Dynamic workplace interactions for improving patient safety climate

Interprofessional Team Collaboration as a Mediator Between Workplace Social Capital and Patient Safety Climate: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Patient-safety climate is one of the most important organizational factors contributing to health care quality. We hypothesized that a patient safety climate is fostered by the willingness to collaborate and trust among members as well as by daily collaborative practices. This study aimed to clarify the effect of workplace social capital on patient safety climate. We also sought to investigate the mediating effect of interprofessional team collaboration on the relationship between workplace social capital and patient safety climate.

METHODS

This cross-sectional survey was conducted from November 2021 to January 2022 using anonymous web-based questionnaires. The survey was distributed to 1495 employees working in a hospital in Tokyo, Japan. The questionnaire included the patient safety climate scale, workplace social capital scale, Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II-J), and demographic items. Structural equation modeling was performed to verify the associations among the 3 variables. In addition, a significance test for indirect effects was conducted using the bootstrap method to confirm the mediating effect of AITCS-II-J.

RESULTS

A total of 725 employees participated in this survey, and 632 data items were analyzed. Nurses were the highest number of respondents (68.2%), followed by physicians (13.3%). Workplace social capital and patient safety were directly and significantly associated (β = .309, P < .01). Furthermore, the partially indirect effect of the AITCS-II-J on the association between workplace social capital and patient safety climate was also significant (β = .430, P < .01).

CONCLUSIONS

Workplace social capital was significantly and directly related to patient safety climate and was also significantly related to patient safety climate partially mediated by interprofessional team collaboration. Our findings suggest the importance of workplace social capital and routine multidisciplinary collaboration for a patient safety climate to manage health care quality.

Interprofessional collaboration mediates the relationship between perceived organizational learning and safety climate in hospitals: A cross-sectional study

BACKGROUND

Organizational learning (OL) and interprofessional collaboration (IPC) are said to enhance medical safety in hospitals, but the relationship between these variables has not been quantitatively tested.

OBJECTIVE

This study examines the mediating effects of IPC on the relationship between OL and safety climate (improvement, compliance, and patient/family involvement).

METHODS

An anonymous self-reporting questionnaire was administered to 1,495 healthcare workers from November 2021 to January 2022. The questions regarded the hospital's safety climate, OL, and IPC. A mediation analysis using structural equation modeling was conducted to examine the mediating role of IPC on the relationship between OL and the three safety climates. The indirect effect was estimated using 2,000 bootstrap samples.

RESULTS

Responses from 643 healthcare workers were analyzed. The direct effects of OL were 𝛽 = .74, 75 (p < .001) on improvement and involvement and 𝛽 = 0.1 (p > .05) on compliance. The indirect effects of IPC on improvement and involvement were 𝛽 = .14 (95%CI: .00 ∼ .06) and 𝛽 = .37 (95%CI: .04 ∼ .09), respectively.

CONCLUSION

This study determined the mechanisms that enhance a hospital's safety climate, demonstrating that IPC mediates the relationship between OL and improvement and patient/family involvement. However, OL and IPC are not related to compliance.

Exploring the Impact of Employee Engagement and Patient Safety

Background

Health service administrators are continually investigating new ways to improve the safety and quality of health services. A positive and powerful relationship between employee engagement and patient safety has been suggested in the research literature, and steps can be taken by employers to enhance engagement to improve the safety of health services, particularly considering the coronavirus disease 2019 (COVID-19) pandemic.

Objective

The aim of this review was to explore the current literature on the impact of employee engagement on patient safety.

Methods

A review of peer-reviewed literature relating to the impact of employee engagement on patient safety within health services between January 2015 and May 2021 was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline Complete, Scopus, Health Business Elite and Business Source Ultimate databases. A search of grey literature using the Bielefeld Academic Search Engine database was also completed.

Results

Of relevant articles, 3693 were identified, of which 15 studies were included in this review. Ten articles measured employee engagement using existing, validated tools, whereas patient safety was most frequently assessed through surveys seeking staff member’s perceptions of safety or the quality of care they provide. Overall, there appeared to be a positive correlation between employee engagement and patient safety, but the strength of the relationship varied.

Conclusion

Anecdotal accounts of improving employee engagement and improving patient safety abound, and the evidence reviewed appears in agreement. However, research into the impact of employee engagement on patient safety is in its early stages. As health service managers consider the best use of funding to support safe and high-quality care, evidence to support the positive impact employee engagement has on patient safety may be useful in managing the fallout from the COVID-19 pandemic.

Health Care Transition Planning: Educational Needs of Pediatric Nurses and Pediatric Nurse Practitioners

INTRODUCTION

The purpose was to identify the educational needs of pediatric nurses and pediatric nurse practitioners providing direct care to transition-aged youth with chronic illness and disability and to identify strategies to develop health care transition planning (HCTP) expertise.

