10 patients are harmed in healthcare, more than three million deaths occur annually worldwide due to patient safety incidents, and the economic burden of patient safety incidents accounts for 15% of hospital expenditure. Poor communication between patients and practitioners is a significant contributor to patient safety incidents. This study aims to evaluate the extent to which patient safety is affected by communication and to provide a logic model that illustrates how communication impacts patient safety.

METHODS AND ANALYSIS

We will conduct a systematic review of randomised and non-randomised studies, reported in any language, that quantify the effects of practitioner and patient communication on patient safety. We will search MEDLINE, CINAHL, APA PsychINfo, CENTRAL, Scopus and ProQuest theses and dissertations from 2013 to 7 February 2024. We will also hand-search references of included studies. Screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Risk of bias will be assessed using the Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) for non-randomised studies, and the Cochrane Risk of Bias V.2 (RoB2) for randomised controlled trials. If appropriate, results will be pooled with summary estimates and 95% confidence intervals (CIs); otherwise, we will conduct a narrative synthesis. We will organise our findings by healthcare discipline, type of communication and type of patient safety incident. We will produce a logic model to illustrate how communication impacts patient safety.

ETHICS AND DISSEMINATION

This systematic review does not require formal ethics approval. Findings will be disseminated through international conferences, news and peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42024507578.

Enhancing communication within nursing and multiprofessional healthcare teams

Effective communication within nursing and multiprofessional healthcare teams is essential to promote patient safety. However, communication is a complex concept comprising various elements and variables that affect how messages are delivered, received and interpreted. In this article, the author explores communication within healthcare teams and provides some insight into the factors that affect team communication, such as interpersonal relationships. The author also explores organisational culture and cultural sensitivity, and discusses some evidence-based approaches to enhancing communication within healthcare teams.

The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway

BACKGROUND

In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department.

METHODS

This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes.

RESULTS

The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning.

CONCLUSIONS

This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.

Nursing students' evaluation of patient safety culture in three central European countries: a cross-sectional study

OBJECTIVES

This cross-sectional study aimed to investigate and compare the perceptions of nursing students regarding patient safety culture (PSC) during the COVID-19 pandemic in three Central European countries.

METHODS

Data were collected from 624 nursing students between April and September 2021 using the Hospital Survey on Patient Safety Culture.

RESULTS

The evaluation of the PSC dimensions did not reach the expected level of 75 %. Significant associations were found between the perception of the dimensions of the individual PSC and age, student status, study year, and clinical placement. The overall patient safety grade, the number of events reported, and the number of events reported by nursing students were significantly predicted by several dimensions of the PSC (p<0.05).

CONCLUSIONS

The evaluation of patient safety culture by nursing students offers a unique perspective. Students come with 'fresh eyes' and provide different perspectives that can provide healthcare leaders with a practical opportunity to identify blind spots, review and improve safety protocols, and foster a more inclusive culture that prioritizes patient safety.

Personal Actions to Create a Culture of Inclusion: Navigating Difficult Conversations With Medical Colleagues

Microaggressions between members of a team occur often in medicine, even despite good intentions. Such situations call for difficult conversations that restore inclusivity, diversity, and a healthy work culture. These conversations are often hard because of the unique background, experiences, and biases of each person. In medicine, skillful navigation of these interactions is paramount as it influences patient care and the workplace culture. Although much has been published about difficult interactions between providers and patients, significantly less information is available to help navigate provider-to-provider interactions, despite their critical role in improving multidisciplinary patient care teams and organizational environments. This article is intended to serve as a guide for medical professionals who are interested in taking personal responsibility for promoting a safe and inclusive culture by engaging in and modeling difficult conversations with colleagues. The article outlines important considerations to assist with intentional preparation and modulation of responses for all parties involved: conversation initiators, observers of the incident, and conversation receivers. Although these interactions are challenging, together as medical professionals we can approach each other with humility and compassion to achieve our ultimate goal of promoting humanity, not only for our patients but for ourselves and one another.

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.

Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs

BACKGROUND

Patient safety incidents (PSIs) in healthcare settings are a critical concern globally, and Ghana is no exception. Addressing PSIs to improve health outcomes requires various initiatives to be implemented including improving patient safety culture, teamwork and communication between healthcare providers during handoffs. It is essential to acknowledge the significance of teamwork, communication openness, and effective handoffs in preventing and managing such incidents. These factors play a pivotal role in ensuring the well-being of patients and the overall quality of healthcare services.

AIM

This study assessed the occurrence and types of PSIs in health facilities in Ghana. It also examined the role of teamwork, handoffs and information exchange, and communication openness in response to PSIs by health professionals.

METHODS

A cross-sectional study was conducted among 1651 health workers in three regions of Ghana. Using a multi-staged sampling technique, the Survey on Patient Safety Culture Hospital Survey questionnaire and the nurse-reported scale were used to collect the data and it was analysed by descriptive statistics, Pearson correlation, and linear multiple regression model at a significance of 0.05.

RESULTS

There was a reported prevalence of PSIs including medication errors (30.4%), wound infections (23.3%), infusion reactions (24.7%), pressure sores (21.3%), and falls (18.7%) at least once a month. There was a satisfactory mean score for responses to adverse events (3.40), teamwork (4.18), handoffs and information exchange (3.88), and communication openness (3.84) among healthcare professionals. Teamwork, handoffs and information exchange and communication openness were significant predictors of response to PSIs, accounting for 28.3% of the variance.

CONCLUSIONS

Effective teamwork, handoffs and information exchange, and communication openness in the healthcare environment are critical strategies to enhance PSI response. Creating a culture that encourages error response through teamwork, communication and handoffs provides healthcare professionals with opportunities for learning and improving patient outcomes. Training programs should therefore target health professionals to improve patient safety and competency. Through the implementation of evidence-based practices and learning from past incidents, the healthcare system will be able to deliver safe and high-quality care to patients nationwide. Patient safety must be recognized as an ongoing process. Therefore, a meaningful improvement in patient outcomes requires all stakeholders' commitment.

Issues and complexities in safety culture assessment in healthcare

The concept of safety culture in healthcare-a culture that enables staff and patients to be free from harm-is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to "survey fatigue," with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.

Psychosocial Processes in Healthcare Workers: How Individuals' Perceptions of Interpersonal Communication Is Related to Patient Safety Threats and Higher-Quality Care

Interpersonal communication, as a central form of social resource derived from social relations, is crucial for individuals coping with threats in the workplace, especially for hospitals that provide high-quality care and patient safety. Using social system mentalization as a theoretical background, we applied psychosocial processes and a psychodynamic system approach to get insights on how healthcare workers interact with team members and patients. The goal was to test the following hypotheses: H1: Better communication is associated with fewer patient safety threats (H1a) and higher-quality care (H1b). H2: The associations between communication and patient safety threats (H2a) and higher-quality care (H2b) are mediated by psychological safety. In this two-studies design, we conducted a cross-sectional hospital survey (N = 129) and a survey of obstetric team members (N = 138) in Germany. Simple mediation analyses were run. Results revealed that communication is associated with safety performance. Further, the mediating effect of psychological safety between communication and safety performance was demonstrated. These findings contribute to an understanding of social relation representations, as individuals' communication interrelates with safety performance mediated by psychological safety to complement healthcare and public health strategies. With a better understanding of communication and psychological safety, tools, routines, and concrete trainings can be designed.

The effects of leadership for self-worth, inclusion, trust, and psychological safety on medical error reporting

BACKGROUND

Although trust and psychological safety (PS) are critical for improving patient safety and medical error reporting, little is known about how they work together and how health care systems promote PS.

PURPOSE

This study examined how leadership for self-worth, inclusion, and trust may work together to foster PS and how this influences medical error reporting.

APPROACH

Data were collected in 2019 from 373 employees (24% response rate) in 85 hospital departments (54% response rate) in a nonprofit health care system in the eastern United States. Constructs were operationalized at the department level.

