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Saeed MHB, Raja UB, Khan Y, Gidman J, Niazi M. Interplay between leadership and patient safety in dentistry: a dental hospital-based cross-sectional study. BMJ Open Qual 2024; 13:e002376. [PMID: 38719526 PMCID: PMC11086432 DOI: 10.1136/bmjoq-2023-002376] [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] [Received: 04/18/2023] [Accepted: 12/19/2023] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES The study aimed to study the association of leadership practices and patient safety culture in a dental hospital. DESIGN Hospital-based, cross-sectional study SETTING: Riphah Dental Hospital (RDH), Islamabad, Pakistan. PARTICIPANTS All dentists working at RDH were invited to participate. MAIN OUTCOME MEASURES A questionnaire comprised of the Transformational Leadership Scale (TLS) and the Dental adapted version of the Medical Office Survey of Patient Safety Culture (DMOSOPS) was distributed among the participants. The response rates for each dimension were calculated. The positive responses were added to calculate scores for each of the patient safety and leadership dimensions and the Total Leadership Score (TLS) and total patient safety score (TPSS). Correlational analysis is performed to assess any associations. RESULTS A total of 104 dentists participated in the study. A high positive response was observed on three of the leadership dimensions: inspirational communication (85.25%), intellectual stimulation (86%), and supportive leadership (75.17%). A low positive response was found on the following items: 'acknowledges improvement in my quality of work' (19%) and 'has a clear sense of where he/she wants our unit to be in 5 years' (35.64%). The reported positive responses in the patient safety dimensions were high on three of the patient safety dimensions: organisational learning (78.41%), teamwork (82.91%), and patient care tracking/follow-up (77.05%); and low on work pressure and pace (32.02%). A moderately positive correlation was found between TLS and TPSS (r=0.455, p<0.001). CONCLUSIONS Leadership was found to be associated with patient safety culture in a dental hospital. Leadership training programmes should be incorporated during dental training to prepare future leaders who can inspire a positive patient safety culture.
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Affiliation(s)
- Muhammad Humza Bin Saeed
- Community Dentistry, Riphah International University, Islamabad, Pakistan
- Research, Development & Grants, NHS North Bristol Trust, Bristol, Bristol, UK
| | | | - Yawar Khan
- Riphah International University Faculty of Health and Medical Sciences, Islamabad, Pakistan
| | - Janice Gidman
- University of Chester, Chester, Cheshire West and Chester, UK
| | - Manahil Niazi
- Community Dentistry, Riphah International University, Islamabad, Pakistan
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Eccher A, Malvi D, Novelli L, Mescoli C, D'Errico A. Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In. Clin Pract 2023; 13:610-615. [PMID: 37218806 DOI: 10.3390/clinpract13030055] [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: 03/12/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
Second opinion consultation is a well-established practice in different clinical settings of diagnostic medicine. However, little is known about second opinion consultation activity in transplantation, and even less is known about it concerning donor assessment. The consultations provided by the second opinion service led to the safer and homogeneous management of donors with a history of malignancy or ongoing neoplasm by transplant centers. Indeed, two of the most important aspects are the reduction of semantic differences in cancer reporting and the standardization of procedures, which are mainly due to the different settings and logistics of different pathology services. This article aims to discuss the role and the future of the second opinion in Italy during organ procurement, highlighting the critical issues and areas for improvement.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, 37136 Verona, Italy
- Second Opinion, National Transplant Center, 00161 Rome, Italy
| | - Deborah Malvi
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Novelli
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, 50134 Florence, Italy
| | - Claudia Mescoli
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, 35128 Padua, Italy
| | - Antonietta D'Errico
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Diamant A, Shevchenko A, Johnston D, Quereshy F. Consecutive surgeries with complications: the impact of scheduling decisions. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2023. [DOI: 10.1108/ijopm-07-2022-0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PurposeThe authors determine how the scheduling and sequencing of surgeries by surgeons impacts the rate of post-surgical complications and patient length-of-stay in the hospital.Design/methodology/approachLeveraging a dataset of 29,169 surgeries performed by 111 surgeons from a large hospital network in Ontario, Canada, the authors perform a matched case-control regression analysis. The empirical findings are contextualized by interviews with surgeons from the authors’ dataset.FindingsSurgical complications and longer hospital stays are more likely to occur in technically complex surgeries that follow a similarly complex surgery. The increased complication risk and length-of-hospital-stay is not mitigated by scheduling greater slack time between surgeries nor is it isolated to a few problematic surgery types, surgeons, surgical team configurations or temporal factors such as the timing of surgery within an operating day.Research limitations/implicationsThere are four major limitations: (1) the inability to access data that reveals the cognition behind the behavior of the task performer and then directly links this behavior to quality outcomes; (2) the authors’ definition of task complexity may be too simplistic; (3) the authors’ analysis is predicated on the fact that surgeons in the study are independent contractors with hospital privileges and are responsible for scheduling the patients they operate on rather than outsourcing this responsibility to a scheduler (i.e. either a software system or an administrative professional); (4) although the empirical strategy attempts to control for confounding factors and selection bias in the estimate of the treatment effects, the authors cannot rule out that an unobserved confounder may be driving the results.Practical implicationsThe study demonstrates that the scheduling and sequencing of patients can affect service quality outcomes (i.e. post-surgical complications) and investigates the effect that two operational levers have on performance. In particular, the authors find that introducing additional slack time between surgeries does not reduce the odds of back-to-back complications. This result runs counter to the traditional operations management perspective, which suggests scheduling more slack time between tasks may prevent or mitigate issues as they arise. However, the authors do find evidence suggesting that the risk of back-to-back complications may be reduced when surgical pairings are less complex and when the method involved in performing consecutive surgeries varies. Thus, interspersing procedures of different complexity levels may help to prevent poor quality outcomes.Originality/valueThe authors empirically connect choices made in scheduling work that varies in task complexity and to patient-centric health outcomes. The results have implications for achieving high-quality outcomes in settings where professionals deliver a variety of technically complex services.
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Scott AL, Howe WT, Bisel R. Reviewing High Reliability Team (HRT) Scholarship: A 21st Century Approach to Safety. SMALL GROUP RESEARCH 2022. [DOI: 10.1177/10464964221116349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High reliability team (HRT) theorizing emerged from high reliability organization (HRO) theory and now represents a distinct subset of HRO literature. Seeking to capture the development and range of HRT research, a comprehensive literature review was conducted. This systematic review of HRT scholarship, the first of its kind, provides a foundation from which small group and team scholars across disciplines may reflect on key lessons and chart future research. This review includes 71 articles across 21 disciplines and incorporates historical reflection on HRT theory foundations, existing empirical support, critiques and rivals, theory extensions, and ideas for future scholarship efforts.