METHOD

Mixed-methods descriptive analyses were performed on survey data extracted from a larger national study exploring the provision of HCTP activities performed by nurses of two pediatric nursing professional organizations.

RESULTS

Items querying educational needs were completed by 1,162 pediatric nurses serving in advanced practice and staff roles. Twenty percent reported having specialized HCTP education. Of which more than half received it outside of the workplace. Factor analysis revealed two constructs explaining 73.4% of the variance in nurses' reported level of knowledge.

DISCUSSION

HCTP education and the development of nurse-led services to facilitate optimal health care transitions outcomes are necessitated. Academia and service have a shared responsibility in educating nurses.

Governance for Patient Safety: A Framework of Strategy Domains for Risk Management

BACKGROUND

Adverse events in healthcare are primarily due to system failures rather than individuals. Risk reduction strategies should therefore focus on strengthening systems, bringing about improvements in governance, and targeting individual practices or products. The purpose of this study was to conduct a scoping review to develop a global framework of management strategies for sustaining a safety-oriented culture in healthcare organizations, focusing on patient safety and the adoption of good safety-related practices.

METHODS

We conducted a search on safety-related strategies in 2 steps. The first involved a search in the PubMed database to identify effective, broadly framed, cross-sector domains relevant to clinical risk management strategies in healthcare systems. In the second step, we then examined the strategies adopted by running a scoping review for each domain.

RESULTS

Our search identified 8 strategy domains relevant to patient safety: transformational leadership, patient engagement, human resources management quality, innovation technology, skills certification, education in patient safety, teamwork, and effective communication.

CONCLUSIONS

This scoping review explores management strategies key to healthcare systems' efforts to create safety-oriented organizations. Improvement efforts should focus particularly on the domains identified: combined together, they would nurture an overall safety-oriented culture and have an impact on preventable adverse events.

Measuring the safety climate in an Australian emergency department

BACKGROUND

There are numerous intricate human, system and cultural factors that can impact upon the safe and effective implementation of patient safety systems (e.g. rapid response systems). Safety climate is one of these factors and is a measure of frontline healthcare workers' shared perceptions, behaviours, beliefs and attitudes towards the organisation's culture of safety. Safety climate scores are also associated with the frequency of errors and adverse events in the healthcare setting. However, there is little evidence regarding the relationships between attitudes to patient safety and staff characteristics such as emergency care expertise and experience. The aims of this study were to measure perceptions of the safety climate in an Australian metropolitan Emergency Department and examine relationships between safety climate perceptions and staff characteristics.

METHODS

The Victorian Managed Insurance Authority Safety Climate Survey was administered to all doctors (n = 44) and nurses (n = 119) at an Australian emergency department.

RESULTS

Completed surveys were received from 127 (78%) respondents, 25 (52%) doctors and 100 (84%) nurses. Reliability analysis showed very good internal consistency of all 43-items of the survey (α = 0.94). With the exception of stress recognition, nurses rated the organisation's commitment to patient safety higher than doctors in all remaining attitudinal domains (p < 0.05). Both groups acknowledge that fatigue, increased workload and stress recognition negatively impacts upon patient safety. There was a significant trend for declining safety climate ratings related to participants' clinical competence level and experience across all domains except stress recognition (p < 0.05).

CONCLUSIONS

The Safety Climate Survey appears to be a reliable measure of patient safety climate for use in Emergency Departments. Emergency doctors and nurses did not perceive there to be a strong organisational commitment to patient safety in an Australian Emergency Department. Emergency Departments can provide a safer environment through genuine commitment to safety culture improvement which capitalises on the insights, intrinsic strengths and behaviours characteristic of the ED team's expertise and experience. This kind of commitment can positively influence the effectiveness of actions taken to minimise risk to patient safety and improve ED staff job satisfaction and effectiveness.

Identifying management practices that drive production-line workers' engagement through qualitative analysis

INTRODUCTION

Engagement research - most often defined by a worker's psychological state of vigor, dedication, and absorption - pays little attention to production-line workers. This study therefore explores factors that drive workers' engagement with health and safety (H&S) in a production-line context as well as their perception of managerial influence Furthermore, the study adds to the body of research by exploring H&S engagement concepts through the use of qualitative research methods.

METHOD

38 semi-structured interviews were conducted and analyzed through template analysis to identify themes that promote and hinder engagement.

RESULTS

The main engagement drivers were found to be: (a) the displayed safety focus of the company in organizational and social aspects; (b) the quality of the communication approach with respect to quality, consistency and direction; and (c) the environment encompassing the relationship between workers and supervisors and peers as well as the psychological environment. Notably, a trusting relationship between supervisors and workers appeared to be the most influential driver in determining engaged H&S behavior. Discussion and impact in industry: The study highlights factors that could be adapted to improve engagement and consequently enhance H&S approaches. Originality: The study reported in this paper offers a unique insight into individual production workers' perceived drivers of H&S engagement using Qualitative Analysis. Practical applications: The study identified the important role that supervisors play in workers' H&S engagement levels and what skills they need to employ to enhance workers' engagement in general and in the context of H&S behavior and performance. Furthermore, the importance of psychological and sociological factors in safety approaches are highlighted and were found to be key for creating safer workplaces.

