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VIRTIČ POTOČNIK T, KLEMENC-KETIŠ Z. Perception Of Patient Safety Culture At The Primary Care Level: The Case Of The Community Health Centre Ljubljana. Zdr Varst 2024; 63:21-29. [PMID: 38156339 PMCID: PMC10751894 DOI: 10.2478/sjph-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background Patient safety is a crucial element of quality healthcare, and endeavours to enhance it are vital for attaining universal health coverage and improving patient outcomes. This study aimed to evaluate the perception of patient safety culture among staff at the Community Health Centre Ljubljana (CHCL). Methods A cross-sectional study was conducted in December 2022. All CHCL staff (N=1,564) from different professional groups were invited to participate in an anonymous electronic survey using the validated Slovenian version of the "Medical Office Survey on Patient Safety Culture" (MOSPSC). Mean percent positive scores for all items in each composite were calculated. Results The final sample included 377 participants (response rate, 24.1%), most of whom were women (91.5%, N=345) with different professional profiles. The mean age of the participants was 44.5 years (SD 11.1) with a mean work experience of 20.1 years (SD 12.1). The percentage of positive overall MOSPSC composite scores was 59.6%. A strong patient safety culture perception was identified in the following dimensions: Information exchange with other settings (93.5%), Organisational learning (90.2%), List of patient safety and quality issues (88.1%), Patient care tracking/follow-up (76.2 %) and Teamwork (75.0%). Weak patient safety culture was identified in the dimensions of Work pressure and pace (10.7%), Leadership support for patient safety (27.1%), Communication openness (40.9%), Office processes and standardisation (48.2%) and Overall ratings on quality and patient safety (49.4%). Conclusions CHCL leadership should address weaknesses, redesign processes, and implement strategies to reduce patient safety incidents. Establishing a just culture that encourages employees to report errors fosters transparency and facilitates learning from errors.
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Affiliation(s)
- Tina VIRTIČ POTOČNIK
- Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
| | - Zalika KLEMENC-KETIŠ
- Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
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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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Gulma K. Enhancing public health programs with performance-based memorandum of understanding. J Public Health Policy 2023; 44:634-642. [PMID: 37891354 DOI: 10.1057/s41271-023-00446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/29/2023]
Abstract
This Viewpoint presents a case study that explored the effects of using a performance-based Memorandum of Understanding (MoU) in public health donor programs to enhance health metrics, program efficiency, and accountability. The MoU between Kebbi State Government in Nigeria and the United States Agency for International Development (USAID) focused on strengthening primary healthcare. It covered Health Systems Strengthening (HSS) indicators, overseen by an Operations Committee (OC) and a high-level Steering Committee (SC). Quarterly and biannual reviews tracked indicators through a dashboard developed by the Integrated Health Program (IHP). Results suggest that the MoU led to better monitoring of primary healthcare (PHC) revitalization, health sector work plan harmonization, and data quality. Dashboard tracking showed improved health facility financing, immunization, antenatal care, and skilled attendants at births. The use of the MoU demonstrated potential for boosting program efficiency, cost-effectiveness, and political commitment for resource mobilization in public health initiatives. Results support recommending MoUs as valuable tools for effective outcome-driven public health funding.
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Affiliation(s)
- Kabiru Gulma
- Euclid University, PMB 819, Brusubi, Banjul, Gambia.
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Pevec T, Albreht T, Turk E. Safety culture in the operating room: translation, validation of the safety attitudes questionnaire - operating room version. BMC Health Serv Res 2023; 23:491. [PMID: 37193963 DOI: 10.1186/s12913-023-09539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Measuring the safety culture in Healthcare is an important step in improving patient safety. One of the most commonly used instruments to measure the safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the current study was to establish the validity and reliability of the Slovenian version of the SAQ for the operating room SAQ-OR. METHODS The SAQ, consisting of six dimensions, was translated and adapted to the Slovenian context and applied in operating rooms from seven out of ten Slovenian regional hospitals. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument. RESULTS The sample consisted of 243 health care professionals who hold positions in the OR, divided into 4 distinct professional classes, namely, 76 surgeons (31%), 15 anesthesiologists (6%), 140 nurses (58%) and 12 auxiliary persons (5%). It was observed a very good Cronbach's alpha (0.77 to 0.88). The CFA and its goodness-of-fit indices (CFI 0.912, TLI 0.900, RMSE 0.056, SRMR 0.056) showed an acceptable model fit. There are 28 items in the final model. CONCLUSIONS The Slovenian version of the SAQ-OR revealed good psychometric properties for studying the organisational safety culture.