RESULTS

Negative binomial path model results found several direct effects. Leadership for self-worth was positively associated with inclusion, inclusion was positively associated with trust and PS, trust was positively associated with reported medical errors, and PS was negatively associated with reported medical errors. Indirect effects uncovered leadership for self-worth was positively associated with PS by enhancing inclusion. In addition, leadership for self-worth increased inclusion, which increased trust and ultimately encouraged PS. Leadership for self-worth was associated with fewer reported medical errors through increasing inclusion, trust, and PS.

PRACTICAL IMPLICATIONS

Trust encourages the formal reporting of medical errors whereas PS encourages learning from mistakes and improving care to reduce future errors (and consequently the number of reported errors). Leaders who understand employees' unique needs, express confidence in employees' abilities, and encourage employees to share their ideas, create inclusive and trusting work environments that encourage PS and ultimately help reduce reported medical errors.

Building a safety culture for infection prevention and control adherence at Howard Springs: A workplace survey

BACKGROUND

Building a safety culture is essential to facilitate infection prevention and control (IPC) adherence in workplaces. We aimed to explore perceptions, barriers and facilitators to IPC procedures by the Australian Medical Assistance Team (AUSMAT) at Howard Springs International Quarantine Facility (HSIQF).

METHODS

We performed a descriptive analysis of a cross-sectional survey administered to the AUSMAT employed at HSQIF from October 2020 to April 2021. We described motivation, training and compliance to IPC adherence and Likert scales described the level of agreement to the success of IPC procedures across the domains of communication, risk, trust, safety and environment, from the individual, team and organisational perspective.

RESULTS

There were 101 participants (response rate 59%, 101/170) and 70% (71/101) were clinical. There was strong agreement to the success of IPC procedures, with a median 4 (agree) or 5 (strongly agree) across each domain and perspective of the 67 Likert items. Clinical staff reported slightly higher agreement than non-clinical staff across Likert items. To improve IPC compliance, most reported that daily training should be provided (77/97, 79%) and daily training was very or extremely effective (91/97, 93%). Participants were motivated by protecting self, friends, family and the community rather than workplace pressures. Barriers to IPC compliance were the ambient environment and fatigue.

CONCLUSIONS

A safety culture was successfully built at HSQIF to optimise IPC adherence whilst managing multiple hazards including prevention of COVID-19 transmission. Strategies implemented by AUSMAT at the quarantine facility may inform the development of safety culture in other settings.

Influence of Sociodemographic and Occupational Factors on Safety Culture in Neonatal Intensive Care in Brazil

BACKGROUND

Patient safety culture is influenced by factors such as professional category, experience, and age. Understanding these factors can inform initiatives to improve safety.

PURPOSE

To evaluate the relationship between sociodemographic and occupational characteristics on health professionals' perception of patient safety culture.

METHODS

A cross-sectional study involving 514 health care professionals from Brazilian neonatal intensive care units was conducted using the Hospital Survey on Patient Safety Culture.

RESULTS

Several sociodemographic and occupational characteristics were associated with higher perceptions of safety culture, including older age and having a higher level of education.

CONCLUSION

Sociodemographic and occupational factors may influence the safety culture in neonatal intensive care units and should be considered when developing and implementing strategies to improve safety.

A National Study of Patient Safety Culture and Patient Safety Goal in Chinese Hospitals

OBJECTIVES

This study aimed to measure the patient safety culture and the current practice of patient safety goals in China.

METHODS

This cross-sectional survey was conducted between November 2020 and November 2021. The 12-dimensions Hospital Survey on Patient Safety Culture questionnaire and the 14-items Survey on the Current Practice of Patient Safety Goal questionnaire were electronically distributed to 8164 healthcare providers across 26 provinces in China. Data were analyzed using descriptive statistics, correlation analysis, and multivariate linear regression.

RESULTS

A total of 8164 surveys were received, of which 7765 were valid and analyzed. The average positive response rate for the Hospital Survey on Patient Safety Culture survey was 69.68% (43.41%-91.54%). The percentage of positive responses in 5 dimensions (organizational learning, teamwork within units, feedback about error, management support for safety, and teamwork across units) was above the control limits, and 3 (nonpunitive response to error, staffing, and frequency of event reporting) were below the control limits. The average positive response rate for the Survey on the Current Practice of Patient Safety Goal survey was 96.11%. Patient safety culture was positively related to the current practice of patient safety goals ( r = 0.34, P < 0.001).

