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Brown A, La J, Keri MI, Hillis C, Razack S, Korah N, Karpinski J, Frank JR, Wong B, Goldman J. In EPAs we trust, is quality and safety a must? A cross-specialty analysis of entrustable professional activity guides. MEDICAL TEACHER 2024:1-9. [PMID: 38527417 DOI: 10.1080/0142159x.2024.2323177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/21/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE The inclusion of quality improvement (QI) and patient safety (PS) into CanMEDS reflects an expectation that graduating physicians are competent in these areas upon training completion. To ensure that Canadian postgraduate specialty training achieves this, the translation of QI/PS competencies into training standards as part of the implementation of competency-based medical education requires special attention. METHODS We conducted a cross-specialty, multi-method analysis to examine how QI/PS was incorporated into the EPA Guides across 11 postgraduate specialties in Canada. RESULTS We identify cross-specialty variability in how QI/PS is incorporated, positioned, and emphasized in EPAs and milestones. QI/PS was primarily referenced alongside clinical activities rather than as a sole competency or discrete activity. Patterns were characterized in how QI/PS became incorporated into milestones through repetition and customization. QI/PS was also decoupled, conceptualized, and emphasized differently across specialties. CONCLUSIONS Variability in the inclusion of QI/PS in EPAs and milestones has important implications considering the visibility and influence of EPA Guides in practice. As specialties revisit and revise EPA Guides, there is a need to balance the standardization of foundational QI/PS concepts to foster shared understanding while simultaneously ensuring context-sensitive applications across specialties. Beyond QI/PS, this study illuminates the challenges and opportunities that lie in bridging theoretical frameworks with practical implementation in medical education, prompting broader consideration of how intrinsic roles and emergent areas are effectively incorporated into competency-based medical education.
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Affiliation(s)
- Allison Brown
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Julie La
- Graduate Program in Health Quality, Queen's University, Kingston, Canada
- Department of Surgery, Queen's University, Kingston, Canada
| | | | - Chris Hillis
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Saleem Razack
- Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Nadine Korah
- Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Jason R Frank
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Brian Wong
- Centre for Quality Improvement and Patient Safety, Toronto, Canada
- Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Joanne Goldman
- Centre for Quality Improvement and Patient Safety, Toronto, Canada
- Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
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Er ÖS, Altinbaş Y. Nurses' Perceptions of Patient Safety on Patient Safety Climate. J Perianesth Nurs 2023; 38:408-413. [PMID: 36621378 DOI: 10.1016/j.jopan.2022.06.004] [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: 01/01/2022] [Revised: 05/23/2022] [Accepted: 06/05/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to determine the relationship between nurses' perception of patient safety and the safety climate. DESIGN Descriptive study. METHODS The sample consisted of 262 surgical nurses. Data were collected with an online questionnaire system using the Leiden Operating Theatre and Intensive Care Safety (LOTICS) Scale and Patient Safety Climate (PSC) Scale. FINDINGS Intensive care unit (ICU) nurses were found to have higher perceptions of patient safety (106.0 ± 15.2 vs 102.6 ± 17.0) and safety climate (59.2 ± 20.9 vs 50.9 ± 24.3) than Operating Room (OR) nurses. According to ICU nurses, OR nurses stated that teamwork was weak, they did not feel like a part of the team, and teamwork was incompatible. They stated that there was no preliminary information about the operation, that they could not get enough information during the operation, that sufficient materials were not available in the OR in case of need, and that the worn-out materials were not replaced and repaired in a timely manner. CONCLUSION As nurses' perception of patient safety increases; patient safety climate perceptions also increased. Providing both professional and in-service trainings to raise awareness of patient safety, developing strategies that prevent team conflicts, providing preliminary information about the surgery, and eliminating material deficiencies can increase nurses' perception of PSC.
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Affiliation(s)
- Özlem Soyer Er
- Afyonkarahisar Sağlık Bilimleri Üniversitesi, Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Afyon, Turkey
| | - Yasemin Altinbaş
- Department of Surgical Nursing, Adıyaman University, Faculty of Health Sciences, Adıyaman, Turkey.