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Affiliation(s)
- Teodor Pevec
- General Hospital Dr. Jožeta Potrča Ptuj, Ptuj, Slovenia.
- Medical Faculty, University of Maribor, Maribor, Slovenia.
| | - Tit Albreht
- Medical Faculty, University of Maribor, Maribor, Slovenia
- National Institute of Public Health, Ljubljana, Slovenia
| | - Eva Turk
- Medical Faculty, University of Maribor, Maribor, Slovenia
- Centre for Digital Health and Social Innovation, University of Applied Sciences St. Pölten, St. Pölten, Austria
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Gontijo MD, Freitas ATS, Maia AFDF, Oliveira VJD, Viegas SMDF. Professional Safety in the daily life of primary health care: grounded theory. Rev Bras Enferm 2021; 75:e20210033. [PMID: 34669906 DOI: 10.1590/0034-7167-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand Professional Safety in daily life in Primary Health Care. METHODS this is a study on the Grounded Theory method and the Symbolic Interactionism theoretical framework with 82 health professionals. RESULTS it presents the category "Professional Safety in Daily Life in Primary Health Care: a Grounded Theory" and two subcategories determining and conditioning Professional Safety in PHC: professional training, infrastructure, support and technical responsibility; Professional Safety: physical protection, psychological support, distress and feelings reveal the (un)safe conditions. Professional Safety is mentioned in several dimensions that include professionals' knowledge, decision-making skills, the practice of the profession and what regulates it, the structure and organization of the Unified Health System and services, permanent education. It presents the context of primary care and the factors that impact an (unsafe) work. FINAL CONSIDERATIONS this study contributes to reflect on Professional Safety to strengthen safety culture in Primary Health Care.
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Klemenc-Ketis Z, Stojnić N, Zavrnik Č, Ružić Gorenjec N, Danhieux K, Lukančič MM, Susič AP. Implementation of Integrated Primary Care for Patients with Diabetes and Hypertension: A Case from Slovenia. Int J Integr Care 2021; 21:15. [PMID: 34690619 PMCID: PMC8485865 DOI: 10.5334/ijic.5637] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Research on models of integrated health care for hypertension and diabetes is one of the priority issues in the world. There is a lack of knowledge about how integrated care is implemented in practice. Our study assessed its implementation in six areas: identification of patients, treatment, health education, self-management support, structured collaboration and organisation of care. METHODS This was a mixed methods study based on a triangulation method using quantitative and qualitative data. It took place in different types of primary health care organisations, in one urban and two rural regions of Slovenia. The main instrument for data collection was the Integrated Care Package (ICP) Grid, assessed through four methods: 1) a document analysis (of a current health policy and available protocols; 2) observation of the infrastructure of health centres, organisation of work, patient flow, interaction of patients with health professionals; 3) interview with key informants and 4) review of medical documentation of selected patients. RESULTS The implementation of the integrated care in Slovenia was assessed with the overall ICP score of 3.7 points (out of 5 possible points). The element Identification was almost fully implemented, while the element Self-management support was weakly implemented. DISCUSSION The implementation of the integrated care of patients with diabetes and/or hypertension in Slovenian primary health care organisations achieved high levels of implementation. However, some week points were identified. CONCLUSION Integrated care of the chronic patients in Slovenia is already provided at high levels, but the area of self-management support could be improved.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
| | - Nataša Stojnić
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Črt Zavrnik
