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Müller BS, Lüttel D, Schütze D, Blazejewski T, Pommée M, Müller H, Rubin K, Thomeczek C, Schadewitz R, Heuzeroth R, Schwappach D, Güthlin C, Paulitsch M, Gerlach FM. Supporting Error Management and Safety Climate in Ambulatory Care Practices: The CIRSforte Study. J Patient Saf 2024; 20:314-322. [PMID: 38489154 DOI: 10.1097/pts.0000000000001225] [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: 03/17/2024]
Abstract
BACKGROUND To improve patient safety, it is important that healthcare facilities learn from critical incidents. Tools such as reporting and learning systems and team meetings structure error management and promote learning from incidents. To enhance error management in ambulatory care practices, it is important to promote a climate of safety and ensure personnel share views on safety policies and procedures. In contrast to the hospital sector, little research has been dedicated to developing feasible approaches to supporting error management and safety climate in ambulatory care. In this study, we developed, implemented, and evaluated a multicomponent intervention to address how error management and safety climate can be improved in ambulatory care practices. METHODS In a prospective 1-group pretest-posttest implementation study, we sought to encourage teams in German ambulatory practices to use proven methods such as guidelines, workshops, e-learning, (online) meetings, and e-mail newsletters. A pretest-posttest questionnaire was used to evaluate level and strength of safety climate and psychological behavioral determinants for systematic error management. Using 3 short surveys, we also assessed the state of error management in the participating practices. In semistructured interviews, we asked participants for their views on our intervention measures. RESULTS Overall, 184 ambulatory care practices nationwide agreed to participate. Level of safety climate and safety climate strength (rwg) improved significantly. Of psychological behavioral determinants, significant improvements could be seen in "action/coping planning" and "action control." Seventy-six percent of practices implemented a new reporting and learning system or modified their existing system. The exchange of information between practices also increased over time. Interviews showed that the introductory workshop and provided materials such as report forms or instructions for team meetings were regarded as helpful. CONCLUSIONS A significant improvement in safety climate level and strength, as well as participants' knowledge of how to analyze critical incidents, derive preventive measures and develop concrete plans suggest that it is important to train practice teams, to provide practical tips and tools, and to facilitate the exchange of information between practices. Future randomized and controlled intervention trials should confirm the effectiveness of our multicomponent intervention.Trial registration: Retrospectively registered on 18. November 2019 in German Clinical Trials Register No. DRKS00019053.
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Affiliation(s)
| | | | - Dania Schütze
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Tatjana Blazejewski
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | | | | | | | | | | | | | - David Schwappach
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Corina Güthlin
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Michael Paulitsch
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
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Olesen AE, Juhl MH, Deilkås ET, Kristensen S. Review: application of the Safety Attitudes Questionnaire (SAQ) in primary care - a systematic synthesis on validity, descriptive and comparative results, and variance across organisational units. BMC PRIMARY CARE 2024; 25:37. [PMID: 38273241 PMCID: PMC10809511 DOI: 10.1186/s12875-024-02273-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
Patient safety research has focused mostly on the hospital and acute care setting whereas assessments of patient safety climate in primary health care settings are warranted. Valid questionnaires as e.g., the Safety Attitudes Questionnaire (SAQ) may capture staff perceptions of patient safety climate but until now, an overview of the use of SAQ in primary care has not been systematically presented. Thus, the aim of this systematic review is to present an overview of SAQ used in primary care.Methods The electronic databases: PubMed, Embase, Cinahl, PsycInfo and Web of Science were used to find studies that used any version of SAQ in primary care. Studies were excluded if only abstract or poster was available, as the information in abstract and posters was deemed insufficient. Commentaries and nonempirical studies (e.g., study protocols) were excluded. Only English manuscripts were included.Results A total of 43 studies were included and 40 of them fell into four categories: 1) validation analysis, 2) descriptive analysis, 3) variance assessment and 4) intervention evaluation and were included in further analyses. Some studies fell into more than one of the four categories. Seventeen studies aimed to validate different versions of SAQ in a variety of settings and providers. Twenty-five studies from fourteen different countries reported descriptive findings of different versions of SAQ in a variety of settings. Most studies were conducted in primary health care centres, out-of-hours clinics, nursing homes and general practice focusing on greatly varying populations. One study was conducted in home care. Three studies investigated variance of SAQ scores. Only five studies used SAQ to assess the effects of interventions/events. These studies evaluated the effect of electronic medical record implementation, a comprehensive Unit-based Safety Program or COVID-19.Conclusion The synthesis demonstrated that SAQ is valid for use in primary care, but it is important to adapt and validate the questionnaire to the specific setting and participants under investigation. Moreover, differences in SAQ factor scores were related to a variety of descriptive factors, that should be considered in future studies More studies, especially variance and intervention studies, are warranted in primary care.Trial registration This systematic review was not registered in any register.