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Whittaker JD, Davison I. A Lack of Communication and Awareness in Nontechnical Skills Training? A Qualitative Analysis of the Perceptions of Trainers and Trainees in Surgical Training. JOURNAL OF SURGICAL EDUCATION 2020; 77:873-888. [PMID: 32037236 DOI: 10.1016/j.jsurg.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/22/2019] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the perceptions of surgical trainees and trainers towards nontechnical skills (NTS) as a concept, its role in training, and the challenges of developing these skills. DESIGN A case series of semistructured interviews using an interpretivist grounded theory approach for qualitative analysis. SETTING East Midlands (North) core surgical training programme in the United Kingdom. PARTICIPANTS Ten out of 81 volunteer core surgical trainees and academic educational supervisors (consultant surgeon trainers). RESULTS Understanding of NTS was consistent amongst trainers and trainees but the conceived definition of NTS was much broader than previous definitions. Most viewed NTS as important for surgeons. Trainees believed trainers did not appreciate or were unaware of NTS, likely because of a lack of discussion in practice. Trainers had several reasons for not discussing NTS including insufficient personal relationships with trainees and a lack of robust evidence on which to base discussions. A lack of insight into NTS and surgeon arrogance were suggested as barrier to effective learning. CONCLUSIONS Apparent discordant perceptions may be contributing to a lack of focused NTS feedback for surgeons in training. To implement NTS training changes, more will have to be done to develop a shared understanding.
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Affiliation(s)
- Joshua D Whittaker
- Otolaryngology, Univerisity Hospitals Nottingham, Nottingham, United Kingdom.
| | - Ian Davison
- School of Education, Univeristy of Birmingham, Birmingham, United Kingdom
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Abstract
BACKGROUND Anaesthesia teams are temporarily assembled to cooperate with teams in emergency departments in the immediate management of events compromising patients’ airway, ventilation and circulation. PURPOSE The aim was to describe a temporary ad-hoc anaesthesia team’s performance. DESIGN An observational study was conducted. METHODS Data, collected with 12 non-participatory observations, were analysed using both an thematic method, and a validated assessment tool, the Team Emergency Assessment Measure. RESULTS Three themes were identified: (1) flexibility in assuming varying roles, (2) expertise in verbal and non-verbal communication and (3) skills dealing with the challenges of working in unfamiliar dynamic environments. Ninety per cent of anaesthesia teams scored 7.6 (0–10) on the overall assessment according to the Team Emergency Assessment Measure rating. CONCLUSION Ad-hoc anaesthesia team members communicated in various ways and the anaesthesia team adapted well to the unpredictable environment in the emergency department.
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Affiliation(s)
| | - Caisa Öster
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Dunstan E, Coyer F. Safety culture in two metropolitan Australian tertiary hospital intensive care units: A cross-sectional survey. Aust Crit Care 2019; 33:4-11. [PMID: 30660433 DOI: 10.1016/j.aucc.2018.11.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Safety culture is significant in the complex intensive care environment, where the consequences of human error can be catastrophic. Research within Australian intensive care units has been limited and little is understood about the safety culture of intensive care units in Queensland. AIM The aim was to evaluate and compare safety culture in the intensive care units of two metropolitan tertiary hospitals in Queensland. METHOD A cross-sectional survey, Safety Attitudes Questionnaire, was administered to all medical, nursing and allied health professionals in the research sites (A and B) during January and February 2016. Data were collated into six safety culture domains of teamwork climate, safety climate, job satisfaction, stress recognition, working conditions and perceptions of management. Comparison was made using t-tests and between demographic groups using generalising estimating equations. RESULTS In total, 206 surveys were returned from 522 staff (39.5% response rate). The majority of respondents were nurses (80.6%). Site B scored all domains of the safety attitudes questionnaire significantly higher than Site A (p < 0.001). The scores for both site A and B were significantly higher in all domains (p < 0.001) than a previous Australian study conducted in 2013. Both sites returned low scores in the stress recognition domain. Medical staff perceived the teamwork climate as more positive than nursing staff (mean difference 16.6 [Wald χ2 = 10383.8, p < 0.001]). Allied health professionals reported poorer perceptions of working conditions than medical staff (mean difference 7.8 [Wald χ2 = 775.4, p < 0.001]). CONCLUSION Despite similar governance and external structures, differences were found in safety culture between the two research sites. This finding emphasises the importance of local, unit-level assessment of safety culture and planning of improvement strategies. This study adds to the evidence and implications for critical care clinical practice that these interventions need to be unit focused, supported by management and multidisciplinary in approach.