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Dreyfus D, Nair A. The impact of operational disruptions on performance in surgical settings: moderating roles of risk management infrastructure and information exchange. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2022. [DOI: 10.1108/ijopm-08-2021-0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDrawing on normal accident and high-reliability organizational theories, this study examines the impact of magnitude and likelihood of disruptions on surgical procedure performance. More importantly, the authors investigate the moderating role played by information exchange and risk management infrastructure in mitigating the negative effect of disruption on performance.Design/methodology/approachA nationwide multi-respondent survey was administered to operating room personnel to collect information on their experiences with disruptions experienced in surgeries. The survey data are analyzed to examine the relationship between operational disruptions and procedure performance. Additionally, the moderating roles of risk management infrastructure and information exchange on the relationship between disruptions and performance are investigated. The results obtained from the empirical analysis are validated using data from an ethnographic investigation of surgeries at a major hospital.FindingsThe results show that both the magnitude and the likelihood of a disruption adversely impact procedure performance. Interestingly, the authors find that risk management infrastructure and information exchange play different roles in mitigating the effect of disruptions on performance. The authors find that while risk management infrastructure helps mitigate the effect of magnitude of service disruptions, information exchange helps reduce the effects of likelihood of disruptions. The findings lend strong support to the theoretical assertions. By means of the participant–observer data collected from over 100 surgeries as part of the ethnographic investigation, the authors validate the key findings. The findings suggest that disruptions are common occurrences in surgical settings, but their performance impact may be lessened or altogether avoided with the proper information and risk management mechanisms in place.Originality/valueThis survey research extends the understanding of risk management by considering a context that is highly prone to disruptions. The authors adopt existing constructs pertaining to supply chain disruptions within this context and find new insights. The findings of the study show differential roles played by information exchange and risk management infrastructure in mitigating disruptions. This nuanced understanding provides directions for aligning efforts towards risk mitigation in surgical settings in a more focused way. This study supplements findings from survey data analysis with an examination of data collected by means of ethnographic investigation.
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Milliren CE, Bailey G, Graham DA, Ozonoff A. Relationships Between Pediatric Safety Indicators Across a National Sample of Pediatric Hospitals: Dispelling the Myth of the "Safest" Hospital. J Patient Saf 2022; 18:e741-e746. [PMID: 35617599 PMCID: PMC9136151 DOI: 10.1097/pts.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There are many measures of healthcare quality, but no obvious summary measures to simplify ranking of hospital performance. With public reporting and accountability for hospital performance, the validity of composite measures for performance rankings has increased importance. This study aimed to explore the covariance of pediatric hospital quality indicators and evaluate the use of a single composite score. METHODS We performed an observational study of pediatric hospital performance across 13 safety indicators extracted from the Pediatric Health Information System, a comparative database of children's hospitals in the United States. We included patients discharged from 36 hospitals from January 1, 2016, to December 31, 2019. Using principal components analysis, we investigate relationships among patient safety measures from the Agency for Healthcare Research and Quality pediatric quality indicators and Center for Medicare and Medicaid Services hospital-acquired conditions. We compare and summarize rankings based on individual safety indicators and calculate alternative composite scores. RESULTS We identified 5 orthogonal variance components accounting for 68% of variation in pediatric hospital quality indicators. Rankings demonstrated greater within-hospital variation compared with between-hospital variation. We observed discordant rankings across commonly used summary measures and conclude that these pediatric safety measures demonstrate at least 2 underlying variance components. CONCLUSIONS This study demonstrates the multifactorial nature of patient safety. This implies no unique ordering of hospitals based on these measures, and thus, no pediatric hospital can claim to be "the safest." This raises further questions about appropriate methods to rank hospitals by safety.
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Affiliation(s)
- Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, United States
| | | | - Dionne A. Graham
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Al Ozonoff
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
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Yilmaz C, Turan AH. THE CAUSES OF OCCUPATIONAL ACCIDENTS IN HUMAN RESOURCES: THE HUMAN FACTORS THEORY AND THE ACCIDENT THEORY PERSPECTIVE. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022; 29:796-805. [PMID: 35635526 DOI: 10.1080/10803548.2022.2082677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Despite many precautions have been taken in our country, the number of occupational accidents elevates continously. In the literature, the causes of accidents caused by human error are usually determined by a single theory base. However, according to the combination theorem; The real causes of occupational accidents can only be found by adopting more than one theory. The main purpose of this study is to evaluate the causes of occupational accidents in human resources with combination of Human Factors and Accident Theory. Methods: We examined 600 occupational accident reports and our data was analyzed with SPSS version 20.0. Results: Five basic dimensions of occupational accidents related to human resources have been determined. Occupational accidents caused by tiredness and inadequacy differ in favor of the fatal accident type, while the others differ in favor of the injury accident type. The dimensions of tiredness and erroneous behavior differ in favor of the cut injury type, while other accidents differ in favor of the fall from height type. Conclusion: In the context of the combination theorem, the most dangerous causes of occupational accidents due to human resources are overload and ergonomic traps. Tiredness, inexperience and inadequacy dimensions are the among the other most dangerous causes.
