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Wilson MA, Sinno M, Hacker Teper M, Courtney K, Nuseir D, Schonewille A, Rauchwerger D, Taher A. Toward Zero Harm: Mackenzie Health's Journey Toward Becoming a High Reliability Organization and Eliminating Avoidable Harm. J Patient Saf 2022; 18:680-685. [PMID: 35152233 DOI: 10.1097/pts.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In response to an organizational survey revealing low safety culture scores, we implemented a "zero harm" approach to eliminate preventable harm across a wide variety of clinical areas. We aimed to achieve this objective within 3 years. METHODS We developed a 5-part strategy for cultural and process redesign that included (1) engaging leadership; (2) developing an organization-specific patient safety framework; (3) monitoring specific quality aims based on high-risk, high-volume, high-cost, and problem-prone areas; (4) standardizing a 3-part review process that includes a root cause analysis for moderate and critical patient safety incidents; and (5) communicating progress to staff in real time via unit-specific electronic dashboards. RESULTS In less than 1 year, we increased patient safety incident reporting by 37% while simultaneously decreasing falls with injury by 39%, pressure injury rates by 37%, and central line-associated blood stream infections by 34%. We also improved medication reconciliation rate by 3.3% and decreased our irretrievable specimen rate to 0. Finally, we noted increased awareness around patient safety within clinical teams, with open discussions about patient safety becoming a routine part of patient care. CONCLUSIONS This study describes an initiative that sought to introduce system-wide changes to practice and patient safety culture in a rapid time frame. Results suggest that our 5-step approach to transformation may confer substantial gains in patient safety for peer institutions. Next steps include continuing to expand and monitor quality aims as we progress through our journey to eliminating preventable patient harm in our healthcare system.
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Zwaiman A, da Luz LT, Perrier L, Hacker Teper M, Strauss R, Harth T, Haas B, Nathens AB, Gotlib Conn L. The involvement of trauma survivors in hospital-based injury prevention, violence intervention and peer support programs: A scoping review. Injury 2022; 53:2704-2716. [PMID: 35773023 DOI: 10.1016/j.injury.2022.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite decades-long involvement of trauma survivors in hospital-based program delivery, their roles and impact on trauma care have not been previously described. We aimed to characterize the literature on trauma survivor involvement in hospital-based injury prevention, violence intervention and peer support programs to map what is currently known and identify future research opportunities. METHODS A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology. Articles were identified through electronic databases and gray literature. Included articles described hospital-based injury prevention programs, violence intervention programs and peer support programs that involved trauma survivors leveraging their injury experiences to counsel others. Studies were screened and data were abstracted in duplicate. Data were synthesized generally and by program type. RESULTS Thirty-six published articles and four program reports were included. Peer support programs were described in 21 articles, mainly involving trauma survivors as mentors or peer supporters. Peer support programs' most commonly reported outcome was participant satisfaction (n = 6), followed by participant self-efficacy (n = 5), depression (n = 4), and community integration (n = 3). Eleven injury prevention studies were included, all involving trauma survivors as speakers in youth targeted programs. Injury prevention studies commonly reported outcomes of participants' risk behaviors and awareness (n = 9). Violence intervention programs were included in four articles involving trauma survivors as intervention counsellors. Recidivism rate was the most commonly reported outcome (n = 3). Variability exists across and within program types when reporting on involved trauma survivors' gender, age, selection and training, duration of involvement and number of survivors involved. Outcomes related to trauma survivors' own experiences and the impacts to them of program involvement were under-studied. CONCLUSIONS Significant opportunity exists to fill current knowledge gaps in trauma survivors' involvement in trauma program delivery. There is a need to describe more fully who involved trauma survivors are to inform the development of effective future interventions.
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Affiliation(s)
- Ashley Zwaiman
- University of Toronto, 27 King's College Cir, Toronto, ON M5S 1A1 Canada
| | - Luis T da Luz
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Laure Perrier
- University Health Network, 190 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | | | - Rachel Strauss
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Tamara Harth
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Barbara Haas
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, 5 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Avery B Nathens
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, 5 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Lesley Gotlib Conn
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, 5 College St 4th Floor, Toronto, ON M5T 3M6 Canada.
