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Motzkus CA, Lilly CM. Accountability for Sepsis Treatment. Chest 2017; 151:955-957. [DOI: 10.1016/j.chest.2017.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/24/2022] Open
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Babashahy S, Baghbanian A, Manavi S, Sari AA, Olyaee Manesh A, Ronasiyan R. Towards Reforming Health Provider Payment Methods: Evidence from Iran. HEALTH SCOPE 2016. [DOI: 10.17795/jhealthscope-33575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trotti LM. Toward a Definition of Quality Care for Patients with Restless Legs Syndrome. Sleep Med Clin 2015; 10:293-301, xiii. [DOI: 10.1016/j.jsmc.2015.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Pronovost PJ, Armstrong CM, Demski R, Callender T, Winner L, Miller MR, Austin JM, Berenholtz SM, Yang T, Peterson RR, Reitz JA, Bennett RG, Broccolino VA, Davis RO, Gragnolati BA, Green GE, Rothman PB. Creating a high-reliability health care system: improving performance on core processes of care at Johns Hopkins Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:165-172. [PMID: 25517699 DOI: 10.1097/acm.0000000000000610] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this article, the authors describe an initiative that established an infrastructure to manage quality and safety efforts throughout a complex health care system and that improved performance on core measures for acute myocardial infarction, heart failure, pneumonia, surgical care, and children's asthma. The Johns Hopkins Medicine Board of Trustees created a governance structure to establish health care system-wide oversight and hospital accountability for quality and safety efforts throughout Johns Hopkins Medicine. The Armstrong Institute for Patient Safety and Quality was formed; institute leaders used a conceptual model nested in a fractal infrastructure to implement this initiative to improve performance at two academic medical centers and three community hospitals, starting in March 2012. The initiative aimed to achieve ≥ 96% compliance on seven inpatient process-of-care core measures and meet the requirements for the Delmarva Foundation and Joint Commission awards. The primary outcome measure was the percentage of patients at each hospital who received the recommended process of care. The authors compared health system and hospital performance before (2011) and after (2012, 2013) the initiative. The health system achieved ≥ 96% compliance on six of the seven targeted measures by 2013. Of the five hospitals, four received the Delmarva Foundation award and two received The Joint Commission award in 2013. The authors argue that, to improve quality and safety, health care systems should establish a system-wide governance structure and accountability process. They also should define and communicate goals and measures and build an infrastructure to support peer learning.
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Affiliation(s)
- Peter J Pronovost
- Dr. Pronovost is senior vice president of quality and safety, Johns Hopkins Medicine, director, Armstrong Institute for Patient Safety and Quality, and professor, Departments of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, School of Nursing and Carey Business School, Johns Hopkins University, Baltimore, Maryland. Mr. Armstrong is chairman, Johns Hopkins Medicine Patient Safety and Quality Board Committee, and, until October 2013, was chairman, Johns Hopkins Medicine Board of Trustees, Baltimore, Maryland. Ms. Demski is vice president of quality improvement, Armstrong Institute for Patient Safety and Quality and Johns Hopkins Health System, Baltimore, Maryland. Ms. Callender is senior quality and innovation coach, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Ms. Winner is director of Lean Sigma deployment, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Dr. Miller is Johns Hopkins Medicine chief quality officer for pediatrics, vice chair of quality and safety, and professor, Department of Pediatrics, Johns Hopkins University, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Dr. Austin is assistant professor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. Dr. Berenholtz is professor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Departments of Anesthesiology and Critical Care Medicine, Surgery, and School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. Dr. Yang is senior biostatistician, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
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Danielsson M, Nilsen P, Ohrn A, Rutberg H, Fock J, Carlfjord S. Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study. BMC Nurs 2014; 13:39. [PMID: 25435809 PMCID: PMC4247876 DOI: 10.1186/s12912-014-0039-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/10/2014] [Indexed: 11/21/2022] Open
Abstract
Background Patient safety culture emerges from the shared assumptions, values and norms of members of a health care organization, unit, team or other group with regard to practices that directly or indirectly influence patient safety. It has been argued that organizational culture is an amalgamation of many cultures, and that subcultures should be studied to develop a deeper understanding of an organization’s culture. The aim of this study was to explore subcultures among registered nurses and nurse assistants in Sweden in terms of their assumptions, values and norms with regard to practices associated with patient safety. Methods The study employed an exploratory design using a qualitative method, and was conducted at two hospitals in southeast Sweden. Seven focus group interviews and two individual interviews were conducted with registered nurses and seven focus group interviews and one individual interview were conducted with nurse assistants. Manifest content analysis was used for the analysis. Results Seven patient safety culture domains (i.e. categories of assumptions, values and norms) that included practices associated with patient safety were found: responsibility, competence, cooperation, communication, work environment, management and routines. The domains corresponded with three system levels: individual, interpersonal and organizational levels. The seven domains consisted of 16 subcategories that expressed different aspects of the registered nurses and assistants nurses’ patient safety culture. Half of these subcategories were shared. Conclusions Registered nurses and nurse assistants in Sweden differ considerably with regard to patient safety subcultures. The results imply that, in order to improve patient safety culture, efforts must be tailored to both registered nurses’ and nurse assistants’ patient safety-related assumptions, values and norms. Such efforts must also take into account different system levels. The results of the present study could be useful to facilitate discussions about patient safety within and between different professional groups.