CONCLUSIONS

Our study concludes that although healthcare providers in China feel positively toward patient safety culture and practicably toward patient safety goals, considerable work is still needed to promote a patient safety movement.

Effects of Inclusive Leadership on Quality of Care: The Mediating Role of Psychological Safety Climate and Perceived Workgroup Inclusion

Purpose: The aim of the study is to investigate the multilevel effects of the inclusiveness of workgroup leaders on quality of care by intervening through a “psychological safety climate” at the group level and “perceived workgroup inclusion” at the individual level within professionally diverse workgroups of healthcare professionals. Material and Methods: Data are collected from 305 healthcare professionals nested in 61 workgroups and 305 patients treated by the same workgroups working in public-sector hospitals in Pakistan. Hypothesized relationships are tested through multilevel analyses using Mplus 7. Results: The results of the study show that inclusive leadership can enhance the quality of care delivered by multiprofessional workgroups of healthcare professionals through perceived workgroup inclusion. Further, the psychological safety climate does not mediate the relationship between inclusive leadership and quality of care individually, but it transmits the effects of inclusive leadership through perceived workgroup inclusion on quality of care. Conclusion: The results of the study suggest that the inclusiveness of workgroup leaders, the psychological safety climate, and perceived workgroup inclusion can create safe and inclusive interpersonal mechanisms that play a key role in transmitting the positive effects of inclusive leadership on quality of care.

The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings

OBJECTIVES

The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) exploring whether PS differs by healthcare worker demographic factors, and (4) exploring whether PS differs by participation in 2 institutional programs, which encourage PS and speaking-up with patient safety concerns (i.e., Safety WalkRounds and Positive Leadership WalkRounds).

METHODS

Of 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate, 81%) completed the 6-item PS scale, demographics, safety culture scales, and questions on exposure to institutional initiatives. Psychometric analyses, correlations, analyses of variance, and t tests were used to test the properties of the PS scale and how it differs by demographic factors and exposure to PS-enhancing initiatives.

RESULTS

The PS scale exhibited strong psychometric properties, and a 1-factor model fit the data well (Cronbach α = 0.80; root mean square error approximation = 0.08; Confirmatory Fit Index = 0.97; Tucker-Lewis Fit Index = 0.95). Psychological Safety scores differed significantly by role, shift, shift length, and years in specialty. The PS scale correlated significantly and in expected directions with safety culture scales. The PS score was significantly higher in work settings with higher rates of exposure to Safety WalkRounds or Positive Leadership WalkRounds.

CONCLUSIONS

The PS scale is brief, diagnostic, and actionable. It exhibits strong psychometric properties; is associated with better safety, teamwork climate, and well-being; differs by demographic factors; and is significantly higher for those who have been exposed to PS-enhancing initiatives.

Fostering a just culture in healthcare organizations: experiences in practice

Background

A just culture is regarded as vital for learning from errors and fostering patient safety. Key to a just culture after incidents is a focus on learning rather than blaming. Existing research on just culture is mostly theoretical in nature.

Aim

This study aims to explore requirements and challenges for fostering a just culture within healthcare organizations.

Methods

We examined initiatives to foster the development of a just culture in five healthcare organizations in the Netherlands. Data were collected through interviews with stakeholders and observations of project group meetings in the organizations.

Results

According to healthcare professionals, open communication is particularly important, paying attention to different perspectives on an incident. A challenge related to open communication is how to address individual responsibility and accountability. Next, room for emotions is regarded as crucial. Emotions are related to the direct consequences of incidents, but also to the response of the outside world, including the media and the health inspectorate.