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Affiliation(s)
- Elspeth Dunstan
- Clinical Nurse, Intensive Care Unit, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD, Australia.
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Metro North Health Service District, Queensland, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom.
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Sellers MM, Berger I, Myers JS, Shea JA, Morris JB, Kelz RR. Using Patient Safety Reporting Systems to Understand the Clinical Learning Environment: A Content Analysis. JOURNAL OF SURGICAL EDUCATION 2018; 75:e168-e177. [PMID: 30174144 DOI: 10.1016/j.jsurg.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/05/2018] [Accepted: 08/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine patient safety event reporting behavior by trainees caring for surgical patients compared to other clinicians. DESIGN Qualitative analysis of a patient safety event reporting system comparing reports entered by trainees to those entered by attending physicians and nurses. Categorical data associated with reports were compared, and free-text event descriptions underwent content analysis focusing on themes related to report completeness and report focus. SETTING The Hospital of the University of Pennsylvania, an academic tertiary care hospital in Philadelphia, Pennsylvania. PARTICIPANTS All patient safety event reports related to surgical patients from a 6-month period (July-December 2016). RESULTS One thousand four hundred twenty-three reports were entered by trainees (T), attendings (A), and nurses (N). Trainees had a lower number of reports entered per reporter compared to nurses (T median [IQR]: 1 [1-2], N: 2 [1-3]), and the highest percentage of reports entered anonymously for any group (T: 28.7%, N: 9.9%, A: 4.6%). The overall distribution of event location and event type differed significantly between groups (p < 0.001). Trainee reports were found to have a broader range of focus, more elements associated with completeness of reports, and more frequent use of blame language. CONCLUSIONS Surgical trainees report a wide variety of issues in the perioperative, floor, and ICU settings. Their reports often include more details than those entered by other clinicians, but feature higher rates of anonymous reporting and use of blame language. Analysis of patient safety event reports by trainees compared with other healthcare professionals can reveal important insights into the clinical learning environment and areas for safety improvement.
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Affiliation(s)
- Morgan M Sellers
- Department of Surgery, Center for Surgery Healthcare and Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Ian Berger
- Department of Surgery, Center for Surgery Healthcare and Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer S Myers
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judy A Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon B Morris
- Department of Surgery, Center for Surgery Healthcare and Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Center for Surgery Healthcare and Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Patterson C, Procter N, Toffoli L. Situation awareness: when nurses decide to admit or not admit a person with mental illness as an involuntary patient. J Adv Nurs 2016; 72:2042-53. [DOI: 10.1111/jan.13024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 12/19/2022]
Affiliation(s)
| | - Nicholas Procter
- University of South Australia; Adelaide South Australia Australia
| | - Luisa Toffoli
- University of South Australia; Adelaide South Australia Australia
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Thomas CEL, Phipps DL, Ashcroft DM. When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff. BMJ Open 2016; 6:e010851. [PMID: 27266770 PMCID: PMC4908895 DOI: 10.1136/bmjopen-2015-010851] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Our aim was to explore how members of community pharmacy staff perceive and experience the role of procedures within the workplace in community pharmacies. SETTING Community pharmacies in England and Wales. PARTICIPANTS 24 community pharmacy staff including pharmacists and pharmacy support staff were interviewed regarding their view of procedures in community pharmacy. Transcripts were analysed using thematic analysis. RESULTS 3 main themes were identified. According to the 'dissemination and creation of standard operating procedures' theme, community pharmacy staff were required to follow a large amount of procedures as part of their work. At times, complying with all procedures was not possible. According to the 'complying with procedures' theme, there are several factors that influenced compliance with procedures, including work demands, the high workload and the social norm within the pharmacy. Lack of staff, pressure to hit targets and poor communication also affected how able staff felt to follow procedures. The third theme 'procedural compliance