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Affiliation(s)
- Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8a, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark.
| | - Marie Haase Juhl
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8a, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
| | - Ellen Tveter Deilkås
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Oslo, Norway
| | - Solvejg Kristensen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark
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Lydon S, Cupples ME, Murphy AW, Hart N, O'Connor P. A Systematic Review of Measurement Tools for the Proactive Assessment of Patient Safety in General Practice. J Patient Saf 2021; 17:e406-e412. [PMID: 28376058 DOI: 10.1097/pts.0000000000000350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary care physicians have reported a difficulty in understanding how best to measure and improve patient safety in their practices. OBJECTIVES The aims of the study were to identify measures of patient safety suitable for use in primary care and to provide guidance on proactively monitoring and measuring safety. METHODS Searches were conducted using Medline, Embase, CINAHL and PsycInfo in February 2016. Studies that used a measure assessing levels of or attitudes toward patient safety in primary care were considered for inclusion. Only studies describing tools focused on the proactive assessment of safety were reviewed. Two independent reviewers extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs. RESULTS More than 2800 studies were screened, of which 56 were included. Most studies had used healthcare staff survey or interviews to assess patient safety (n = 34), followed by patient chart audit (n = 14) or use of a practice assessment checklist (n = 7). Survey or interview of patients, active monitoring systems, and simulated patients were used with less frequency. CONCLUSIONS A lack of appropriate measurement tools has been suggested to limit the ability to monitor patient safety in primary care and to improve patient care. There is no evident "best" method of measuring patient safety in primary care. However, many of the measures are readily available, quick to administer, do not require external involvement, and are inexpensive. This synthesis of the literature suggests that it is possible for primary care physicians to take a proactive approach to measuring and improving safety.
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Affiliation(s)
| | | | | | - Nigel Hart
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Jachan DE, Müller‐Werdan U, Lahmann NA. Patient safety. Factors for and perceived consequences of nursing errors by nursing staff in home care services. Nurs Open 2021; 8:755-765. [PMID: 33570279 PMCID: PMC7877149 DOI: 10.1002/nop2.678] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
AIM To identify factors for and perceived consequences of nursing errors by nursing staff in home care services in correlation with qualification, work experience, working hours and trainings. BACKGROUND Patient safety has increasingly been brought into focus of politics and care practices over the past few years. However, little evidence has been provided yet on nursing errors in out-of-hospital settings. DESIGN A cross-sectional study. METHODS Randomized sample of 107 home care services and 656 nurses and nursing assistants recruited from all 16 federal states in Germany. RESULTS Missing trainings on error management within the past 2 years were identified to be an important factor for mistakes regarding hygienic measures and medication administration. However, most errors arose in documentation without any significant differences in qualification, work experience, training and working hours. CONCLUSION Findings indicate that insufficient hygiene and medication administration might be reduced by implementing error management trainings on a regular basis in home care services.