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Nina Ružić Gorenjec
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Katrien Danhieux
- Department of Primary & Interdisciplinary Care Antwerp, University of Antwerp, Belgium
| | | | - Antonija Poplas Susič
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia
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Variation in Perception of Safety Culture in Out-of-hours Family Medicine Service in Croatia. Zdr Varst 2021; 60:152-157. [PMID: 34249161 PMCID: PMC8256768 DOI: 10.2478/sjph-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The Safety Attitudes Questionnaire (SAQ) is among the most frequently cited tools for measuring safety culture in healthcare settings. Its ambulatory version was used in this study. The aim was to assess safety culture in out-of-hours (OOH) family medicine service and its variation across job positions, regions, and respondents’ demographic characteristic. Methods A cross-sectional observational study was carried out targeting 358 health professionals working in the 29 largest Croatian healthcare centres providing out-of-hours family medicine service. The response rate was 51.7% (185 questionnaires). The questionnaire comprised 62 Likert items with 5 responses (fully disagree to fully agree). Scores of negatively worded items were reversed before analysis. Scores on the total scale and subscales were calculated as additive scores. The study included demographic data on gender, age, working experience, and job position. Repeated measurement analysis of variance was used to assess variation of Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV) sub-scales. Results Nurses assessed safety culture higher than did physicians and residents. Teamwork climate had higher scores than Ambulatory process of care and Organizational climate. Stress recognition and Perceptions of workload had the lowest overall scores. Variation across gender, age, working experience, and region was not statistically significant. Conclusions SAQ-AV can be used to identify areas for improvement in patient safety at OOH GPs. There is a need to improve staffing and support for OOH GP residents. Further research is needed in order to gain better understanding of factors influencing observed variations among job positions.
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The Safety Culture of The Ljubljana Community Health Centre's Employees. Zdr Varst 2021; 60:145-151. [PMID: 34249160 PMCID: PMC8256766 DOI: 10.2478/sjph-2021-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Patient safety is one of the key aspects of healthcare quality and a serious global public health concern. Patient safety culture is a part of the patient safety concept. In Slovenia, primary care is easily accessible, and for medical care, it serves as a gatekeeper to hospital care. For several years, the quality and safety at the primary healthcare level have been the focus of several studies. The present study aimed to assess patient safety culture among all employees of the Community Health Centre Ljubljana. Methods We conducted a cross-sectional study in 2017 using the Slovene version of “Medical Office Survey on Patient Safety Culture” from the Agency for Healthcare Research and Quality. Mean percent positive scores on all items in each composite were calculated according to a user guide. Results The final sample contained 1021 participants (67.8% response rate), of which 909 (89.0%) were women. The mean age of the sample was 43.0±11.0 years. The dimensions most highly rated by the respondents were: teamwork and patient care tracking/follow-up. The lowest scores came from leadership support for patients’ safety and work pressure and pace. Conclusion Patient safety culture in the Community Health Centre Ljubljana is high, but there are certain areas of patient safety that need to be evaluated further and improved. Our study revealed differences between professions, indicating that a customized approach per profession group might contribute to the successful implementation of safety strategies. Patient safety culture should be studied at national levels.