Conclusions

A challenge in relation to emotions is how to combine attention for emotions with focusing on facts, both within and outside the organization. Finally, healthcare professionals attach importance to commitment and exemplary behavior of management. A challenge as a manager here is how to keep distance while also showing commitment. Another challenge is how to combine openness with privacy of the parties involved, and how to deal with less nuanced views in other layers of the organization and in the outside world. Organizing reflection on the experienced tensions may help to find the right balance.

Role of the regulator in enabling a just culture: a qualitative study in mental health and hospital care

OBJECTIVES

A just culture is considered a promising way to improve patient safety and working conditions in the healthcare sector, and as such is also of relevance to healthcare regulators who are tasked with monitoring and overseeing quality and safety of care. The objective of the current study is to explore the experiences in healthcare organisations regarding the role of the healthcare inspectorate in enabling a just culture.

DESIGN

Qualitative study using interviews and focus groups that were transcribed verbatim, and observations of which written reports were made. Transcripts and observation reports were thematically analysed.

SETTING

Three mental healthcare providers, two hospitals and the healthcare inspectorate in the Netherlands.

PARTICIPANTS

We conducted 61 interviews and 7 focus groups with healthcare professionals, managers and other staff in healthcare organisations and with inspectors. Additionally, 27 observations were conducted in healthcare organisations.

RESULTS

We identified three themes in our data. First, professionals and managers in healthcare organisations perceive the inspectorate as a potential catalyst for learning processes, for example, as an instigator of investigating incidents thoroughly, yet also as a potential barrier as its presence and procedures limit how open employees feel they can be. Second, a just culture is considered relational and layered, meaning that relationships between different layers within or outside the organisation might hinder or promote a just culture. Finally, for inspectors to enable a just culture requires finding a balance between allowing organisations the time to take responsibility for quality and safety issues, and timely regulatory intervention when healthcare providers are unwilling or unable to act.

CONCLUSIONS

If regulators intend to enable the development of a just culture within healthcare organisations, they must adopt regulatory procedures that support reflection and learning within the organisations they regulate and consider mutual trust as a vital regulatory tool.

Evaluation of the Culture of Safety and Quality in Pediatric Primary Care Practices

OBJECTIVES

The purposes of this article were to describe the perceptions of the culture of safety in pediatric primary care and evaluate whether organizational factors and staff roles are associated with perceptions of the culture of safety.

METHODS

We conducted a secondary data analysis using 2020 Agency for Healthcare Research and Quality Medical Office Survey on Patient Safety Culture to examine the culture of safety and quality in pediatric primary care practices. We used descriptive statistics and calculated differences in perceptions of patient safety and quality based on practice size, ownership, and staff roles using bivariate and logistic regressions.

RESULTS

The sample included 99 pediatric primary care practices and 1228 staff (physicians n = 169, advanced practice providers n = 70, nurses n = 338, and administration/management n = 651). The "teamwork" domain had the highest positive ratings (≥81.6% positive responses), whereas the "work pressure and pace" domain had the lowest positive ratings (≤28.6% positive response). There were no differences in perceptions of safety or quality based on practice size or ownership. However, there were differences based on staff roles, specifically between administration/management and direct care staff.

CONCLUSIONS

Overall, perceptions of the culture of safety and quality in pediatric primary care practices were positive. Differences in perceptions existed based on staff role. Future studies are needed to determine whether differences are clinically meaningful and how to narrow differences in perceptions among staff and improve of the culture of safety as a mechanism to improve the safety and quality of pediatric primary care.

Teams and continuity of end-of-life care in hospitals: managing differences of opinion

Background

Recognised as an essential element in end-of-life care by the Australian Commission on Safety and Quality in Health Care, effective teamwork can enhance the quality and safety of end-of-life care for patients in hospitals. End-of-Life Essentials (EOLE) is a Commonwealth funded project that delivers peer-reviewed, evidence-based, online education and practice change resources for doctors, nurses and allied health professionals working in hospitals. ‘Teams and Continuity for the Patient’ features in the suite of EOLE modules and includes education around effective teamwork in end-of-life care. The aim of this study was to explore the views of module learners on managing differences of opinion among staff regarding patient care management.