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Affiliation(s)
- Deborah Elisabeth Jachan
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDepartment of Geriatric MedicineNursing Research Group in GeriatricsCharitéplatz 1Berlin10117Germany
| | - Ursula Müller‐Werdan
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDepartment of Geriatric MedicineNursing Research Group in GeriatricsCharitéplatz 1Berlin10117Germany
| | - Nils Axel Lahmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDepartment of Geriatric MedicineNursing Research Group in GeriatricsCharitéplatz 1Berlin10117Germany
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Lockwood AM, Proulx J, Hill M, Pendray J. Using safety culture results to guide the merger of four general practices in the UK. BMJ Open Qual 2020; 9:bmjoq-2019-000860. [PMID: 32193196 PMCID: PMC7101040 DOI: 10.1136/bmjoq-2019-000860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/06/2020] [Accepted: 03/01/2020] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
| | - Joshua Proulx
- Safe and Reliable Healthcare, Evergreen, Colorado, USA
| | - Matthew Hill
- Anaesthetics, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Joanna Pendray
- Southwest Academic Health Science Network (SWAHSN), Exeter, Devon, UK
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Pohlman KA, Salsbury SA, Funabashi M, Holmes MM, Mior S. Patient safety in chiropractic teaching programs: a mixed methods study. Chiropr Man Therap 2020; 28:50. [PMID: 32943068 PMCID: PMC7500017 DOI: 10.1186/s12998-020-00339-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Patient safety research has lagged within academic settings, including chiropractic teaching institutions. To develop a robust patient safety culture, the Institute of Medicine emphasized the need for employee’s attitudes to be understanding and positive. To initiate the assessment of the current culture and future needs, this study evaluated patient safety attitudes among chiropractic teaching clinic stakeholders (supervising clinicians, student interns, and administrative staff) and compared their standardized survey scores to established medical survey databases. Methods We conducted a cross-sectional, mixed methods survey design with quantitative analytic priority. Chiropractic interns, clinical faculty, and clinic staff of 5 international chiropractic educational programs completed a modified version of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture for Medical Offices Survey with open-ended comment fields between 2014 and 2016. Composite means of positive responses were calculated and compared to patient safety, quality of care, and overall self-ratings benchmarks from Canadian providers and academic settings in the AHRQ database. Qualitative responses were thematically categorized for a convergent analysis of quantitative results for the chiropractic sample. Results Chiropractic survey response rate was 45.3% (n = 645). Quantitative survey results indicated moderate scores and ranges (57–85%) on all patient safety dimensions for the chiropractic samples. Academic medicine and chiropractic providers’ benchmarks scored higher positive responses than chiropractic teaching clinics on most quantitative dimensions, except for work pressure/pace. Teamwork, organizational learning, and patient tracking/follow-up were the most positively endorsed quantitative dimensions, with communication, staff training, office standardization, and leadership support considered areas for improvement in both settings. Qualitative responses for the chiropractic clinics identified a need for open communication; additional staff training and student involvement in creating safety cultures; standardization of office processes including information exchange, scheduling, and equipment maintenance; and leadership support that focused on decreasing work pressure/pace and setting safety priorities. Conclusion As the first report of patient safety attitudes from stakeholders in chiropractic teaching clinics, specific areas of improvement were identified. Chiropractic teaching programs might consider incorporating these and related patient safety concepts into their formal curricula. Mixed methods approach offers teaching clinics opportunities to assess stakeholders’ insights and enhance safe delivery of chiropractic care.