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Affiliation(s)
- Canan Yilmaz
- Business School, Human Resources Management Department, Sakarya University, Sakarya, Turkey
| | - Aykut H Turan
- Business School, Management Information Systems Department, Sakarya University, Sakarya, Turkey. E-Mail:
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Peters C, Lawton T, Butler M, Waters H, Hughes E. Why is respiratory protective equipment still an issue in the NHS? BMJ 2022; 377:o1082. [PMID: 35477859 DOI: 10.1136/bmj.o1082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Gee JP, Palmer M, Friel BA, Collingridge DS. Challenging tradition: Nurses' attitudes toward single checking of subcutaneous insulin. Nursing 2022; 52:52-57. [PMID: 34979015 DOI: 10.1097/01.nurse.0000803528.94354.6d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Julie Peila Gee
- Julie Peila Gee is a clinical associate professor at the University of Utah's College of Nursing. At Intermountain Healthcare, Maryanne Palmer is a continuous improvement consultant, Beth Ann Friel is a professional practice consultant, and Dave S. Collingridge is a senior research statistician
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Pavithra A. Towards developing a comprehensive conceptual understanding of positive hospital culture and approaches to healthcare organisational culture change in Australia. J Health Organ Manag 2021; ahead-of-print. [PMID: 33837683 DOI: 10.1108/jhom-10-2020-0385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The key aim of this narrative literature review, therefore, is to identify the key conceptual categories that inform the construction of positive person-centred culture within hospitals, and how these frameworks are brought to bear upon organisational culture within healthcare systems in Australia. DESIGN/METHODOLOGY/APPROACH This narrative review presents a thematic synthesis of literature identified through a systematic search protocol undertaken across 19 academic databases and Google Scholar as an additional search tool. Thematic qualitative analysis was performed on the research results to determine the common themes within the diverse literature presented within this study. FINDINGS Culture change interventions in hospitals attempt to address the problem of widespread unprofessional behaviour within healthcare systems. However, diverse definitions and seemingly fragmented approaches to understanding and enacting organisational culture change present a significant hurdle in achieving cohesive and sustainable healthcare reform. This narrative literature review offers a comprehensive conceptual view of the key approaches that inform positive person-centred culture within hospital settings. In total, three primary dimensions, belonging, behaving and being, aligned against organisational goals, individual behaviours and worker as well as organisational identity were identified. Other individual and group interactional dynamics that give rise to negative organisational culture are further analysed to understand the fault lines along which existing culture change interventions are typically operationalised. RESEARCH LIMITATIONS/IMPLICATIONS This review is not exhaustive and is limited in its methodological scope. The central values and themes identified within the literature are integral to designing humanised healthcare systems. However, owing to the qualitative nature and contextual variability of these factors, these themes do not lend themselves to replicable quantification. SOCIAL IMPLICATIONS This analysis contributes to foundational research efforts towards transforming healthcare practice to be more aligned with humanised and equitable values within increasingly complex healthcare organisational settings. Designing culture change interventions that align more suitably with the values-driven categories identified in this literature review may increase the effectiveness and sustainability of these interventions and reform efforts at organisational and systemic levels. ORIGINALITY/VALUE This article presents a comprehensive framework to approach healthcare organisational reform through shared and equitable models of operation, management and governance rather than continuing to promote narrowly defined outcomes derived from commodified models of healthcare practice.
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Affiliation(s)
- Antoinette Pavithra
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Sydney, Australia
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Hedsköld M, Sachs MA, Rosander T, von Knorring M, Pukk Härenstam K. Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work. BMC Health Serv Res 2021; 21:48. [PMID: 33419431 PMCID: PMC7796601 DOI: 10.1186/s12913-020-06042-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Safety culture can be described and understood through its manifestations in the organization as artefacts, espoused values and basic underlying assumptions and is strongly related to leadership-yet it remains elusive as a concept. Even if the literature points to leadership as an important factor for creating and sustaining a mature safety culture, little is known about how the safety work of first line managers' is done and how they balance the different and often conflicting organizational goals in everyday practice. The purpose of this study was to explore how health care first line managers perceive their role and how they promote patient safety and patient safety culture in their units. METHODS Interview study with first line managers in intensive care units in eight different hospitals located in the middle of Sweden. An inductive qualitative content analysis approach was used, this was then followed by a deductive analysis of the strategies informed by constructs from High reliability organizations. RESULTS We present how first line managers view their role in patient safety and exemplify concrete strategies by which managers promote patient safety in everyday work. CONCLUSIONS Our study shows the central role of front-line managers in organizing for safe care and creating a culture for patient safety. Although promoted widely in Swedish healthcare at the time for the interviews, the HSOPSC was not mentioned by the managers as a central source of information on the unit's safety culture.
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Affiliation(s)
- Mats Hedsköld
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Magna Andreen Sachs
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Torleif Rosander
- Department of Anaesthesiology and intensive care, Södersjukhuset, Stockholm Region, Sweden
| | - Mia von Knorring
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Karin Pukk Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Paediatric Emergency Care, Astrid Lindgren's Children's' Hospital, Karolinska University Hospital, Stockholm, Stockholm Region, Sweden.
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Lee K, Yoon K, Yoon B, Shin E. Differences in the perception of harm assessment among nurses in the patient safety classification system. PLoS One 2020; 15:e0243583. [PMID: 33284853 PMCID: PMC7721130 DOI: 10.1371/journal.pone.0243583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background Precise harm assessment by the medical staff is very important in a patient safety event reporting system but there are differences in perception due to insufficiencies in education. Methods We developed the survey tool consisting of nine patient safety incident scenarios to investigate the interrater agreement in the harm score assigning among nurses. The survey tool was distributed to 287 nurses working at two hospitals. Results The overall kappa value for interrater agreement was k = 0.21 for harm and k = 0.28 for harm duration. In nine patient safety event scenarios, such as “mislabeled specimen” or “chest tube drain”, when the degree of harm was not clear, the assessments of harm and harm duration were somewhat dispersed. Conclusion For the quality of the patient safety incident reporting system, the accurate harm assessment of medical personnel is highly important; however, results in this study indicated that theassessment of the degree of harm by Korean nurses was not standardized. The reason for this variability could be due to the lack of education that takes harm assessment into account. Therefore, training in harm assessment and the development of programs to support this training are both necessary.
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Affiliation(s)
- Kwangmi Lee
- Department of Nursing, National Cancer Center, Goyang, Republic of Korea
| | - Kyeongsuk Yoon
- Division of Nursing, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Byeongsook Yoon
- Division of Nursing, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Eunhee Shin
- Department of Nursing Science, Sangji University College of Health Sciences, Wonju, Republic of Korea
- * E-mail:
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Pfeiffer Y, Zimmermann C, Schwappach DLB. What do double-check routines actually detect? An observational assessment and qualitative analysis of identified inconsistencies. BMJ Open 2020; 10:e039291. [PMID: 32948574 PMCID: PMC7500291 DOI: 10.1136/bmjopen-2020-039291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Double checking is used in oncology to detect medication errors before administering chemotherapy. The objectives of the study were to determine the frequency of detected potential medication errors, i.e., mismatching information, and to better understand the nature of these inconsistencies. DESIGN In observing checking procedures, field noteswere taken of all inconsistencies that nurses identified during double checking the order against the prepared chemotherapy. SETTING Oncological wards and ambulatory infusion centres of three Swiss hospitals. PARTICIPANTS Nurses' double checking was observed. OUTCOME MEASURES In a qualitative analysis, (1) a category system for the inconsistencies was developed and (2) independently applied by two researchers. RESULTS In 22 (3.2%) of 690 observed double checks, 28 chemotherapy-related inconsistencies were detected. Half of them related to non-matching information between order and drug label, while the other half was identified because the nurses used their own knowledge. 75% of the inconsistencies could be traced back to inappropriate orders, and the inconsistencies led to 33 subsequent or corrective actions. CONCLUSIONS In double check situations, the plausibility of the medication is often reviewed. Additionally, they serve as a correction for errors and that are made much earlier in the medication process, during order. Both results open up new opportunities for improving the medication process.