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Malinowska-Lipień I, Brzyski P, Gabryś T, Gniadek A, Kózka M, Kawalec P, Brzostek T, Squires A. Cultural adaptation of the Safety Attitudes Questionnaire - Short Form (SAQ-SF) in Poland. PLoS One 2021; 16:e0246340. [PMID: 33544732 PMCID: PMC7864443 DOI: 10.1371/journal.pone.0246340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background It is essential to provide safe healthcare in complex, difficult, and quickly changing conditions. The quality of healthcare services directly influences the safety of both the patients and staff. Understanding healthcare staff attitudes toward safety in the healthcare delivery context is foundational for building a culture of safety. Aim of the work To adapt, via a structured translation methodology, the Safety Attitudes Questionnaire–Short Form (SAQ-SF), which assesses how employees of the health care sector perceive the safety climate in their workplace, to the Polish context. Methods Using a content validation approach to structure the translation process, we tested and psychometrically analysed the translated SAQ-SF. The sample comprised 322 employees of a district hospital (second referral level, which ensures 24/7 emergency care services) in Poland. Results The reliability of the sub-scales of the Polish version of the SAQ-SF ranged from 0.66 to 0.95. The discriminatory power of particular SAQ items ranged between 0.02 and 0.90. For 6 out of the 8 scale dimensions, the questions with the highest factor loadings were those measuring the same dimensions of the safety climate, according to the original scale. Conclusions The Polish version of the SAQ-SF (SAQ-SF-PL) meets the criteria of psychometric and functional validation as well as demonstrates good reliability as a measure of patient safety culture in the Polish context. The SAQ-SF-PL is an instrument that enable a valid and reliable assessment of patient safety climate in the Polish healthcare facilities and identify opportunities for improvement. International comparisons will also become easier.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
- * E-mail:
| | | | - Teresa Gabryś
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Maria Kózka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Paweł Kawalec
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
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Mesarić J, Šimić D, Katić M, Tveter Deilkås EC, Hofoss D, Bondevik GT. The safety attitudes questionnaire for out-of-hours service in primary healthcare-Psychometric properties of the Croatian version. PLoS One 2020; 15:e0242065. [PMID: 33186353 PMCID: PMC7665828 DOI: 10.1371/journal.pone.0242065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/27/2020] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to assess the reliability and construct validity of the Croatian translation of the Safety Attitudes Questionnaire—Ambulatory version (SAQ-AV) in the out-of-hours (OOH) primary care setting. A cross-sectional observational study using anonymous web-survey was carried out targeting a convenience sample of 358 health professionals working in the Croatian OOH primary care service. The final sample consisted of 185 questionnaires (response rate 51.7%). Psychometric properties were assessed using exploratory hierarchical factor analysis with Schmid-Leiman rotation to bifactor solution, McDonald’s ω, and Cronbach’s α. Five group factors were identified: Organization climate, Teamwork climate, Stress recognition, Ambulatory process of care, and Perceptions of workload. Items loading on the Stress recognition and Perceptions of workload factor had low loadings on the general factor. Cronbach’s α ranged between 0.79 and 0.93. All items had corrected item-total correlation above 0.5. McDonalds’ ω total for group factors ranged between 0.76 and 0.91. Values of ω general for factors Organization climate, Teamwork climate, and Ambulatory process of care ranged between 0.41 and 0.56. McDonalds’ ω general for Stress recognition and Perceptions of workload were 0.13 and 0.16, respectively. Even though SAQ-AV may not be a reliable tool for international comparisons, subsets of items may be reliable tools in several national settings, including Croatia. Results confirmed that Stress recognition is not a dimension of patient safety culture, while Ambulatory process of care might be. Future studies should investigate the relationship of patient safety culture to treatment outcome.
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Affiliation(s)
- Jasna Mesarić
- Faculty of Health Sciences, Libertas International University, Zagreb, Croatia
- Croatian Society for Quality Improvement in Healthcare, Croatian Medical Association, Zagreb, Croatia
- * E-mail: (JM); (DS)
| | - Diana Šimić
- Faculty of Organization and Informatics, University of Zagreb, Varaždin, Croatia
- * E-mail: (JM); (DS)
| | - Milica Katić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ellen Catharina Tveter Deilkås
- The Norwegian Directorate of Health, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Dag Hofoss
- Lovisenberg Diaconal College, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Patient safety culture in Italian out-of-hours primary care service: a national cross-sectional survey study. BJGP Open 2020; 4:bjgpopen20X101098. [PMID: 33172847 PMCID: PMC7880172 DOI: 10.3399/bjgpopen20x101098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background Out-of-hours (OOH) services in Italy provide >10 million consultations every year. To the authors' knowledge, no data on patient safety culture (PSC) have been reported. Aim To assess PSC in the Italian OOH setting. Design & setting National cross-sectional survey using the Safety Attitudes Questionnaire — Ambulatory Version (SAQ-AV). Method The SAQ-AV was translated into Italian and distributed in a convenience sample of OOH doctors in 2015. Answers were collected anonymously by Qualtrics. Stata (version 14) was used to estimate Cronbach’s alpha, perform exploratory and confirmatory factor analysis, correlate items to doctors’ characteristics, and to do item descriptive analysis. Results Overall, 692 OOH doctors were contacted, with a 71% response rate. In the exploratory factor analysis (EFA), four factors were identified: Communication and Safety Climate (14 items); Perceptions of Management (eight items); Workload and Clinical Risk (six items); and Burnout Risk (four items). These four factors accounted for 68% of the total variance (Kaiser–Meyer–Olkin [KMO] statistic = 0.843). Cronbach’s alpha ranged from 0.710–0.917. OOH doctors were often dissatisfied with their job; there is insufficient staff to provide optimal care and there is no training or supervision for new personnel and family medicine trainees. Service managers are perceived as distant, with particular issues concerning the communication between managers and OOH doctors. A large proportion of OOH doctors (56.8%) state that they do not receive adequate support. Conclusion These findings could be useful for informing policies on how to improve PSC in Italian OOH service.