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Affiliation(s)
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, 52803, USA
| | - Martha Funabashi
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Michelle M Holmes
- AECC University College, Parkwood Campus, Parkwood Rd, Bournemouth, BH5 2DF, UK
| | - Silvano Mior
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
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Müller BS, Beyer M, Blazejewski T, Gruber D, Müller H, Gerlach FM. Improving critical incident reporting in primary care through education and involvement. BMJ Open Qual 2019; 8:e000556. [PMID: 31523734 PMCID: PMC6711430 DOI: 10.1136/bmjoq-2018-000556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 07/10/2019] [Accepted: 07/31/2019] [Indexed: 11/24/2022] Open
Abstract
Background Critical incident reporting systems (CIRS) can be an important tool for the identification of organisational safety needs and thus to improve patient safety. In German primary care, CIRS use is obligatory but remains rare. Studies on CIRS implementation in primary care are lacking, but those from secondary care recommend involving management personnel. Objective This project aimed to increase CIRS use in 69 practices belonging to a local practice network. Methods The intervention consisted of the provision of a web-based CIRS, accompanying measures to train practice teams in error management and CIRS, and the involvement of the network’s management. Three measurements were used: (1) number of incident reports and user access rates to the web-based CIRS were recorded, (2) staff were given a questionnaire addressing incident reporting, error management and safety climate and (3) qualitative reflection conferences were held with network management. Results Over 20 months, 17 critical incidents were reported to the web-based CIRS. The number of staff intending to report the next incident online decreased from 42% to 20% of participants. In contrast, the number of practices using an offline CIRS (eg, incident book) increased from 23% to 49% of practices. Practices also began proactively approaching network management for help with incidents. After project completion, participants scored higher in the patient safety climate factor ‘perception of causes of errors’. For many practices, the project provided the first contact with structured error management. Conclusion Specific measures to improve the use of CIRS in primary care should focus on network management and practice owners. Practices need basic training on safety culture and error management. Continuing, practices should implement an offline CIRS, before they can profit from the exchange of reports via web-based CIRS. It is crucial that practices receive feedback on incidents, and trained network management personnel can provide such support.
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Affiliation(s)
- Beate Sigrid Müller
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Martin Beyer
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Tatjana Blazejewski
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Dania Gruber
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
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Kien C, Schultes MT, Szelag M, Schoberberger R, Gartlehner G. German language questionnaires for assessing implementation constructs and outcomes of psychosocial and health-related interventions: a systematic review. Implement Sci 2018; 13:150. [PMID: 30541590 PMCID: PMC6292038 DOI: 10.1186/s13012-018-0837-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background Over the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnaires used in English-speaking countries but limited their search processes to mental health and public health settings. Our aim was to identify questionnaires used in German-speaking countries measuring the implementation of interventions in public health and health care settings in general and to assess their psychometric properties. Methods We searched five different bibliographic databases (from 1985 to August 2017) and used several other search strategies (e.g., reference lists, forward citation) to obtain our data. We assessed the instruments, which were identified in an independent dual review process, using 12 psychometric rating criteria. Finally, we mapped the instruments’ scales and subscales in regard to the constructs of the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcome Framework (IOF). Results We identified 31 unique instruments available for the assessment of implementation science constructs. Hospitals and other health care settings were the ones most often investigated (23 instruments), while education and childcare settings, workplace settings, and community settings lacked published instruments. Internal consistency, face and content validity, usability, and structural validity were the aspects most often described. However, most studies did not report on test-retest reliability, known-groups validity, predictive criterion validity, or responsiveness. Overall, the majority of studies did not reveal high-quality instruments, especially regarding the psychometric criteria internal consistency, structural validity, and criterion validity. In addition, we seldom detected instruments operationalizing the CFIR domains intervention characteristics, outer setting, and process, and the IOF constructs adoption, fidelity, penetration, and sustainability. Conclusions Overall, a sustained and continuous effort is needed to improve the reliability and validity of existing instruments to new ones. Instruments applicable to the assessment of implementation constructs in public health and community settings are urgently needed. Trial registration The systematic review protocol was registered in PROSPERO on October 19, 2017, under the following number: CRD42017075208. Electronic supplementary material The online version of this article (10.1186/s13012-018-0837-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina Kien
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500, Krems a.d. Donau, Austria. .,Center for Public Health, Department of Social and Preventive Medicine, Medical University Vienna, Kinderspitalgasse 15, 1090, Wien, Austria.