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Affiliation(s)
- Yvonne Pfeiffer
- Swiss Patient Safety Foundation, Asylstr, Zurich, Switzerland
| | - Chantal Zimmermann
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Zurich, Switzerland
| | - David L B Schwappach
- Swiss Patient Safety Foundation, Asylstr, Zurich, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Zurich, Switzerland
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Anderson JE, Ross AJ, Macrae C, Wiig S. Defining adaptive capacity in healthcare: A new framework for researching resilient performance. APPLIED ERGONOMICS 2020; 87:103111. [PMID: 32310111 DOI: 10.1016/j.apergo.2020.103111] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 01/06/2020] [Accepted: 04/02/2020] [Indexed: 05/02/2023]
Abstract
Resilience principles show promise for improving the quality of healthcare, but there is a need for further theoretical development to include all levels and scales of activity across the whole healthcare system. Many existing models based on engineering concepts do not adequately address the prominence of social, cultural and organisational factors in healthcare work. Promising theoretical developments include the four resilience potentials, the CARE model and the Moments of Resilience Model, but they are all under specified and in need of further elaboration. This paper presents the Integrated Resilience Attributes Framework in which these three theoretical perspectives are integrated to provide examples of anticipating, responding, monitoring and learning at different scales of time and space. The framework is intended to guide researchers in researching resilience, especially the linkages between resilience at different scales of time and space across the whole healthcare system.
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Affiliation(s)
- J E Anderson
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Centre for Applied Resilience in Healthcare (CARe), King's College London, UK.
| | - A J Ross
- Dental School, School of Medicine, University of Glasgow, UK.
| | - C Macrae
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, UK.
| | - S Wiig
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Norway.
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Westbrook JI, Li L, Raban MZ, Woods A, Koyama AK, Baysari MT, Day RO, McCullagh C, Prgomet M, Mumford V, Dalla-Pozza L, Gazarian M, Gates PJ, Lichtner V, Barclay P, Gardo A, Wiggins M, White L. Associations between double-checking and medication administration errors: a direct observational study of paediatric inpatients. BMJ Qual Saf 2020; 30:320-330. [PMID: 32769177 PMCID: PMC7982937 DOI: 10.1136/bmjqs-2020-011473] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Double-checking the administration of medications has been standard practice in paediatric hospitals around the world for decades. While the practice is widespread, evidence of its effectiveness in reducing errors or harm is scarce. OBJECTIVES To measure the association between double-checking, and the occurrence and potential severity of medication administration errors (MAEs); check duration; and factors associated with double-checking adherence. METHODS Direct observational study of 298 nurses, administering 5140 medication doses to 1523 patients, across nine wards, in a paediatric hospital. Independent observers recorded details of administrations and double-checking (independent; primed-one nurse shares information which may influence the checking nurse; incomplete; or none) in real time during weekdays and weekends between 07:00 and 22:00. Observational medication data were compared with patients' medical records by a reviewer (blinded to checking-status), to identify MAEs. MAEs were rated for potential severity. Observations included administrations where double-checking was mandated, or optional. Multivariable regression examined the association between double-checking, MAEs and potential severity; and factors associated with policy adherence. RESULTS For 3563 administrations double-checking was mandated. Of these, 36 (1·0%) received independent double-checks, 3296 (92·5%) primed and 231 (6·5%) no/incomplete double-checks. For 1577 administrations double-checking was not mandatory, but in 26·3% (n=416) nurses chose to double-check. Where double-checking was mandated there was no significant association between double-checking and MAEs (OR 0·89 (0·65-1·21); p=0·44), or potential MAE severity (OR 0·86 (0·65-1·15); p=0·31). Where double-checking was not mandated, but performed, MAEs were less likely to occur (OR 0·71 (0·54-0·95); p=0·02) and had lower potential severity (OR 0·75 (0·57-0·99); p=0·04). Each double-check took an average of 6·4 min (107 hours/1000 administrations). CONCLUSIONS Compliance with mandated double-checking was very high, but rarely independent. Primed double-checking was highly prevalent but compared with single-checking conferred no benefit in terms of reduced errors or severity. Our findings raise questions about if, when and how double-checking policies deliver safety benefits and warrant the considerable resource investments required in modern clinical settings.
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Affiliation(s)
- Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amanda Woods
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Alain K Koyama
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | - Richard O Day
- St Vincent's Hospital, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Cheryl McCullagh
- Executive, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Mirela Prgomet
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Madlen Gazarian
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Valentina Lichtner
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,School of Pharmacy, University College London, London, UK
| | - Peter Barclay
- Department of Pharmacy, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Alan Gardo
- Nursing Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mark Wiggins
- Department of Pyschology, Macquarie University, Sydney, New South Wales, Australia
| | - Leslie White
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Pfeiffer Y, Zimmermann C, Schwappach DLB. What are we doing when we double check? BMJ Qual Saf 2020; 29:536-540. [PMID: 32071137 DOI: 10.1136/bmjqs-2019-009680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Yvonne Pfeiffer
- Research Department, Patient Safety Foundation, Zurich, Switzerland
| | | | - David L B Schwappach
- Research Department, Patient Safety Foundation, Zurich, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Ibrahim MAM, Osman OB, Ahmed WAM. Assessment of patient safety measures in governmental hospitals in Al-Baha, Saudi Arabia. AIMS Public Health 2020; 6:396-404. [PMID: 31909062 PMCID: PMC6940565 DOI: 10.3934/publichealth.2019.4.396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background/objective There is a need for patient safety in healthcare settings, WHO recommended an intergradation of patient safety in the curriculum of health specialties. This study aimed to assess the application patient safety measures at governmental hospitals in Al-Baha region. Methods This is a descriptive cross-sectional study. It was conducted at Al-Baha governmental hospitals, 2017-2018. The data was collected using a pretested, modified and validated questionnaire, a convenience sampling technique was used among 115 health care providers (doctors and nurses). The collected data was analyzed using SPSS version 22. Results The study showed that most of participants have previous training on patient safety and about 81.7% of them had heard about global aims of patient safety. The level of application of patient safety at Al-Baha governmental hospitals was 106 (92.2%) as very often. The findings showed that there are no significant influencing factors on application of patient safety. Conclusion The application of patient safety in Al-Baha governmental hospitals was very high. There are no significant influencing factors for the application status of patient safety measures in Al-Baha governmental hospitals.