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Sourial N, Hacker Teper M, Arsenault-Lapierre G, Mehta K, Kay K, Vedel I. Interprofessional primary care: indispensable for family physicians yet invisible to older patients. J Interprof Care 2022; 36:786-792. [PMID: 35191765 DOI: 10.1080/13561820.2022.2037529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is growing consensus that interprofessional primary care is key to delivering timely, coordinated, and comprehensive care, especially in the older patient population who often live with complex and chronic needs. Despite significant investments in reforming health systems toward interprofessional primary care, there is a paucity of evidence describing the importance of interprofessional primary care for older patients and physicians. This qualitative descriptive study aimed to understand the use and utility of interprofessional primary care for older patients and family physicians from the perspective of different stakeholders within primary care in Ontario, Canada. Twenty-five semi-structured interviews (including 16 older patients, six family physicians, three primary care managers) and a focus group with 13 patient representatives were conducted. Our study found that while the benefits of interprofessional primary care teams for family physicians were clearly emphasized, stakeholders consistently reported that older patients often appeared to be unaware of the presence of, or roles played by, non-physician healthcare professionals in their clinic. Better transparency and education regarding available services and roles of different care providers may allow for more optimal use of interprofessional family medicine clinics by patients.
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Affiliation(s)
- Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Quebec, Canada
| | | | | | - Kavita Mehta
- Association of Family Health Teams of Ontario, Vice- The Change Foundation, Ontario, Canada
| | - Kelly Kay
- Provincial Geriatrics Leadership Office, Ontario, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Quebec, Canada
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Lee DD, Hacker Teper M, Chartier LB, Crump S, Ma M, Parotto M, Perri P, Chin KJ, Nirmalanathan K, Sabbah S, Taher AK. Experiences of healthcare providers with a novel emergency response intubation team during COVID-19. CAN J EMERG MED 2022; 24:185-194. [PMID: 35041201 PMCID: PMC8764172 DOI: 10.1007/s43678-021-00248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
Objectives In the early stages of the COVID-19 pandemic, there were significant concerns about the infectious risks of intubation to healthcare providers. In response, a dedicated emergency response intubation team (ERIT) consisting of anesthesiologists and allied health providers was instituted for our emergency department (ED). Given the high-risk nature of intubations and the new interprofessional team dynamics, we sought to assess health-care provider experiences and potential areas of improvement. Methods Surveys were distributed to healthcare providers at the University Health Network, a quaternary healthcare centre in Toronto, Canada, which includes two urban EDs seeing over 128,000 patients per year. Participants included ED physicians and nurses, anesthesiologists, anesthesia assistants, and operating room nurses. The survey included free-text questions. Responses underwent thematic analysis using grounded theory and were independently coded by two authors to generate descriptive themes. Discrepancies were resolved with a third author. Descriptive themes were distilled through an inductive, iterative process until fewer main themes emerged. Results A total of 178 surveys were collected (68.2% response rate). Of these, 123 (69%) participated in one or more ERIT activations. Positive aspects included increased numbers of staff to assist, increased intubation expertise, improved safety, and good team dynamics within the ERIT team. Challenges included a loss of scope (primarily ED physicians and nurses) and unfamiliar workflows, perceived delays to ERIT team arrival or patient intubation, role confusion, handover concerns, and communication challenges between ED and ERIT teams. Perceived opportunities for improvement included interprofessional training, developing clear guidelines on activation, inter-team role clarification, and guidelines on handover processes post-intubation. Conclusions Healthcare providers perceived that a novel interprofessional collaboration for intubations of COVID-19 patients presented both benefits and challenges. Opportunities for improvement centred around interprofessional training, shared decision making between teams, and structured handoff processes.