| | - Marie-Therese Schultes
- Department of Applied Psychology: Work, Education, Economy, Faculty of Psychology, University of Vienna, Universitaetsstrasse 7, 1010, Vienna, Austria.,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7445 Rosenau, Chapel Hill, NC, 27599-7445, USA
| | - Monika Szelag
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500, Krems a.d. Donau, Austria
| | - Rudolf Schoberberger
- Center for Public Health, Department of Social and Preventive Medicine, Medical University Vienna, Kinderspitalgasse 15, 1090, Wien, Austria
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500, Krems a.d. Donau, Austria.,RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill, 27599-7445, NC, USA
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Lawati MHA, Dennis S, Short SD, Abdulhadi NN. Patient safety and safety culture in primary health care: a systematic review. BMC FAMILY PRACTICE 2018; 19:104. [PMID: 29960590 PMCID: PMC6026504 DOI: 10.1186/s12875-018-0793-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East. METHODS A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care. RESULTS The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East. CONCLUSIONS This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran.
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Affiliation(s)
- Muna Habib Al Lawati
- Faculty of Health Sciences, Discipline of Behavioral and Social Sciences in Health, The University of Sydney, Science Road, Sydney, NSW, 2006, Australia. .,Department of Quality Assurance and Patient Safety, Ministry of Health, P.O.Box, 626, Wadi Al Kabir, 117, Muscat, PC, Oman.
| | - Sarah Dennis
- Ingham Institute for Applied Medical Research, Campbell Street, Liverpool, NSW, 2170, Australia.,Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, 71 East Street, Lidcombe, NSW, 2141, Australia
| | - Stephanie D Short
- Faculty of Health Sciences, Discipline of Behavioral and Social Sciences in Health, The University of Sydney, Science Road, Sydney, NSW, 2006, Australia
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A Systematic Review of Primary Care Safety Climate Survey Instruments: Their Origins, Psychometric Properties, Quality, and Usage. J Patient Saf 2018; 14:e9-e18. [DOI: 10.1097/pts.0000000000000393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Desmedt M, Bergs J, Vertriest S, Vlayen A, Schrooten W, Hellings J, Vandijck D. Systematic psychometric review of self-reported instruments to assess patient safety culture in primary care. J Adv Nurs 2017; 74:539-549. [DOI: 10.1111/jan.13464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Melissa Desmedt
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Limburg Belgium
| | - Jochen Bergs
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Limburg Belgium
| | - Sonja Vertriest
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Limburg Belgium
| | - Annemie Vlayen
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Limburg Belgium
| | - Ward Schrooten
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Limburg Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Limburg Belgium
| | - Dominique Vandijck
- Faculty of Medicine and Life Sciences; Hasselt University; Hasselt Limburg Belgium
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Abstract
BACKGROUND When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an intervention for improving safety culture. AIM To gain insight into how two interventions affected patient safety culture in everyday practice. DESIGN AND SETTING After conducting a randomised control trial of two interventions, this was a qualitative study conducted in 30 general practices to aid interpretation of the previous quantitative findings. METHOD Interviews were conducted at practice locations (n = 27) with 24 GPs and 24 practice nurses. The theory of communities of practice--in particular, its concepts of a domain, a community, and a practice--was used to interpret the findings by examining which elements were or were not present in the participating practices. RESULTS Communal awareness of the problem was only raised after getting together and discussing patient safety. The combination of a questionnaire and workshop enhanced the interaction of team members and nourished team feelings. This shared experience also helped them to understand and develop tools and language for daily practice. CONCLUSION In order for patient safety culture to improve, the safety culture questionnaire was more successful when accompanied by a practice workshop. Initial discussion and negotiation of shared goals during the workshop fuelled feelings of coherence and belonging to a community wishing to learn about enhancing patient safety. Team meetings and day-to-day interactions enhanced further liaison and sharing, making patient safety a common and conscious goal.
