Redirecting traditional professional values to support safety: changing organisational culture in health care

Hospital organizational change: The importance of teamwork culture, communication, and change readiness

Background

Hospital organizational change can be a challenging time, especially when staff do not feel informed and ready for the change to come. A supportive workplace culture can mitigate the negative effects allowing for a smooth transition during hospital organizational change. In this paper, we test an exploratory path model by which teamwork culture influences staff attitudes in feeling informed and ready for change, and which are ultimately related to reduced staff burnout. We also examined different types of change communication, identifying the channels that were perceived as most useful for communicating organizational change.

Methods

In 2019, a cross-sectional online and paper-based survey of all staff (clinical and non-clinical) was conducted at a hospital undergoing major organizational change in Sydney, Australia. The survey included items regarding teamwork culture, communication (feeling informed, communication channels), change readiness (appropriateness, change efficacy), and burnout. With a sample size of 153 (62% clinical staff), regression and path analyses were used to examine relationships between variables.

Results

The total effects between teamwork culture and burnout was significant [β (Total) = -0.37, p < 0.001) and explained through a serial mediation. This relationship was found to be mediated by three factors (feeling informed, appropriateness of change and change efficacy) in a full mediation. Further, change readiness (appropriateness of change and change efficacy) mediated the relationship between feeling informed and burnout. The most useful channels of change communication included face-to-face informal communication, emails, and a newsletter specifically about the change.

Conclusion

Overall, the results supported the predicted hypotheses and were consistent with past research. In the context of large hospital change, staff with a positive teamwork culture who feel informed are more likely to feel change-ready, heightening the chances of successful organizational change and potentially reducing staff burnout. Understanding the pathways on how culture and communication related to burnout during organizational change provides an explanatory pathway that can be used to heighten the chances of a smooth change transition with minimal disruption to staff and patient care.

Organizational Change in Complex Systems: Organizational and Leadership Factors in the Introduction of Open Dialogue to Mental Health Care Services

Conventional mental health services are frequently criticized for failing to support people and communities in their care. Open Dialogue is a non-conventional humanistic approach to mental health care, which has been implemented in many different settings globally. At two Australian public health care services, implementation of the approach led to positive client outcomes and sustained organizational and clinical change. The aim of the study was to identify and explore the organizational, management, leadership and cultural factors that contributed to sustained implementation in these complex systems. We conducted nine individual semi-structured interviews of health care leaders and managers from the two sites. Transcriptions of the interviews were analyzed thematically. Leaders facilitated a gradual development of clinical and organizational legitimacy for the non-standardized Open Dialogue approach by holding the anxiety and frustration of practitioners and parts of the administration, cultivating cultural change and adaptation and by continually removing organizational obstacles.

Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study

Background

International efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub.

Methods

Twenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis.

Results

Four key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals.

Discussion

Our findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.

Leveraging human factors in cybersecurity: an integrated methodological approach

Computer and Information Security (CIS) is usually approached adopting a technology-centric viewpoint, where the human components of sociotechnical systems are generally considered as their weakest part, with little consideration for the end users' cognitive characteristics, needs and motivations. This paper presents a holistic/Human Factors (HF) approach, where the individual, organisational and technological factors are investigated in pilot healthcare organisations to show how HF vulnerabilities may impact on cybersecurity risks. An overview of current challenges in relation to cybersecurity is first provided, followed by the presentation of an integrated top-down and bottom-up methodology using qualitative and quantitative research methods to assess the level of maturity of the pilot organisations with respect to their capability to face and tackle cyber threats and attacks. This approach adopts a user-centred perspective, involving both the organisations' management and employees, The results show that a better cyber-security culture does not always correspond with more rule compliant behaviour. In addition, conflicts among cybersecurity rules and procedures may trigger human vulnerabilities. In conclusion, the integration of traditional technical solutions with guidelines to enhance CIS systems by leveraging HF in cybersecurity may lead to the adoption of non-technical countermeasures (such as user awareness) for a comprehensive and holistic way to manage cyber security in organisations.

Night-time Noise Levels and Patients’ Sleep Experiences in a Medical Assessment Unit in Northern England

Background:

Hospital in-patients need sleep so that restorative process and healing can take place. However, over one third of in-patients experience sleep disturbance, often caused by noise. This can compromise patients’ perceptions of care quality and cause physical and psychological ill health.