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Affiliation(s)
| | - Osman Babiker Osman
- Public Health Department, Faculty of Applied Medical Sciences, Albaha University, Saudi Arabia
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18
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19
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20
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Jafari H, Raeisi AR, Yarmohammadian MH, Heidari M, Niknam N. Developing and validating a checklist for accreditation in leadership and management of hospitals in Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2018; 7:136. [PMID: 30505864 PMCID: PMC6225389 DOI: 10.4103/jehp.jehp_54_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/29/2018] [Indexed: 06/02/2023]
Abstract
INTRODUCTION In the Iranian Accreditation System, leadership and management standards have been almost ignored and not paid enough and necessary attention to the structural components and the infrastructures standards in management and leadership sections. Governing body, medical staff, chief executive officer (CEO), and nursing management standards are inadequate and lack accountability. These standards could lead to reform and finally provide the context for accomplishment of an appropriate accreditation program. MATERIALS AND METHODS This is a descriptive, comparative, and qualitative study. It was done in two phases. The first phase included literature review of the standards of the selected countries followed by comparison of the standards of the board of trustees, medical staff, CEOs, and nursing management standards to develop the primary framework for Iranian hospitals. In phase two, the primary framework was validated true three rounds of Delphi technique. RESULTS Surveying the accreditation system standards in selected countries included the USA, Egypt, Malaysia, and Iran. It was found that the management and leadership standards were classify as governing body, medical staff, CEOs, and nursing management standards. The result of this study provides a framework for improvement of the Iranian national accreditation program. CONCLUSION In regarded to the importance of the leadership and management standards in reform and change and promotion of the health services quality, efficiency, and effectiveness, the results of this study showed that the present standards of the Iranian accreditation assessment system and guidelines lack the necessary infrastructures for implementing a successful national accreditation program.
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Affiliation(s)
- Hamid Jafari
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Health Services Management, School of Health Management and Information, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Raeisi
- Health Management and Economic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohammad Heidari
- Department of Medical and Surgical, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Noureddin Niknam
- Department of Health Services Management, School of Health Management and Information, Iran University of Medical Sciences, Tehran, Iran
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21
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Zadeh SE, Haussmann R, Barton CD. Health care risk managers' consensus on the management of inappropriate behaviors among hospital staff. J Healthc Risk Manag 2018; 38:32-42. [PMID: 30136752 DOI: 10.1002/jhrm.21349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Medical errors are the third-leading cause of death in the United States. One of the problems is timely recognition and management of inappropriate health care worker behaviors that lead to intimidation and loss of staff focus, eventually leading to errors. The purpose of this qualitative modified Delphi study was to seek consensus among a panel of experts in hospital risk management practices on the practical methods for early detection of inappropriate behaviors among hospital staff, which may be used by hospital managers to considerably mitigate the risk of medical mishaps. High reliability theory guided the research process, utilizing the conceptual framework of the fair and just culture patient safety model. A single research question asked what level of consensus exists among hospital risk management experts as to the practical methods for early detection of inappropriate behavior among hospital staff, which managers may use to ultimately mitigate the risk of preventable medical mishaps. This study included nonprobability purposive sampling (n = 34) and three rounds of questionnaires. Consensus was reached on 8 factors: setting expectations, developing a culture of respect, holding staff accountable, enforcing a zero-tolerance policy, confidentiality of reporting, communicating expected behavior, open communication, and investigating inappropriate behaviors.
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22
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Hallam C, Jackson T, Rajgopal A, Russell B. Establishing catheter-related bloodstream infection surveillance to drive improvement. J Infect Prev 2018; 19:160-166. [PMID: 30013620 PMCID: PMC6039910 DOI: 10.1177/1757177418767759] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 02/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Catheter-related blood stream infections (CRBSI) are an important complication of central venous access devices but are often poorly measured. This article describes the journey of one hospital trust to set up a surveillance process for CRBSI across all specialties of the trust and to reduce CRBSI. METHOD Using a locally adapted CRBSI criteria and root cause analysis (RCA) for investigation we identified a number of opportunities for a quality improvement programme. FINDINGS Over a 5-year period we saw a significant and sustained reduction in the rate of CRBSI from 5 per 1000 catheter days to 0.23 per 1000 catheter days. CONCLUSIONS The surveillance enabled rates of CRBSI to be monitored across the trust and the success of our improvements to be measured.
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Affiliation(s)
- Carole Hallam
- Calderdale and Huddersfield NHS Foundation Trust,
Lindley, Huddersfield, UK
| | - Tim Jackson
- Calderdale and Huddersfield NHS Foundation Trust,
Lindley, Huddersfield, UK
| | - Anu Rajgopal
- Calderdale and Huddersfield NHS Foundation Trust,
Lindley, Huddersfield, UK
| | - Belinda Russell
- Calderdale and Huddersfield NHS Foundation Trust,
Lindley, Huddersfield, UK
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MOUSAVI SMH, JABBARVAND BEHROUZ M, ZERATI H, DARGAHI H, ASADOLLAHI A, MOUSAVI SA, ASHRAFI E, ALIYARI A. Assessment of High Reliability Organizations Model in Farabi Eye Hospital, Tehran, Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:77-85. [PMID: 29318121 PMCID: PMC5756604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A high-reliability organization (HRO) is a separate paradigm can indicate medical error reduction and patient safety improvement. Hospitals, as vital organizations in the health care system, can transform to HROs to achieve optimal performance and maximum safety in order to manage unpredicted events efficiently. Therefore, the aim of this research was to determine the knowledge of managers and staffs of Farabi Eye Hospital, Tehran, Iran about HROs model, and the extent of HROs establishment in this hospital in 2015-2016. METHODS In this descriptive-analytical and cross-sectional study, data were collected through HROs questionnaire and checklist. Validity of questionnaire and checklist was confirmed by expert panel, and the questionnaire reliability by Alpha-Cronbach method with 0.85. The collected data were analyzed with Spearman's correlation coefficient and Mann-Whitney test using the SPSS software version 19. RESULTS Most of the respondents were familiar with HROs model to some extent and only 18.8% had a high level of knowledge in this regard. In addition, there was no significant correlation between the knowledge of staffs and managers with establishment of HROs model in Farabi eye hospital. CONCLUSION Managers and staffs of Farabi Eye Hospital did not have a high knowledge level of the model of HROs and had little information about the functions and characteristics of these organizations. Therefore, we suggest HROs training courses and workshops should be established in this hospital to increase the knowledge of the managers and staffs for better establishment of HROs model.