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Affiliation(s)
- Daniel D Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Lucas B Chartier
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Crump
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Martin Ma
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Matteo Parotto
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Pauline Perri
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Ki Jinn Chin
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Konika Nirmalanathan
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Sam Sabbah
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed K Taher
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Arora AK, Rodriguez C, Carver T, Teper MH, Rojas-Rozo L, Schuster T. Evaluating Usability in Blended Learning Programs Within Health Professions Education: a Scoping Review. Med Sci Educ 2021; 31:1213-1246. [PMID: 34031640 PMCID: PMC8133057 DOI: 10.1007/s40670-021-01295-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED Knowledge was mapped about how usability has been applied in the evaluation of blended learning programs within health professions education. Across 80 studies, usability was explicitly mentioned once but always indirectly evaluated. A conceptual framework was developed, providing a foundation for future instruments to evaluate usability in this context. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01295-x.
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Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec Canada
| | - Charo Rodriguez
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec Canada
| | - Tamara Carver
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec Canada
| | | | - Laura Rojas-Rozo
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec Canada
| | - Tibor Schuster
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec Canada
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Teper MH, Godard-Sebillotte C, Vedel I. Achieving the Goals of Dementia Plans: A Review of Evidence-Informed Implementation Strategies. ACTA ACUST UNITED AC 2020; 18:37-46. [PMID: 31917668 DOI: 10.12927/whp.2019.26060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 2019 report by the Canadian Academy of Health Sciences identified the importance of evidence-informed implementation strategies in reforming dementia care. Such implementation strategies may be relevant to changing clinical practice in the wake of Canada's impending federal dementia plan (initiated by Bill C-233). As this federal dementia plan is elaborated, there may be value in looking ahead to some of the implementation challenges likely to be faced "on the ground" in healthcare settings. We thus conducted a rapid review of provincial and national dementia plans from high-income countries and reviewed studies on implementation strategies to dementia care. We advance seven key implementation strategies that may be useful for future dementia care reform.
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Affiliation(s)
- Matthew Hacker Teper
- Researcher, Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC
| | | | - Isabelle Vedel
- Assistant Professor, Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC
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Teper MH, Vedel I, Yang XQ, Margo-Dermer E, Hudon C. Understanding Barriers to and Facilitators of Case Management in Primary Care: A Systematic Review and Thematic Synthesis. Ann Fam Med 2020; 18:355-363. [PMID: 32661038 PMCID: PMC7358023 DOI: 10.1370/afm.2555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/30/2019] [Accepted: 11/29/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Despite evidence on the benefits of case management for the care of patients with complex needs in primary care, implementing the program-necessary to achieve its benefits-has been challenging worldwide. Evidence on factors affecting implementation remains disparate. Accordingly, the objective of this systematic review was to identify barriers to and facilitators of case management, from the perspectives of health care professionals, in primary care settings around the world. METHODS We conducted a systematic review and thematic synthesis of qualitative findings. In collaboration with 2 librarians, we searched 3 electronic databases (MEDLINE, CINAHL, EMBASE) for studies related to factors affecting case management function in primary care. Two researchers screened titles, abstracts, and full texts for inclusion, then assessed included studies for quality. Results from included studies were synthesized by thematic synthesis, and a framework was developed. RESULTS Of 1,640 unique records identified, 22 studies, originating from 6 countries, met the inclusion criteria. We identified 9 barriers and facilitators: family context; policy and available resources; physician buy-in and understanding of the case manager role; relationship building; team communication practices; autonomy of case managers; training in technology; relationships with patients; and time pressure and workload. We describe these factors, then present a framework demonstrating the relationships among them. CONCLUSIONS Our study's findings show that multiple factors influence case management implementation. These findings have implications for researchers, clinicians, and policy makers who strive to implement or reform case management programs in local or larger primary care settings.
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Affiliation(s)
- Matthew Hacker Teper
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Xin Qiang Yang
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Eva Margo-Dermer
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine, Univer-sité de Sherbrooke, Sherbrooke, Québec, Canada
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Godard-Sebillotte C, Hacker Teper M, Vedel I. Quebec doctors' pay rise should be evidence based and transparent. BMJ 2018; 362:k3148. [PMID: 30030241 DOI: 10.1136/bmj.k3148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Claire Godard-Sebillotte
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, 3rd Floor, Montreal, Quebec, Canada H3S 1Z1
| | - Matthew Hacker Teper
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, 3rd Floor, Montreal, Quebec, Canada H3S 1Z1
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, 3rd Floor, Montreal, Quebec, Canada H3S 1Z1
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