Aims:

To assess 1) in-patients sleep quality, quantity, reported sources of sleep disturbance and their suggestions for improvement 2) objectively measure decibel levels recorded at night.

Methods:

This descriptive study conducted in a Medical Assessment Unit used multi-methods; a semi-structured ‘sleep experience’ questionnaire administered to a purposive sample of in-patients; recording of night-time noise levels, on 52 consecutive nights, using two calibrated Casella sound level meters.

Results:

Patient ratings of ‘in-hospital’ sleep quantity (3.25; 2.72 SD) and quality (2.91; 2.56 SD) was poorer compared to ‘home’ sleep quantity (5.07; 2.81 SD) and quality (5.52; 2.79 SD). The difference in sleep quality (p<0.001) and quantity (p<0.001) ratings whilst in hospital, compared to at home, was statistically significant. Care processes, noise from other patients and the built environment were common sources of sleep disturbance. Participants’ suggestions for improvement were similar to interventions identified in current research. The constant noise level ranged from 38-57 decibels (equivalent to an office environment), whilst peak levels reached a maximum of 116 decibels, (equivalent to banging a car door one metre away).

Conclusion:

The self-rated patient sleep experience was significantly poorer in hospital, compared to home. Noise at night contributed to sleep disturbance. Decibel levels were equivalent to those reported in other international studies. Data informed the development of a ‘Sleep Smart’ toolkit designed to improve the in-patient sleep experience.

The four Ps of patient experience: A new strategic framework informed by theory and practice

This article proposes a new strategic framework to assist healthcare organizations in achieving great patient experiences in the healthcare setting. We synthesize models of practice and literature relevant to the patient experience in order to propose the four Ps of patient experience. Key levers used in this model are: (a) trained autonomous physicians, (b) multidisciplinary partners, (c) alternative places of care delivery matched to patient conditions and needs, and (d) standardized yet flexible processes. Healthcare leaders will be able to use the proposed framework to develop detailed strategies toward improving patient satisfaction and experiences.

Involvement Drivers: A Study of Nurses and Physicians in Improvement Work

This article reports on the involvement of nurses and physicians in improvement work, with a special focus on the drivers. The purpose was to describe how the nurse and physician groups understand involvement drivers for improvement work and to explain the differences in how they understand involvement. The study was conducted at 2 Swedish hospitals, and a total of 20 nurses and 10 physicians were interviewed. The theoretical framework, developed by an interpretative approach, identifies and describes a number of involvement drivers. On clustering the drivers into larger involvement factors, the study shows clear differences and profiles in terms of the 2 groups' perception and understanding of the involvement-drivers. Each group's profile was then analyzed on the basis of concept of professional culture.

Completing the audit cycle: the impact of an electronic reporting system on the feedback loop in surgical specialties

INTRODUCTION

The feedback loop of incident reporting is essential in improving patient care. Few studies have followed the loop around its cycle and little data are available concerning the impact of interventions. We investigated the feedback loop before and after the implementation of an electronic reporting system.

METHOD

Data were collected before and after our intervention. Data were analyzed in terms of the percentage of incidents evaluated, the percentage of incidents resulting in action, whether correlations demonstrated an increased rate of action taken as incident risk score increased.

RESULTS

Prior to our intervention, 43% and 40% of incidents reported were evaluated and acted upon, respectively. Postintervention, the number of incidents reported increased by 198%. All incidents were evaluated and 66% were acted upon. Both pre- and postintervention, no correlations demonstrated an increase in action taken as incident severity increased.

CONCLUSION

Our intervention resulted in a considerable increase in the number of incidents reported, evaluated, and acted upon. Such an effect would be expected to improve patient safety, although further studies are needed to definitively confirm this. We therefore recommend the use of electronic systems and further studies to evaluate their impact on patient safety.

Glancing beyond or being confined to routines: labour ward midwives' responses to change as a result of action research

OBJECTIVE

to examine midwives' responses to a changed approach in the initial encounters with women and their partners in the labour ward.

DESIGN

as part of a local project to improve hospital based childbirth care, Action Research (AR) was undertaken with midwives. To establish their beliefs, practices, and responses to change during the first cycle, 37 out of 57 midwives were interviewed. Data analysis was guided by interpretative description.

SETTING

a labour ward in western Sweden.

FINDINGS

two themes emerged: 'Glancing beyond routines' describes how the changed care approach enabled 'valuing the idea' and 'acquiring extended space to create a lingering presence'. The theme 'being confined to inherent routines' expresses 'resistance to the need for change' and a 'feeling of pressure to change'.