Methods

Participants were learners (health professionals) who registered to the EOLE website and engaged with the Teams module. Learner responses to a question posed at the end of the module ‘How do you manage differences of opinion among staff regarding patient care management?’ were extracted for a 12-month period. Qualitative data were analysed thematically in NVivo V.12, with pragmatism as an overarching theoretical framework. Data were coded using an inductive, open approach, and axial coding was used to organise the codes into themes and subthemes.

Findings

A total of 293 learner statements were analysed, with subthemes organised into three overarching themes: prioritising the patient, team collaboration and communication skills and emotional awareness.

Conclusion

In complex, fast-paced, hospital environments, the potential for conflict among teams is high. Quality care relies on team members who work in unison, who can also recognise conflict emerging and respond in respectful and appropriate ways. In this study, the management actions reported by health professionals as proving helpful when differences of opinion among team members arise, are valuable to organisations who are considering how to prepare for quality and safety accreditation.

Effect of after action review on safety culture and second victim experience and its implementation in an Irish hospital: A mixed methods study protocol

Background

After Action Review is a form of facilitated team learning and review of events. The methodology originated in the United States Army and forms part of the Incident Management Framework in the Irish Health Services. After Action Review has been hypothesized to improve safety culture and the effect of patient safety events on staff (second victim experience) in health care settings. Yet little direct evidence exists to support this and its implementation has not been studied.

Aim

To investigate the effect of After Action Review on safety culture and second victim experience and to examine After Action Review implementation in a hospital setting.

Methods

A mixed methods study will be conducted at an Irish hospital. To assess the effect on safety culture and second victim experience, hospital staff will complete surveys before and twelve months after the introduction of After Action Review to the hospital (Hospital Survey on Safety Culture 2.0 and Second Victim Experience and Support Tool). Approximately one in twelve staff will be trained as After Action Review Facilitators using a simulation based training programme. Six months after the After Action Review training, focus groups will be conducted with a stratified random sample of the trained facilitators. These will explore enablers and barriers to implementation using the Theoretical Domains Framework. At twelve months, information will be collected from the trained facilitators and the hospital to establish the quality and resource implications of implementing After Action Review.

Discussion

The results of the study will directly inform local hospital decision-making and national and international approaches to incorporating After Action Review in hospitals and other healthcare settings.

Violence and abuse against nurses in Saudi Arabia: A narrative review

AIM

To explore recent workplace violence literature against nurses in Saudi Arabia in terms of prevalence, contributing factors and recommendations for prevention.

BACKGROUND

Workplace violence in healthcare settings is a growing concern and efforts to provide nurses with optimum protection against workplace violence are challenged by multifaceted contributing factors.

METHOD

A systematic search strategy was employed to search workplace violence studies in the Saudi context in PubMed, ProQuest and Google Scholar. A narrative analysis was performed on peer-reviewed articles published in English between 2011 and 2021.

FINDINGS

Issues related to the prevalence of nursing workplace violence before and after the Saudi government's healthcare workers protection act, measurement and monitoring issues, contributing factors and interventions for mitigating workplace violence are explored.

CONCLUSION

There was inflation of quantitative descriptions of workplace violence on the account of qualitative approaches to understand the phenomenon. Workplace violence has decreased since the introduction of the Saudi government's legislative act in 2018. Overcrowding, miscommunication, and unmet patient needs were the factors most frequently contributing to workplace violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Healthcare organizations should enhance workplace violence reporting systems and provide interpreters to support international nurses' communication with Saudi patients and families. Nurses need to be trained in workplace violence-related policies and procedures.

Towards remote leadership in health care: Lessons learned from an integrative review

AIM

To gather and synthesize current empirical evidence on remote leadership and to provide knowledge that can be used to develop successful remote leadership in health care.

DESIGN

A integrative literature review with an integrated mixed methods design.

DATA SOURCES

The literature search was carried out between February and March 2019 in the CINAHL, Medline (Ovid), PsycInfo, Scopus, SocIndex, Web of Science and Business Source Elite (EBSCO) databases.