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Affiliation(s)
| | | | - Hojjat ZERATI
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein DARGAHI
- Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Akram ASADOLLAHI
- Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad MOUSAVI
- Deputy of Planning and Development of Resources, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham ASHRAFI
- Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl ALIYARI
- Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Henriksen K, Dymek C, Harrison MI, Brady PJ, Arnold SB. Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on improving diagnosis: a proceedings review. Diagnosis (Berl) 2017. [DOI: 10.1515/dx-2017-0016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractBackground:TheContent:The goals of the summit were to learn from the insights of participants; examine issues associated with definitions of diagnostic error and gaps in the evidence base; explore clinician and patient perspectives; gain a better understanding of data and measurement, health information technology, and organizational factors that impact the diagnostic process; and identify potential future directions for research.Summary and outlook:Plenary sessions focused on the state of the new diagnostic safety discipline followed by breakout sessions on the use of data and measurement, health information technology, and the role of organizational factors. The proceedings review captures many of the key challenges and areas deserving further research, revealing stimulating yet complex issues.
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25
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FOCUS ON SAFETY, THEN QUALITY. Gastroenterol Nurs 2017; 39:429-430. [PMID: 27922513 DOI: 10.1097/sga.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Silla I, Navajas J, Koves GK. Organizational culture and a safety-conscious work environment: The mediating role of employee communication satisfaction. JOURNAL OF SAFETY RESEARCH 2017; 61:121-127. [PMID: 28454857 DOI: 10.1016/j.jsr.2017.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/22/2016] [Accepted: 02/16/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION A safety-conscious work environment allows high-reliability organizations to be proactive regarding safety and enables employees to feel free to report any concern without fear of retaliation. Currently, research on the antecedents to safety-conscious work environments is scarce. METHOD Structural equation modeling was applied to test the mediating role of employee communication satisfaction in the relationship between constructive culture and a safety-conscious work environment in several nuclear power plants. RESULTS Employee communication satisfaction partially mediated the positive relationships between a constructive culture and a safety-conscious work environment. CONCLUSIONS Constructive cultures in which cooperation, supportive relationships, individual growth and high performance are encouraged facilitate the establishment of a safety-conscious work environment. This influence is partially explained by increased employee communication satisfaction. PRACTICAL APPLICATION Constructive cultures should be encouraged within organizations. In addition, managers should promote communication policies and practices that support a safety-conscious work environment.
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Affiliation(s)
- Inmaculada Silla
- CIEMAT-CISOT (Sociotechnical Research Institute), Gran Via de las Cortes Catalanas, 604, 4, 2, Barcelona 08007, Spain.
| | - Joaquin Navajas
- CIEMAT-CISOT (Sociotechnical Research Institute), Gran Via de las Cortes Catalanas, 604, 4, 2, Barcelona 08007, Spain.
| | - G Kenneth Koves
- Institute of Nuclear Power Operations (INPO), 700 Galleria Parkway, SE, Atlanta, GA 30339-5943, United States.
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Cross R, Bennett PN, Ockerby C, Wang WC, Currey J. Nurses' Attitudes Toward the Single Checking of Medications. Worldviews Evid Based Nurs 2017; 14:274-281. [PMID: 28437836 DOI: 10.1111/wvn.12201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The policy of single over double checking of medications has been adopted by many health services; however, nurses' attitudes toward single-checking medications remains unclear. The aim of this study was to explore the attitudes of nurses who single check and administer medications in a setting where single checking has been in place for over a decade. METHODS A cross-sectional survey design using the validated Single Checking Administration Medication Scale-II to registered nurses (n = 299) working in one metropolitan teaching hospital in Victoria, Australia. Descriptive analyses for participants' demographics were examined and confirmatory factor analysis (CFA) was performed on the survey items to represent the main themes of nurses' attitudes toward single checking. RESULTS Nurses reported single checking allowed a greater accountability as a professional nurse and more control over drug administration. The efficiency of single checking was welcomed by nurses through reductions in administration time and workplace interruptions. Nurses were more likely to adhere to drug administration procedures when single checking and this process facilitated drug knowledge updates. There was significant variance in attitudes amongst nurses based upon current appointment and years of clinical experience. Free text responses indicated nurses' attitudes were situated in the context of the traditional double-checking system. LINKING EVIDENCE TO ACTION Understanding nurses' attitudes toward single checking may assist health care services to positively address medication safety. Accountability, efficiency and knowledge are important for nurses when administering medications. Nurses' attitudes are varied when correlated with demographic characteristics.