KEY CONCLUSIONS

the AR study design enabled the midwives to reflect on their routines and to transform tacit use-in-action to reflection-in-action. Midwives who persisted in being confined to inherent routines felt pressured by the change process. Others felt that the AR process granted them official licence to create chronological and emotional space in which they could 'be' and not just 'do'.

IMPLICATIONS FOR PRACTICE

to a greater or lesser extent, midwives in this setting had integrated relatively impersonal system-wide technocratic norms of childbirth into their belief systems and behaviours. The data suggest that a whole-system shift is necessary to enable caring, behaviours based on the formation of positive relationships to become the key driver of the first encounter on the labour ward.

Measuring safety climate in elderly homes

INTRODUCTION

Provision of a valid and reliable safety climate dimension brings enormous benefits to the elderly home sector. The aim of the present study was to make use of the safety climate instrument developed by OSHC to measure the safety perceptions of employees in elderly homes such that the factor structure of the safety climate dimensions of elderly homes could be explored.

METHOD

In 2010, surveys by mustering on site method were administered in 27 elderly homes that had participated in the "Hong Kong Safe and Healthy Residential Care Home Accreditation Scheme" organized by the Occupational Safety and Health Council.

RESULTS

Six hundred and fifty-one surveys were returned with a response rate of 54.3%. To examine the factor structure of safety climate dimensions in our study, an exploratory factor analysis (EFA) using principal components analysis method was conducted to identify the underlying factors. The results of the modified seven-factor's safety climate structure extracted from 35 items better reflected the safety climate dimensions of elderly homes. The Cronbach alpha range for this study (0.655 to 0.851) indicated good internal consistency among the seven-factor structure. Responses from managerial level, supervisory and professional level, and front-line staff were analyzed to come up with the suggestion on effective ways of improving the safety culture of elderly homes. The overall results showed that managers generally gave positive responses in the factors evaluated, such as "management commitment and concern to safety," "perception of work risks and some contributory influences," "safety communication and awareness," and "safe working attitude and participation." Supervisors / professionals, and frontline level staff on the other hand, have less positive responses. The result of the lowest score in the factors - "perception of safety rules and procedures" underlined the importance of the relevance and practicability of safety rules and procedures.

CONCLUSION

The modified OSHC safety climate tool provided better evidence of structural validity and reliability for use by elderly homes' decision makers as an indicator of employee perception of safety in their institution.

IMPACT ON INDUSTRY

The findings and suggestions in the study provide useful information for the management, supervisors/professionals and frontline level staff to cultivate the safety culture in the elderly home sector. Most important, elderly homes can use the modified safety climate scale to identify problem areas in their safety culture and safety management practices and then target these for intervention.

Interprofessional collaboration among junior doctors and nurses in the hospital setting

OBJECTIVES

Evidence suggests that doctors and nurses do not always work collaboratively in health care settings and that this contributes to suboptimal patient care. However, there is little information on interprofessional collaboration (IPC) among new medical and nursing graduates working together for the first time in a multidisciplinary health care team. Our aim was to understand the nature of the interactions, activities and issues affecting these new graduates in order to inform interventions to improve IPC in this context.

METHODS

We interviewed 25 junior doctors and nurses and explored their experiences of working together. Interviews were transcribed, entered into a qualitative analysis software package and data were coded against a theoretical framework for health care team function.

RESULTS

Although interviewees expressed mutual respect, organisational structures often limited the extent to which they could establish professional relationships. Sharing information and agreeing goals were considered fundamental to good decision making, but the working environment and differing perspectives could make this difficult to achieve. Our data suggest that junior doctors and nurses see themselves as having complementary and non-competitive roles in patient care. The establishing of an interprofessional team was seen to require leadership, which was not always apparent. Without leadership, new members were not always well oriented to the team. The need to maintain an environment in which open communication could take place was acknowledged as important for patient safety, but there were some barriers to achieving this.

CONCLUSIONS

Our data highlight the professionalism, respect and adaptability of these junior health professionals. We document the types of collaborative activities and tensions relevant in this context and, based on our findings, provide some strategies for improving IPC.