Simulation Interventions for the Classroom to Support the Acquisition of Interprofessional Competencies

Interprofessional collaboration (IPC) supports the delivery of quality and safe healthcare. The acquisition of interprofessional competencies both pre-licensure and post-licensure are key to implementing this approach in the healthcare workplace. This report documents the development and implementation of a simulation intervention to support interprofessional education (IPE) in the undergraduate classroom for pre-licensure learners. The learning activity framework includes an exposure phase (e.g., didactic classroom instruction) and an immersion phase (e.g., simulation intervention and debriefing). Details on the debriefing process are included as it is key to achieving the learning objectives. The three learning activity pilot tests (n=150) revealed that learners recognized that interprofessional competencies were an important asset to support IPC. The pilot tests identified the need for further development in order for students to make a connection with the mastery phase (i.e., clinical placement). The next steps will include the development and incorporation of formative tools to assess learners' progress, as well as a plan to evaluate the learning activity that will connect all three phases (exposure, immersion, and mastery) of the learning framework.

Understanding roles in health care through interprofessional educational experiences

Background:

Students can find interacting within a healthcare team challenging. It is important for students to understand their role and respect those of other healthcare team members. Interprofessional education (IPE) is a strategy for exploring the roles of self and others within the team.

Aim:

The purpose of this study was to evaluate nursing students' perceptions of roles and responsibilities following an IPE experience.

Methods:

Students in an undergraduate baccalaureate degree nursing programme participated in a two-day IPE event with students in the physician's assistant's (PA) programme, pharmacy programme, and physical therapy (PT) programme.

Findings:

Self-perception and the perception of others were two main themes that emerged. The results suggested that roles and responsibilities are often misunderstood.

Conclusion:

Educators must be committed to educating our future healthcare workforce on role expectations and responsibilities within an individual's own profession and that of others. This education should start in the foundation stages of each discipline's educational curricula.

Association of Nurse Engagement and Nurse Staffing on Patient Safety

BACKGROUND

Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention.

PURPOSE

Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings.

METHODS

A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety.

RESULTS

Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the least or only somewhat engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% (P < .001). Hospitals where nurses reported higher levels of engagement were 19% (P < .001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients "fell through the cracks" when transferring patients across units (P < .001).

CONCLUSIONS

Interventions to improve nurse engagement and adequate staffing serve as strategies to improve patient safety.

Constructing responsibility in social interaction: an analysis of responsibility talk in hospital administrative groups

The role of responsibility in hospitals is undeniable. Although administrative groups are essential to organizational performance, previous group and team studies of responsibility in hospital organizations have concentrated mainly on healthcare teams. This study aims to describe and understand responsibility construction in the social interaction in hospital administrative group meetings, based on observation and analysis of seven administrative group meetings in a Finnish hospital. Categories generated by thematic content analysis were compared with responsibility types. The findings show that responsibility is constructed by creating co-responsibility, taking individual responsibility, and constructing non-responsibility. Action and role and task responsibilities emerged as types from the interaction. To support employee involvement in responsibility processes, they must also be provided with sufficient resources to deal with that responsibility and to manage its different dimensions. These insights can be utilized to improve administrative groups.

How to improve healthcare? Identify, nurture and embed individuals and teams with "deep smarts"

Purpose Unlocking and transferring skills and capabilities in individuals to the teams they work within, and across, is the key to positive organisational development and improved patient care. Using the "deep smarts" model, the purpose of this paper is to examine these issues. Design/methodology/approach The "deep smarts" model is described, reviewed and proposed as a way of transferring knowledge and capabilities within healthcare organisations. Findings Effective healthcare delivery is achieved through, and continues to require, integrative care involving numerous, dispersed service providers. In the space of overlapping organisational boundaries, there is a need for "deep smarts" people who act as "boundary spanners". These are critical integrative, networking roles employing clinical, organisational and people skills across multiple settings. Research limitations/implications Studies evaluating the barriers and enablers to the application of the deep smarts model and 13 knowledge development strategies proposed are required. Such future research will empirically and contemporary ground our understanding of organisational development in modern complex healthcare settings. Practical implications An organisation with "deep smarts" people - in managerial, auxiliary and clinical positions - has a greater capacity for integration and achieving improved patient-centred care. Originality/value In total, 13 developmental strategies, to transfer individual capabilities into organisational capability, are proposed. These strategies are applicable to different contexts and challenges faced by individuals and teams in complex healthcare organisations.