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Klemenc-Ketis Z, Makivić I, Poplas-Susič A. Safety culture in the primary health care settings based on workers with a leadership role: the psychometric properties of the Slovenian-language version of the safety attitudes questionnaire - short form. BMC Health Serv Res 2018; 18:767. [PMID: 30305161 PMCID: PMC6180368 DOI: 10.1186/s12913-018-3594-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/02/2018] [Indexed: 11/21/2022] Open
Abstract
Background Safety culture describes leader and staff interactions, attitudes, routines, awareness, and practices within an organisation. With this study, we aimed to determine the psychometric properties of the Slovenian-language version of the Safety Attitudes Questionnaire (SAQ) – Short Form in primary health care settings. Methods This was a cross-sectional study in the largest primary health care in Slovenia. We invited all employees with a leadership role to participate in the study (N = 211). We used the Slovenian-language version of the SAQ – Short Form. Results There were 154 participants in the final sample (73.0% response rate), of which 136 (88.3%) were women. The mean age of the sample was 46.2 ± 10.0 years. Exploratory factor analysis put forward six factors: 1) Perceptions of Management; 2) Stress recognition; 3) Teamwork Climate; 4) Communication; 5) Safety Climate; 6) Working Conditions and Satisfaction. This model explained 61.7% of the variance of the safety culture in the primary health care setting. The reliability of the whole scale and of the six factors, assessed using Cronbach’s alpha, was all above 0.78. Conclusion The results of our study suggests that the Slovenian-language version of the SAQ – Short Form with six factors could be a reliable and valid tool for measuring the safety culture in the primary health care workers with leadership role In Slovenia. The Slovenian version differed from the original SAQ – Short Form and the majority of other translated versions. Also, the data was from one health centre only and therefore we cannot draw strong conclusions on its external validity.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia. .,Department of Family Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000, Maribor, Slovenia. .,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
| | - Irena Makivić
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
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Klemenc-Ketis Z, Makivić I, Poplas Susic A. The development and validation of a new interprofessional team approach evaluation scale. PLoS One 2018; 13:e0201385. [PMID: 30092005 PMCID: PMC6084891 DOI: 10.1371/journal.pone.0201385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
A team approach in health care involves an interprofessional approach to patient care. We wanted to develop and validate a tool that would evaluate the interprofessional team approach to patients of a family medicine team. We performed a descriptive study in three consecutive phases: a literature review, consensus development panels, and a cross-sectional validation study. Three rounds of consensus development panels were carried out in order to evaluate and adapt the initial scale. The cross-sectional study was carried out in all Slovenian family medicine practices, each invited 10 consecutive patients. In the quantitative study, 3,292 patients participated (a 50.7% response rate), of which 1,810 (55.0%) were women. The mean age of the sample was 53.1 ± 1.2 years. The final Cronbach’s alpha was 0.901. A factor analysis of the 9-item scale put forward two factors (Team Approach and Person-Centred approach) which explained 68.6% of the variance. This study provided a new scale for the evaluation of patient satisfaction with the interprofessional family medicine team from the patients’ point of view. It opened the question of family medicine team competencies and pointed towards the need to develop a family medicine interprofessional team competency framework and a comprehensive tool for its assessment.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Community Health Centre Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- * E-mail:
| | - Irena Makivić
- Community Health Centre Ljubljana, Ljubljana, Slovenia