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Manser T, Brösterhaus M, Hammer A. You can't improve what you don't measure: Safety climate measures available in the German-speaking countries to support safety culture development in healthcare. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 114:58-71. [PMID: 27566270 DOI: 10.1016/j.zefq.2016.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Safety climate measurement is a key input into safety culture development. The aim of this review is to provide an overview of the safety climate measures that have been evaluated for their psychometric properties in a German-speaking country and to make recommendations on how to use them in quality and patient safety improvement. METHODS A systematic search strategy was implemented to obtain relevant articles. PubMed and Web of Science databases were searched, and 128 abstracts were identified. After application of limits, 33 full texts were retrieved for subsequent evaluation. Studies were included on the basis of predetermined inclusion criteria and independent assessment by two reviewers. Publications were reviewed concerning healthcare setting, target group, safety culture dimensions covered and results of their psychometric evaluation. RESULTS This review identified 11 instruments for safety climate assessment in different healthcare settings (i. e. hospitals, nursing homes, primary care, dental care and community pharmacy) for which acceptable to good internal consistency was reported. We observed wide variability concerning the number of dimensions (1 to 14; in some cases including outcome dimensions) and items (9 to 128) that the instruments were comprised of. Nevertheless, consistency with regard to the thematic areas covered was rather high. DISCUSSION AND CONCLUSION While there is clear evidence that we can assess safety climate in healthcare, the application of safety climate measures by quality and patient safety practitioners has so far been rather limited. This review bridges this gap between research and improvement practice by highlighting the central role of safety climate assessment in a mixed methods approach to inform safety culture development.
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Affiliation(s)
- Tanja Manser
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany.
| | | | - Antje Hammer
- University Hospital Bonn, Institute for Patient Safety, Bonn, Germany
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Crossland L, Janamian T, Jackson CL. Key elements of high-quality practice organisation in primary health care: a systematic review. Med J Aust 2014; 201:S47-51. [PMID: 25047881 DOI: 10.5694/mja14.00305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/29/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify elements that are integral to high-quality practice and determine considerations relating to high-quality practice organisation in primary care. STUDY DESIGN A narrative systematic review of published and grey literature. DATA SOURCES Electronic databases (PubMed, CINAHL, the Cochrane Library, Embase, Emerald Insight, PsycInfo, the Primary Health Care Research and Information Service website, Google Scholar) were searched in November 2013 and used to identify articles published in English from 2002 to 2013. Reference lists of included articles were searched for relevant unpublished articles and reports. DATA SYNTHESIS Data were configured at the study level to allow for the inclusion of findings from a broad range of study types. Ten elements were most often included in the existing organisational assessment tools. A further three elements were identified from an inductive thematic analysis of descriptive articles, and were noted as important considerations in effective quality improvement in primary care settings. CONCLUSION Although there are some validated tools available to primary care that identify and build quality, most are single-strategy approaches developed outside health care settings. There are currently no validated organisational improvement tools, designed specifically for primary health care, which combine all elements of practice improvement and whose use does not require extensive external facilitation.
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Affiliation(s)
- Lisa Crossland
- Centre of Research Excellence in Primary Health Care Microsystems, University of Queensland, Brisbane, QLD, Australia.