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Affiliation(s)
- Marita Danielsson
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden ; Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden
| | - Annica Ohrn
- Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden
| | - Hans Rutberg
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden
| | - Jenni Fock
- Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden
| | - Siw Carlfjord
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, SE- 581 83 Sweden
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Affiliation(s)
- Vimal Ramjee
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Ridelberg M, Roback K, Nilsen P. Facilitators and barriers influencing patient safety in Swedish hospitals: a qualitative study of nurses' perceptions. BMC Nurs 2014; 13:23. [PMID: 25132805 PMCID: PMC4134467 DOI: 10.1186/1472-6955-13-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/08/2014] [Indexed: 11/22/2022] Open
Abstract
Background Sweden has undertaken many national, regional, and local initiatives to improve patient safety since the mid-2000s, but solid evidence of effectiveness for many solutions is often lacking. Nurses play a vital role in patient safety, constituting 71% of the workforce in Swedish health care. This interview study aimed to explore perceived facilitators and barriers influencing patient safety among nurses involved in the direct provision of care. Considering the importance of nurses with regard to patient safety, this knowledge could facilitate the development and implementation of better solutions. Methods A qualitative study with semi-structured individual interviews was carried out. The study population consisted of 12 registered nurses at general hospitals in Sweden. Data were analyzed using qualitative content analysis. Results The nurses identified 22 factors that influenced patient safety within seven categories: ‘patient factors’, ‘individual staff factors’, ‘team factors’, ‘task and technology factors’, ‘work environment factors’, ‘organizational and management factors’, and ‘institutional context factors’. Twelve of the 22 factors functioned as both facilitators and barriers, six factors were perceived only as barriers, and four only as facilitators. There were no specific patterns showing that barriers or facilitators were more common in any category. Conclusion A broad range of factors are important for patient safety according to registered nurses working in general hospitals in Sweden. The nurses identified facilitators and barriers to improved patient safety at multiple system levels, indicating that complex multifaceted initiatives are required to address patient safety issues. This study encourages further research to achieve a more explicit understanding of the problems and solutions to patient safety.
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Affiliation(s)
- Mikaela Ridelberg
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linkoping University, Linköping 581 83, Sweden
| | - Kerstin Roback
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linkoping University, Linköping 581 83, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linkoping University, Linköping 581 83, Sweden
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Pronovost PJ, Demski R, Callender T, Winner L, Miller MR, Austin JM, Berenholtz SM, Abundo C, Allen S, Applestein M, Atha W, Baca K, Baker D, Baxter J, Bessman E, Brinkman M, Brown J, Brown T, Bryant B, Carmody B, Carroll K, Carver B, Castellani J, Choi YH, Clarke C, Coker M, Cuccia M, Dalgetty R, Day R, DelRosario A, Deruggiero K, Duda D, Dudas R, Dunn J, Duquaine D, Dwyer J, Edwards A, Flowers D, Garger C, Goldsborough K, Groman S, Guzman F, Hack L, Hackett M, Hagan L, Haynos J, Heck E, Heitmiller G, Hill P, Hoffman A, Horvath K, Jensen R, Johnson P, Jonas I, Kelly K, Kemmerer T, Khan S, Landrum M, Leonard B, Lieberman K, Lobien J, Maritim C, Markovich G, Marquis B, McClammer B, McDonough D, McGuiness B, McIntyre J, McQuigg D, Means M, Michaels K, Miller J, Minor V, Morton R, Moyer J, Nimako H, Owens S, Park E, Peck J, Petrucci P, Petty B, Post M, Rasmussen S, Raynor J, Renjel J, Resar J, Rossi S, Rotello L, Russell S, Saheed M, Schultz J, Schwartz P, Servis K, Shrout A, Sidone L, Smith N, Smith R, Smith T, Martin ES, Taffe E, Thomas C, Tolson T, Trost J, Walters C, Ware C, Wessels R, Whitman G, Wyman C. Demonstrating High Reliability on Accountability Measures at The Johns Hopkins Hospital. Jt Comm J Qual Patient Saf 2013; 39:531-44. [DOI: 10.1016/s1553-7250(13)39069-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sarikhani Y, Bagheri Lankarani K. Mixed Payment Method, the Experience of a New Payment Method for Health Service Providers in Family Physician Program in Iran. SHIRAZ E-MEDICAL JOURNAL 2013. [DOI: 10.17795/semj16651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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