REVIEW METHODS

An integrative review was conducted to identify relevant studies published from 2010 to 2019. Of the 88 eligible studies, 21 studies met the inclusion criteria and were selected for the final review. The included studies were analysed using mixed methods synthesis, more specifically, data-based convergent synthesis.

RESULTS

The performed analysis identified three main themes: characteristics of successful remote leadership; enhancing the leader-member relationship; and challenges in remote leadership. The first theme included the following sub-themes: remote leader characteristics; trust; communication; and leading the team culture. The second theme covered the importance of organizing regular face-to-face meetings, clear communication policies and the connection between positive team spirit and good remote leader-member relationship, while the third theme emphasized leader- and member-related challenges for remote work.

CONCLUSIONS

As none of the identified studies had been conducted in a health care setting, future remote leadership research must also specifically consider the health care context. This will be pivotal to exploring how remote work can foster a safe workplace culture, empower health care workers, increase job satisfaction and improve patient outcomes.

IMPACT

Remote leadership has rarely been studied in the health care context. Trust, communication, team spirit and a leader's characteristics are central to remote leadership, a finding which is useful for re-evaluating and improving the current culture at health care organizations.

Student nurses' strategies when speaking up for patient safety: A qualitative study

The purpose of this study was to understand student nurses' perceptions and experiences of witnessing and responding to risks to patient safety during their integrated learning experiences. This qualitative study's two-phased approach included individual semi-structured interviews, followed by focus group discussions with students. Participants included 53 pre-registration nursing students recruited from the first, second, and third years of study at two Australian universities. All had attended at least one clinical placement experience. Interpretive Description was used as a framework to guide the study. The findings highlight that students engage in specific and deliberate strategies when attempting to speak up. Students weigh up the risk to the patient and themselves. They use questioning techniques and their knowledge, experiences, and resources when speaking up. Students highlighted the need for caution and persistence while aiming to reduce the risk of reprisal. Exposing the challenges and successes students experience will provide educators, managers, and clinicians with the understanding necessary to better support both students and clinicians to achieve safe outcomes for patients as well a students.

Exploring the influence of workplace violence and bystander behaviour on patient safety in Korea: A pilot study

AIMS

To explore the influences of clinical nurses' workplace violence and bystander behaviour on patient safety.

BACKGROUND

Bystanders' role in social violence affects the consequences of said violence; however, few studies have explored the relationship between workplace violence and patient safety among nurses working in clinical settings.

METHODS

A cross-sectional survey design was conducted using a structured questionnaire pertaining to workplace violence, bystander behaviour, patient safety culture and nurse-assessed patient safety outcomes. The questionnaire was administered to 185 bedside nurses at a university hospital in a metropolitan city in Korea.

RESULTS

A regression model with department, patient safety culture, workplace bullying, incivility and bystander behaviour explained approximately 34.0% of patient safety. Further, defending bystander behaviour, facilitating bystander behaviour, work-related bullying and co-worker incivility influenced the patient safety.

CONCLUSION

Being a facilitating bystander was a threat to patient safety, while being a defending bystander enhanced patient safety.

IMPLICATIONS FOR NURSING MANAGEMENT

The negative consequences of workplace violence on patient safety may be mitigated by colleagues' reaction to violence; therefore, nursing policymakers should emphasize the role of positive bystanders as an organisational strategy against workplace violence.

Assessment of patient safety climate by nurses in Slovak Public and private hospitals

AIM

To examine variations in the safety climate reported by nurses in Slovak hospitals and to analyse the association between dimensions of the patient safety climate and demographic and organisational factors.

BACKGROUND

A deeper understanding of how safety climate varies across hospitals can be useful in determining areas with a potential for improvement. Staffing and non-punitive response to errors were identified in recent research syntheses as the weakest dimensions of safety climate that require strengthening.

METHODS

The sample consisted of 1,429 nurses working in public and private hospitals in Slovakia. The Hospital Survey on Patient Safety Culture questionnaire was used for data collection, and descriptive analysis was carried out to examine relationships between variables.