| | - Tina Janamian
- Centre of Research Excellence in Primary Health Care Microsystems, University of Queensland, Brisbane, QLD, Australia
| | - Claire L Jackson
- Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia
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Gehring K, Schwappach D. [Patient safety in general practice]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:25-31. [PMID: 24602524 DOI: 10.1016/j.zefq.2014.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/16/2014] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION So far, there has been a lack of systematic data regarding critical incidents and safety climate in Swiss primary care offices. Therefore, a survey was conducted amongst physicians and nurses ("MPA") working in Swiss German primary care offices leading to a subsequent project on the telephone triage. METHODS Using a standardised questionnaire, healthcare professionals in primary care offices have been surveyed to determine safety risks and safety climate in their offices. The questionnaire consisted of safety-climate items as well as descriptions of 23 safety incidents. These incidents were rated in terms of frequency (appearance in the office during the past 12 months) and severity (harm associated with the last occurrence in the office). In addition, physicians and nurses answered an open-ended question referring to patient safety risks they would wish to eliminate in their offices. In the subsequent project, interviews and group discussions have been conducted with physicians and nurses in order to perform a process analysis of the telephone triage and to develop a tool that may help primary care offices to strengthen telephone triage as a secure process. RESULTS 630 physicians and nurses (50.2% physicians, 49.8% nurses) participated in the study. 30% of the physicians and 17% of the nurses observed at least one of the 23 incidents in their offices on a daily or weekly basis. Errors in documentation were reported most frequently. As regards severity, the triage by nurses at the initial patient contact, errors in diagnosis, failure to monitor patients after therapeutic treatment in the office, and errors regarding the medication process were shown to be the most relevant. Most frequently participants wanted to eliminate the following risks to patient safety in their offices: medication (28% of all mentions), medical procedures in the office (11%) and telephone triage (7%). Participation in team meetings and quality circles proved to be relevant predictors of the safety climate dimension "team-based error prevention". Differences between occupational groups were found regarding safety incidents as well as safety climate. CONCLUSION The results of this study show the telephone triage to be a relevant area of patient safety in primary care that has not been focused on so far. In order to enhance safety of the triage process a new project was initiated. The result of the project is a triage guide for primary care offices. This guide supports physicians and nurses in a joint and critical examination of office structures and processes related to telephone triage. The systematically observed differences between occupational groups indicate that the entire office team need to be involved when analysing safety risks and taking action to improve patient safety. Only in doing so, risks can be identified comprehensively. Moreover, measures can be taken that are relevant to and supported by all healthcare professionals working in a primary care office. This approach of involving the entire team forms the basis for the guide on telephone triage.
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Affiliation(s)
- Katrin Gehring
- patientensicherheit schweiz, Stiftung für Patientensicherheit, Zürich, Schweiz.
| | - David Schwappach
- patientensicherheit schweiz, Stiftung für Patientensicherheit, Zürich, Schweiz; Institut für Sozial- und Präventivmedizin (ISPM), Universität Bern, Bern, Schweiz
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16
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Verbakel NJ, Zwart DLM, Langelaan M, Verheij TJM, Wagner C. Measuring safety culture in Dutch primary care: psychometric characteristics of the SCOPE-PC questionnaire. BMC Health Serv Res 2013; 13:354. [PMID: 24044750 PMCID: PMC3851468 DOI: 10.1186/1472-6963-13-354] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/12/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patient safety has been a priority in primary healthcare in the last years. The prevailing culture is seen as an important condition for patient safety in practice and several tools to measure patient safety culture have therefore been developed. Although Dutch primary care consists of different professions, such as general practice, dental care, dietetics, physiotherapy and midwifery, a safety culture questionnaire was only available for general practices. The purpose of this study was to modify and validate this existing questionnaire to a generic questionnaire for all professions in Dutch primary care. METHODS A validated Dutch questionnaire for general practices was modified to make it usable for all Dutch primary care professions. Subsequently, this questionnaire was administered to a random sample of 2400 practices from eleven primary care professions. The instrument's factor structure, reliability and validity were examined using confirmatory and explorative factor analyses. RESULTS 921 questionnaires were returned. Of these, 615 were eligible for factor analysis. The resulting SCOPE-PC questionnaire consisted of seven dimensions: 'open communication and learning from errors', 'handover and teamwork', 'adequate procedures and working conditions', 'patient safety management', 'support and fellowship', 'intention to report events' and 'organisational learning' with a total of 41 items. All dimensions had good reliability with Cronbach's alphas ranging from 0.70-0.90, and the questionnaire had a good construct validity. CONCLUSIONS The SCOPE-PC questionnaire has sound psychometric characteristics for use by the different professions in Dutch primary care to gain insight in their safety culture.