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Affiliation(s)
- Rachel Cross
- Lecturer, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Paul N Bennett
- Honorary Professor, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Research Director, Pediatric Hospital Medicine, Stanford University, Stanford, CA, USA.,Director, Medical and Clinical Affairs, Satellite Healthcare, San Jose, CA, USA
| | - Cherene Ockerby
- Monash Medical Centre, Deakin University & Monash Health Partnership Centre for Nursing Research, Victoria, Australia
| | - Wei Chun Wang
- Research Fellow, Western Health Centre for Nursing Research, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Judy Currey
- Director of Postgraduate Studies, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Duclos A, Peix JL, Piriou V, Occelli P, Denis A, Bourdy S, Carty MJ, Gawande AA, Debouck F, Vacca C, Lifante JC, Colin C, Aegerter P, Aouifi A, Arickx D, Aubart F, Baudrin D, Berry WR, Beuvry C, Bonnet F, Bouveret L, Cabarrot P, Cames E, Carty MJ, Caton J, Chenitz MC, Clergues F, Colin C, Coudray JM, Damiens M, Dauzac C, Debono B, Debouck F, De Germay B, Deleforterie AC, Denis A, Desrousseaux JF, Didelot MP, Doat B, Domingo-Saidji NY, Duclos A, Durieux P, Fessy M, Hardy P, Cariven P, Fontas N, Ganansia P, Gawande AA, Giraud F, Gostiaux G, Habi S, Haga S, Houlgatte A, Jaffe M, Jourdan J, Kaczmarek N, Lamblin S, Level C, Liaras E, Lifante JC, Lipsitz SR, Majchrzak C, Malavaud B, Serres TM, Martin X, Martinet C, Maupetit B, Michel P, Movondo A, Naamani B, Nacry R, Occelli P, Olousouzian S, Papin P, Paquet JC, Parfaite A, Pattou F, Paugam C, Pavy E, Peix JL, Petit H, Pierre S, Piriou V, Poupon Bourdy S, Pradere B, Quesne M, Radola Y, Raould A, Rongieras F, Rouquette I, Sanders V, Sanz F, Sens F, Surmont S, Sicre C, Tabur D, Targosz P, Thery D, Toppan N, Usandizaga G, Vacca C, Verheyde I, Zadegan F. Cluster randomized trial to evaluate the impact of team training on surgical outcomes. Br J Surg 2016; 103:1804-1814. [DOI: 10.1002/bjs.10295] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/07/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation.
Methods
A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals.
Results
Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals.
Conclusion
Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).
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Affiliation(s)
- A Duclos
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - J L Peix
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - V Piriou
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service d'Anesthésie Réanimation Médicale et Chirurgicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - P Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | - A Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - S Bourdy
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - M J Carty
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - A A Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
- Ariadne Labs and Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - F Debouck
- Air France Consulting, AFM42, Chambourcy, France
| | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes, Lyon, France
| | - J C Lifante
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - C Colin
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | | | | | | | | | - D Baudrin
- Agence Régional de Santé de Toulouse
| | | | | | - F Bonnet
- Assistance Publique-Hôpitaux de Paris
| | | | | | - E Cames
- Centre Hospitalier Universitaire de Toulouse
| | - M J Carty
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Caton
- Clinique Emile Vialar de Lyon
| | | | | | | | | | | | - C Dauzac
- Assistance Publique-Hôpitaux de Paris
| | - B Debono
- Clinique des Cèdres de Cornebarrieu
| | | | | | | | | | | | | | | | | | | | - P Durieux
- Assistance Publique-Hôpitaux de Paris
| | | | - P Hardy
- Assistance Publique-Hôpitaux de Paris
| | | | - N Fontas
- Centre Hospitalier Universitaire de Toulouse
| | | | - A A Gawande
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - S Habi
- Centre Hospitalier de Vienne
| | - S Haga
- Infirmerie Protestante de Lyon
| | - A Houlgatte
- Hôpital d'Instruction des Armées du Val de Grâce
| | - M Jaffe
- Clinique Ambroise Paré de Toulouse
| | | | | | | | - C Level
- Assistance Publique-Hôpitaux de Paris
| | - E Liaras
- Hôpital Privé de Natécia de Lyon
| | | | - S R Lipsitz
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - B Malavaud
- Centre Hospitalier Régional Universitaire de Toulouse
| | | | | | | | | | | | | | | | | | | | | | - P Papin
- Centre Hospitalier de Villefranche sur Saône
| | | | | | - F Pattou
- Centre Hospitalier Régional Universitaire de Lille
| | - C Paugam
- Assistance Publique-Hôpitaux de Paris
| | - E Pavy
- Hôpital Simone Veil d'Eaubonne
| | | | | | - S Pierre
- Institut Claudius Régaud de Toulouse
| | | | | | - B Pradere
- Centre Hospitalier Régional Universitaire de Lille
| | | | - Y Radola
- Centre Hospitalier Régional Universitaire de Lille
| | - A Raould
- Assistance Publique-Hôpitaux de Paris
| | - F Rongieras
- Hôpital d'Instruction des Armées Desgenettes de Lyon
| | | | - V Sanders
- Centre Hospitalier Régional Universitaire de Lille
| | - F Sanz
- Centre Hospitalier Régional Universitaire de Lille
| | | | | | | | | | | | - D Thery
- Institut Catholique de Lille
| | - N Toppan
- Clinique de l'Union de Saint Jean
| | | | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes de Lyon
| | | | - F Zadegan
- Assistance Publique-Hôpitaux de Paris
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Gong Y, Hua L, Wang S. Leveraging user's performance in reporting patient safety events by utilizing text prediction in narrative data entry. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 131:181-189. [PMID: 27265058 PMCID: PMC4899837 DOI: 10.1016/j.cmpb.2016.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 03/16/2016] [Accepted: 03/31/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Narrative data entry pervades computerized health information systems and serves as a key component in collecting patient-related information in electronic health records and patient safety event reporting systems. The quality and efficiency of clinical data entry are critical in arriving at an optimal diagnosis and treatment. The application of text prediction holds potential for enhancing human performance of data entry in reporting patient safety events. OBJECTIVE This study examined two functions of text prediction intended for increasing efficiency and data quality of text data entry reporting patient safety events. METHODS The study employed a two-group randomized design with 52 nurses. The nurses were randomly assigned into a treatment group or a control group with a task of reporting five patient fall cases in Chinese using a web-based test system, with or without the prediction functions. T-test, Chi-square and linear regression model were applied to evaluating the outcome differences in free-text data entry between the groups. RESULTS While both groups of participants exhibited a good capacity for accomplishing the assigned task of reporting patient falls, the results from the treatment group showed an overall increase of 70.5% in text generation rate, an increase of 34.1% in reporting comprehensiveness score and a reduction of 14.5% in the non-adherence of the comment fields. The treatment group also showed an increasing text generation rate over time, whereas no such an effect was observed in the control group. CONCLUSION As an attempt investigating the effectiveness of text prediction functions in reporting patient safety events, the study findings proved an effective strategy for assisting reporters in generating complementary free text when reporting a patient safety event. The application of the strategy may be effective in other clinical areas when free text entries are required.