RESULTS

Nurses working in general private hospitals with a bed capacity of less than 500 beds were more positive about their hospital safety climate than other nurses working in differently organised hospitals. The lowest number of positive responses was scored in the domain of 'Non-Punitive Response to Error'. This result came from a blame-free error-reporting atmosphere.

CONCLUSIONS

Nurses perceived a higher level of patient safety when they had experienced better sharing of information on event reporting and had better learning opportunities.

IMPLICATIONS FOR NURSING MANAGEMENT

The results revealed strengths and weaknesses of the patient safety climate in the network of Slovak hospitals from the perspective of nurses working in these hospitals. This knowledge can enable nurse managers to instigate supportive strategies for just reporting, and learning from events, within an enhanced safety culture.

Senior nurses' perceptions of junior nurses' incident reporting: A qualitative study

AIM

To develop an understanding of senior nurses' ranking and perceptions of incident reporting by junior nurses.

BACKGROUND

Nurses must be encouraged to report incidents to nursing management. It is important to ascertain how senior nurses perceive their concerns, as it is crucial to ensuring that patient safety is managed.

METHOD

Qualitative study. Four focus groups explored senior nurses' perceptions of risks identified by nurses from a live incident reporting database. Data were analysed using framework analysis.

RESULTS

Five themes emerged demonstrating the differences in opinions in relation to the classification of events by senior and non-senior nurses. Senior nurses held the view that some junior nurses use incident reporting to 'vent frustration.'

CONCLUSION

There is a mismatch between senior nurses' and junior nurses' perceptions of safety incidents. Nurses need to develop the writing style and use language that red flags incidents when reporting incidents. Senior nurses need to create a positive culture where risk from incident reporting is used to improve patient safety and subsequently a positive work environment. Implications for Nursing Management Our research identified the need for joint training to promote a shared understanding among nurses as to how incident report should be completed to promote patient safety.

Gaining perspective into the term 'safety culture'; how emergency nurses view its meaning in their everyday practice: a focus group study in an Australian setting

BACKGROUND

The creation of the safety culture coordinator role within an Australian Local Health District followed a critical incident in one of its emergency departments. As part of the role, it was important to have an understanding of how nurses viewed the term safety culture in order to support them in implementing any changes that would influence their everyday practice.

METHODS

A descriptive qualitative design was chosen for the study. Focus groups allowed the perspectives of nurses to be heard and represented.

RESULTS

Five themes emerged from the data: defining safety culture, influences of team culture, differences in environmental impact, the reality of reporting incidents and commitment to best practice and patient care. These highlighted the influencing factors that promoted and inhibited a safety culture.

CONCLUSION

This study provides a greater understanding of what supports a positive safety culture and the challenges that nurses face. Across the three emergency departments, nurses had similar beliefs about safety culture, with a consensus that safety was everyone's responsibility. This has enabled the safety culture coordinator position to have greater consideration of what initiatives are valued and important in working with nurses to design strategies that influence their safety culture.

A qualitative descriptive inquiry of the influences on nurses' missed care decision-making processes in acute hospital paediatric care

AIM

To explore influences on nurses' missed care decision-making processes in acute hospital paediatric care.

BACKGROUND

Many contemporary studies describe the phenomenon of missed care. It is clear that environment and organizational culture influence the nursing activities; however, what influences their decision-making processes has not been investigated.

METHOD

A descriptive qualitative inquiry was performed using semi-structured interviews with paediatric nurses (n = 20) from one Italian paediatric hospital.

FINDINGS

Thematic analysis revealed four themes: nurses' value system; hospital logistics, structures and resources; prioritization processes; and the informal caregiver's role.

CONCLUSION

This paper offers insights into the various factors involved in nurses' decision-making process when contemplating missed care that will be of use to managers when planning care or addressing missed care in the paediatric clinical setting.

IMPLICATIONS FOR NURSING MANAGEMENT

Knowledge and awareness of missed care in children's nursing needs greater exploration, especially in relation to what influences nurses' decision-making choices around missed care. Overall, a greater understanding of this will help managers to manage situations effectively and ethically so that missed care does not impact on outcomes for children in health care.