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Transition from a traditional to a comprehensive quality assurance system in Slovenian family medicine practices. Int J Qual Health Care 2018; 31:319-322. [DOI: 10.1093/intqhc/mzy157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/17/2018] [Accepted: 06/30/2018] [Indexed: 12/20/2022] Open
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Leutgeb R, Frankenhauser-Mannuß J, Scheuer M, Szecsenyi J, Goetz K. Job satisfaction and stressors for working in out-of-hours care - a pilot study with general practitioners in a rural area of Germany. BMC FAMILY PRACTICE 2018; 19:95. [PMID: 29933743 PMCID: PMC6015473 DOI: 10.1186/s12875-018-0777-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Challenging work environment, high workload, and increasing physician shortages characterize current rural general practice in Germany and in most European Countries. These factors extend into Out-Of-Hours Care (OOHC). However, little research about potential stressors for general practitioners (GPs) in OOHC settings is available. This pilot study aimed to evaluate workload, different elements of job satisfaction and stressors for GPs in OOHC and to analyze whether these aspects are associated with overall job satisfaction. METHODS Cross-sectional survey with a sample of 320 GPs who are working in OOHC was used to measure workload in OOHC, job satisfaction (using the Warr-Cook-Wall scale) and stressors with the effort-reward imbalance questionnaire. In order to assess associations between workload, job satisfaction and stressors at work we performed descriptive analyses as well as multivariable regression analyses. RESULTS The response rate was 40.9%. Over 80% agreed that OOHC was perceived as a stressor and 79% agreed that less OOHC improved job satisfaction. Only 42% of our sample were satisfied with their overall job satisfaction. The regression analysis showed that the modification of current OOHC organization was significantly associated with overall job satisfaction. CONCLUSIONS Our results suggest that OOHC in the current form is a relevant stressor in daily work of rural GPs in Germany and one of the reasons for a decreasing overall job satisfaction. Strategic changes such as the implementation of structural reforms e.g. reducing frequency of OOHC duties for each GP and improving continuing professional development options related to OOHC are needed to address current workload challenges experienced by GPs providing OOHC in Germany.
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Affiliation(s)
- R Leutgeb
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arcades, Western Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - J Frankenhauser-Mannuß
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arcades, Western Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - M Scheuer
- Headquarter of Control Centre, District Bergstraße, Gräffstrasse 5, 64646, Heppenheim, Germany
| | - J Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arcades, Western Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katja Goetz
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arcades, Western Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Alle 160, 23538, Luebeck, Germany
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Smits M, Keizer E, Giesen P, Deilkås ECT, Hofoss D, Bondevik GT. Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey. Scand J Prim Health Care 2018; 36:28-35. [PMID: 29334826 PMCID: PMC5901437 DOI: 10.1080/02813432.2018.1426150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness. DESIGN Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience. RESULTS Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N = 470) and triage nurses (N = 189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors. CONCLUSIONS Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents' profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture. Key Points Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that: • healthcare providers in Dutch GP cooperatives perceive patient safety culture positively; • triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals - on several patient safety culture factors; and • within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.