Empowerment and enterprise: the political economy of nursing

Throughout the past decades, Australian nursing has made significant advances in the clinical, research, and political arenas. Capitalising on these advances is a critical step in empowering the professions and a sound investment in the health of the nation. There remains a need to energise and empower the professions, to see our work as an enterprise that has value and a sense of worth because of our professional activities as well as for the political and economic contributions we make to health and wellbeing, quality of life and social justice. The contributions made by nurses and midwives need to be articulated in the policy arena, focused in professional decision-making and elaborated in our research agendas. Our professional organisations provide opportunities for solidarity, and the leverage we need to effect change at the bedside, the community and the whole of society. Renewed commitment to primary health care at the global, national and community level provides a timely rallying call to the professions to refine the way we articulate our position in health care, re-commit to culturally appropriate, socially just actions and embolden our professional goals to inspire the next generations of nurses for a more equitable future.

Benchmarks for effective primary care-based nursing services for adults with depression: a Delphi study

AIM

This paper is a report of a study conducted to identify and gain consensus on appropriate benchmarks for effective primary care-based nursing services for adults with depression.

BACKGROUND

Worldwide evidence suggests that between 5% and 16% of the population have a diagnosis of depression. Most of their care and treatment takes place in primary care. In recent years, primary care nurses, including community mental health nurses, have become more involved in the identification and management of patients with depression; however, there are no appropriate benchmarks to guide, develop and support their practice.

METHOD

In 2006, a three-round electronic Delphi survey was completed by a United Kingdom multi-professional expert panel (n = 67).

FINDINGS

Round 1 generated 1216 statements relating to structures (such as training and protocols), processes (such as access and screening) and outcomes (such as patient satisfaction and treatments). Content analysis was used to collapse statements into 140 benchmarks. Seventy-three benchmarks achieved consensus during subsequent rounds. Of these, 45 (61%) were related to structures, 18 (25%) to processes and 10 (14%) to outcomes.

CONCLUSION

Multi-professional primary care staff have similar views about the appropriate benchmarks for care of adults with depression. These benchmarks could serve as a foundation for depression improvement initiatives in primary care and ongoing research into depression management by nurses.

Trust, communication, theory of mind and the social brain hypothesis: deep explanations for what goes wrong in health care

PURPOSE

The purpose of the paper is to examine the deep conceptual underpinnings of trust and communication breakdowns via selected health inquiries into things that go wrong using evolutionary psychology.

DESIGN/METHODOLOGY/APPROACH

This paper explains how this is carried out, and explores some of the adverse consequences for patient care. Evolutionary psychology provides a means of explaining important mental capacities and constructs including theory of mind and the social brain hypothesis. To have a theory of mind is to be able to read others' behaviours, linguistic and non-verbal cues, and analyse their intentions. To have a social (or Machiavellian) brain means being able to assess, compete with and, where necessary, outwit others. In the tough and complex environment of the contemporary health setting, not too different from the Pleistocene, humans display a well-developed theory of mind and social brains and, using mental attributes and behavioural repertoires evolved for the deep past in hunter-gatherer bands, survive and thrive in difficult circumstances.

FINDINGS

The paper finds that, while such behaviours cannot be justified, armed with an evolutionary approach one can predict survival mechanisms such as turf protection, competitive strategies, sending transgressors and whistleblowers to Coventry, self-interest, and politics and tribal behaviours.

ORIGINALITY/VALUE

The paper shows that few studies examine contemporary health sector behaviours through an evolutionary psychology lens or via such deep accounts of human nature.

AORN Guidance Statement: Creating a Patient Safety Culture

AORN believes all health care organizations must strive to create a culture of safety. Such a culture will provide an atmosphere where all members of the perioperative team can openly discuss errors, process improvements, or system issues without fear of reprisal. A culture of safety places an emphasis on flexibility and learning as a means of improving safety and reducing errors. Characteristics of a culture of safety include the following: communication is open and honest; the emphasis is on the team rather than the individual; standards and practices are developed in a multidisciplinary framework; staff members are helpful and supportive of each other; staff members trust each other; surgical team members have a friendly, open relationship emphasizing credibility and attentiveness; the environment is resilient, encourages creativity, and is patient outcomes-driven; the focus is on work flow and process; and these attributes are supported by an informed culture that learns from incidents and near misses. A commitment to safety must be articulated at all levels of the organization. Safety must be valued as the top priority, even at the expense of efficiency. Health care organizations must allocate an appropriate amount of resources and provide the necessary incentives or rewards to promote a robust patient safety culture. AORN recognizes that most patient safety initiatives will fail in the absence of a viable safety culture.