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Affiliation(s)
- Natasha J Verbakel
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dorien LM Zwart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maaike Langelaan
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Theo JM Verheij
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cordula Wagner
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
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Hoffmann B, Müller V, Rochon J, Gondan M, Müller B, Albay Z, Weppler K, Leifermann M, Mießner C, Güthlin C, Parker D, Hofinger G, Gerlach FM. Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial. BMJ Qual Saf 2013; 23:35-46. [DOI: 10.1136/bmjqs-2013-001899] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hoffmann B, Miessner C, Albay Z, Schröber J, Weppler K, Gerlach FM, Güthlin C. Impact of individual and team features of patient safety climate: a survey in family practices. Ann Fam Med 2013; 11:355-62. [PMID: 23835822 PMCID: PMC3704496 DOI: 10.1370/afm.1500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Knowledge about safety climate is fundamental to improving patient safety in health care organizations. Because individual and organizational factors influence the safety climate, we conducted a health care survey of German family practices so we could analyze the impact of the professional group, the professional experience of practice staff, and practice characteristics on perceptions of the safety climate. METHODS We wrote to health care assistants and doctors in 1,800 randomly selected family practices in Germany and asked them to complete a newly developed and validated Frankfurt Patient Safety Climate Questionnaire. We conducted a descriptive analyses of items and climate factors, as well as regression analysis, to identify potential predictors of the safety climate in family practice. RESULTS The response rate from the participating practices was 36.1%. Safety climate was perceived to be generally positive with the exception of the factors of error management and perception of the causes of errors. We discovered that whether or not the entire team had taken part in the survey had a positive influence on most factors. Doctors had more positive perceptions of 4 of 7 factors addressed to both professions. Male participants and doctors showed the most willingness to admit they had made an error. CONCLUSIONS Though the safety climate in German family practices was positive overall, health care professionals' use of incident reporting and a system's approach to errors was fairly rare. When evaluating the safety climate in primary health care practices, respondents' individual characteristics, as well as organizational features, should be taken into account.
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Affiliation(s)
- Barbara Hoffmann
- Institute of General Practice, Goethe, University Frankfurt, Germany.
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Gehring K, Schwappach DLB, Battaglia M, Buff R, Huber F, Sauter P, Wieser M. Safety climate and its association with office type and team involvement in primary care. Int J Qual Health Care 2013; 25:394-402. [PMID: 23667155 DOI: 10.1093/intqhc/mzt036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess differences in safety climate perceptions between occupational groups and types of office organization in primary care. METHODS Primary care physicians and nurses working in outpatient offices were surveyed about safety climate. Explorative factor analysis was performed to determine the factorial structure. Differences in mean climate scores between staff groups and types of office were tested. Logistic regression analysis was conducted to determine predictors for a 'favorable' safety climate. RESULTS 630 individuals returned the survey (response rate, 50%). Differences between occupational groups were observed in the means of the 'team-based error prevention'-scale (physician 4.0 vs. nurse 3.8, P < 0.001). Medical centers scored higher compared with single-handed offices and joint practices on the 'team-based error prevention'-scale (4.3 vs. 3.8 vs. 3.9, P < 0.001) but less favorable on the 'rules and risks'-scale (3.5 vs. 3.9 vs. 3.7, P < 0.001). Characteristics on the individual and office level predicted favorable 'team-based error prevention'-scores. Physicians (OR = 0.4, P = 0.01) and less experienced staff (OR 0.52, P = 0.04) were less likely to provide favorable scores. Individuals working at medical centers were more likely to provide positive scores compared with single-handed offices (OR 3.33, P = 0.001). The largest positive effect was associated with at least monthly team meetings (OR 6.2, P < 0.001) and participation in quality circles (OR 4.49, P < 0.001). CONCLUSIONS Results indicate that frequent quality circle participation and team meetings involving all team members are effective ways to strengthen safety climate in terms of team-based strategies and activities in error prevention.
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Affiliation(s)
- Katrin Gehring
- Swiss Patient Safety Foundation. Asylstr. 77. 8032 Zuerich, Switzerland.
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