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Affiliation(s)
- Marleen Smits
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- CONTACT Marleen Smits NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
| | - Ellen Keizer
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Paul Giesen
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Ellen Catharina Tveter Deilkås
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- The Norwegian Directorate of Health, Oslo, Norway
| | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
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Klemenc-Ketis Z, Deilkås ET, Hofoss D, Bondevik GT. Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care. J Multidiscip Healthc 2017; 10:417-423. [PMID: 29184416 PMCID: PMC5687361 DOI: 10.2147/jmdh.s149011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups. Materials and methods This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics; 37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). Results The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9±15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4±0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8±0.9). Conclusion Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana.,Community Health Centre Ljubljana, Ljubljana, Slovenia
| | | | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen.,National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
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Klemenc-Ketiš Z, Deilkås ET, Hofoss D, Bondevik GT. Patient Safety Culture in Slovenian out-of-hours Primary Care Clinics. Zdr Varst 2017; 56:203-210. [PMID: 29062394 PMCID: PMC5639809 DOI: 10.1515/sjph-2017-0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/23/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Patient safety culture is a concept which describes how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. We aimed to investigate patient safety culture in Slovenian out-of-hours health care (OOHC) clinics, and determine the possible factors that might be associated with it. Methods This was a cross-sectional study, which took place in Slovenian OOHC, as part of the international study entitled Patient Safety Culture in European Out-of-Hours Services (SAFE-EUR-OOH). All the OOHC clinics in Slovenia (N=60) were invited to participate, and 37 agreed to do so; 438 employees from these clinics were invited to participate. We used the Slovenian version of the Safety Attitudes Questionnaire – an ambulatory version (SAQAV) to measure the climate of safety. Results Out of 438 invited participants, 250 answered the questionnaire (57.1% response rate). The mean overall score ± standard deviation of the SAQ was 56.6±16.0 points, of Perceptions of Management 53.6±19.6 points, of Job Satisfaction 48.5±18.3 points, of Safety Climate 59.1±22.1 points, of Teamwork Climate 72.7±16.6, and of Communication 51.5±23.4 points. Employees working in the Ravne na Koroškem region, employees with variable work shifts, and those with full-time jobs scored significantly higher on the SAQ-AV. Conclusion The safety culture in Slovenian OOHC clinics needs improvement. The variations in the safety culture factor scores in Slovenian OOHC clinics point to the need to eliminate variations and improve working conditions in Slovenian OOHC clinics.
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Affiliation(s)
- Zalika Klemenc-Ketiš
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000, Maribor, Slovenia
| | | | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
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Smits M, Keizer E, Giesen P, Deilkås ECT, Hofoss D, Bondevik GT. The psychometric properties of the 'safety attitudes questionnaire' in out-of-hours primary care services in the Netherlands. PLoS One 2017; 12:e0172390. [PMID: 28207909 PMCID: PMC5313186 DOI: 10.1371/journal.pone.0172390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Safety Attitudes Questionnaire (SAQ) is one of the most widely used instruments to assess safety culture among healthcare providers. The ambulatory version of the SAQ (SAQ-AV) can be used in the primary care setting. Our study objective was to examine the underlying factors and psychometric properties of the Dutch translation of the SAQ-AV in out-of-hours primary care services. DESIGN Cross-sectional observational study using a web-survey. SETTING Sixteen out-of-hours general practitioner cooperatives and two call centers in the Netherlands. PARTICIPANTS Primary healthcare providers in out-of-hours services. MAIN OUTCOME MEASURES Item-descriptive statistics, factor loadings, Cronbach's alpha scores, corrected item-total correlations, scale correlations. RESULTS The questionnaire was answered by 853 (43.2%) healthcare professionals. In the factor analyses, 784 respondents were included; mainly general practitioners (N = 470) and triage nurses (N = 189). Items were included in the analyses based on question type and results from previous studies. Five factors were drawn with reliability scores between .49 and .86 and a good construct validity. The five factors covered 27 of the 62 questionnaire items, with three to five items per factor. CONCLUSIONS The Dutch translation of the SAQ-AV, with five factors, seems to be a reliable tool for measuring patient safety culture and guide quality improvement interventions in out-of-hours primary care services. The Dutch factor structure differed from the original SAQ-AV and other translated versions. In future studies, the questionnaire should be validated further by examining if there is a relationship between the responses on the SAQ-AV, patient experiences, and the occurrence of adverse events.
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Affiliation(s)
- Marleen Smits
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- * E-mail:
| | - Ellen Keizer
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Paul Giesen
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Ellen Catharina Tveter Deilkås
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- The Norwegian Directorate of Health, Oslo, Norway
| | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Uni Research Health, National Centre for Emergency Primary Health Care, Bergen, Norway
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