versus using professional judgement' highlighted tensions between the standardisation of practice and the professional autonomy of pharmacists. Pharmacists feared being unsupported by their employer for working outside of procedures, even when acting for patient benefit. Some support staff believed that strictly following procedures would keep patients and themselves safe. Dispensers described following the guidance of the pharmacist which sometimes meant working outside of procedures, but occasionally felt unable to voice concerns about not working to rule. CONCLUSIONS Organisational resilience in community pharmacy was apparent and findings from this study should help to inform policymakers and practitioners regarding factors likely to influence the implementation of procedures in community pharmacy settings. Future research should focus on exploring community pharmacy employees' intentions and attitudes towards rule-breaking behaviour and the impact this may have on patient safety.
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Affiliation(s)
- Christian E L Thomas
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Manchester Pharmacy School, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Denham L Phipps
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Manchester Pharmacy School, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Manchester Pharmacy School, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
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Matharoo M, Haycock A, Sevdalis N, Thomas-Gibson S. Endoscopic non-technical skills team training: The next step in quality assurance of endoscopy training. World J Gastroenterol 2014; 20:17507-17515. [PMID: 25516665 PMCID: PMC4265612 DOI: 10.3748/wjg.v20.i46.17507] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/24/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes.
METHODS: A novel endoscopy team training intervention for BCS teams was developed and evaluated as a pre-post intervention study. Four multi-disciplinary BCS teams constituting BCS endoscopist(s), specialist screening practitioners, endoscopy nurses and administrative staff (A) from English BCS training centres participated. No patients were involved in this study. Expert multidisciplinary faculty delivered a single day’s training utilising real clinical examples. Pre and post-course evaluation comprised participants’ patient safety awareness, attitudes, and knowledge. Global course evaluations were also collected.
RESULTS: Twenty-three participants attended and their patient safety knowledge improved significantly from 43%-55% (P≤ 0.001) following the training intervention. 12/41 (29%) of the safety attitudes items significantly improved in the areas of perceived patient safety knowledge and awareness. The remaining safety attitude items: perceived influence on patient safety, attitudes towards error management, error management actions and personal views following an error were unchanged following training. Both qualitative and quantitative global course evaluations were positive: 21/23 (91%) participants strongly agreed/agreed that they were satisfied with the course. Qualitative evaluation included mandating such training for endoscopy teams outside BCS and incorporating team training within wider endoscopy training. Limitations of the study include no measure of increased patient safety in clinical practice following training.
CONCLUSION: A novel comprehensive training package addressing patient safety, non-technical skills and adverse event analysis was successful in improving multi-disciplinary teams’ knowledge and safety attitudes.
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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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Abstract
PURPOSE OF REVIEW The very complex process of intensive care is accompanied by a not unexpected accumulation of risk for error and adverse events. The present review addresses strategies to decrease care errors in several domains of daily intensive care practice. RECENT FINDINGS Strategies to decrease care errors now focus on a systematic approach by identifying latent system failures and change the design of the care process in such a way that inevitable human errors are prevented or their consequences are mitigated. Recent examples refer to the standardization of processes, adaptation to cognitive limitations of human beings, optimization of working conditions, and the increasing use of supporting information technologies. The development of a safety climate constitutes a key element and apparently contributes to reduction of medical errors in ICUs. SUMMARY The present review discusses recent approaches aimed to decrease care errors in ICUs. A growing body of evidence demonstrates that a system based approach with the change of process characteristics and the development of a safety climate is most essential in the effort to increase patient safety.
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