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Affiliation(s)
- Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.
| | - Lei Hua
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA; Informatics Institute, University of Missouri, Columbia, MO, USA
| | - Shen Wang
- Department of Nursing, Tianjin First Central Hospital, Tianjin, China
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Schwappach DLB, Pfeiffer Y, Taxis K. Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences. BMJ Open 2016; 6:e011394. [PMID: 27297014 PMCID: PMC4916573 DOI: 10.1136/bmjopen-2016-011394] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Double-checking is widely recommended as an essential method to prevent medication errors. However, prior research has shown that the concept of double-checking is not clearly defined, and that little is known about actual practice in oncology, for example, what kind of checking procedures are applied. OBJECTIVE To study the practice of different double-checking procedures in chemotherapy administration and to explore nurses' experiences, for example, how often they actually find errors using a certain procedure. General evaluations regarding double-checking, for example, frequency of interruptions during and caused by a check, or what is regarded as its essential feature was assessed. METHODS In a cross-sectional survey, qualified nurses working in oncology departments of 3 hospitals were asked to rate 5 different scenarios of double-checking procedures regarding dimensions such as frequency of use in practice and appropriateness to prevent medication errors; they were also asked general questions about double-checking. RESULTS Overall, 274 nurses (70% response rate) participated in the survey. The procedure of jointly double-checking (read-read back) was most commonly used (69% of respondents) and rated as very appropriate to prevent medication errors. Jointly checking medication was seen as the essential characteristic of double-checking-more frequently than 'carrying out checks independently' (54% vs 24%). Most nurses (78%) found the frequency of double-checking in their department appropriate. Being interrupted in one's own current activity for supporting a double-check was reported to occur frequently. Regression analysis revealed a strong preference towards checks that are currently implemented at the responders' workplace. CONCLUSIONS Double-checking is well regarded by oncology nurses as a procedure to help prevent errors, with jointly checking being used most frequently. Our results show that the notion of independent checking needs to be transferred more actively into clinical practice. The high frequency of reported interruptions during and caused by double-checks is of concern.
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Affiliation(s)
- D L B Schwappach
- Swiss Patient Safety Foundation, Zuerich, Switzerland Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Katja Taxis
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands
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Abstract
RATIONALE, AIMS AND OBJECTIVES Double checking is a standard practice in many areas of health care, notwithstanding the lack of evidence supporting its efficacy. We ask in this study: 'How do front line practitioners conceptualize double checking? What are the weaknesses of double checking? What alternate views of double checking could render it a more robust process?' METHOD This is part of a larger qualitative study based on 85 semi-structured interviews of health care practitioners in general internal medicine and obstetrics and neonatology; thematic analysis of the transcribed interviews was undertaken. Inductive and deductive themes are reported. RESULTS Weaknesses in the double checking process include inconsistent conceptualization of double checking, double (or more) checking as a costly and time-consuming procedure, double checking trusted as an accepted and stand-alone process, and double checking as preventing reporting of near misses. Alternate views of double checking that would render it a more robust process include recognizing that double checking requires training and a dedicated environment, Introducing automated double checking, and expanding double checking beyond error detection. These results are linked with the concepts of collective efficiency thoroughness trade off (ETTO), an in-family approach, and resilience. CONCLUSION(S) Double checking deserves more questioning, as there are limitations to the process. Practitioners could view double checking through alternate lenses, and thus help strengthen this ubiquitous practice that is rarely challenged.
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Affiliation(s)
- Tanya Hewitt
- Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Forster
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Affiliation(s)
- Ray Samuriwo
- RGN Lecturer, School of Healthcare Sciences, Cardiff University, Cardiff, UK.,RGN Lecturer, Cardiff Institute of Tissue Engineering and Repair (CITER), Cardiff University, Cardiff, UK.,RGN Lecturer, Visiting Research Fellow School of Healthcare University of Leeds, Leeds UK
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Cross R, Bennett PN, Ockerby C, Busija L, Currey J. Psychometric Properties of a Tool to Measure Nurses' Attitudes to Single Checking Medications: SCAMS-II. Worldviews Evid Based Nurs 2015; 12:337-47. [PMID: 26460515 DOI: 10.1111/wvn.12115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Single checking medications has been increasingly adopted over the past decade by nurses in Australian healthcare services. However, attitudes toward the practice of only one nurse checking medications remain unclear. The aim of this article is to report on the development, reliability, and validity of a tool to measure nurses' attitudes to single checking medications in a health service in which single checking has been in place for over a decade. METHODS In a cross-sectional survey design, the Single Checking and Administration of Medications Scale (SCAMS-II) was used to measure the attitudes of 299 registered nurses (RNs) who were single checking medications in one metropolitan teaching hospital in Australia. Exploratory factor analysis was used to explore the dimensions that best represented the SCAMS-II. Cronbach's α was used to assess internal consistency of the identified subscales. To test the construct validity of the emergent questionnaire, Confirmatory Factor Analysis and Rasch analyses were performed. RESULTS The psychometric properties of the SCAMS-II revealed 12 items with three reliable subscales: a five-item accountability model; a four-item efficiency model; and a three-item knowledge model. LINKING EVIDENCE TO ACTION In settings where single checking is current practice, the SCAMS-II is recommended as a reliable tool to measure nurses' attitudes toward the single checking of medications. The findings from this study may assist healthcare organizations in the development of policy and procedure guidelines for the safe administration of medications.
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Affiliation(s)
- Rachel Cross
- Lecturer Practitioner, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Paul N Bennett
- Professor, Chair in Translational Nursing, Western Health Centre for Nursing Research, Deakin University and School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Cherene Ockerby
- Research Assistant, Centre for Nursing Research, Deakin University and Monash Health Partnership, Victoria, Australia
| | - Lucy Busija
- Senior Biostatistician, Institute for Health and Aging Research, Australian Catholic University Melbourne, Australia
| | - Judy Currey
- Associate Professor, Director of Postgraduate Studies, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Taylor V, Middleton-Green L, Carding S, Perkins P. Hospice nurses' views on single nurse administration of controlled drugs. Int J Palliat Nurs 2015. [PMID: 26203951 DOI: 10.12968/ijpn.2015.21.7.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The involvement of two nurses to dispense and administer controlled drugs is routine practice in most clinical areas despite there being no legal or evidence-based rationale. Indeed, evidence suggests this practice enhances neither safety nor care. Registered nurses at two hospices agreed to change practice to single nurse dispensing and administration of controlled drugs (SNAD). Participants' views on SNAD were evaluated before and after implementation. The aim of this study was to explore the views and experiences of nurses who had implemented SNAD and to identify the views and concerns of those who had not yet experienced SNAD. METHOD Data was obtained through semi-structured interviews. RESULTS Qualitative thematic analysis of interview transcripts identified three key themes: practice to enhance patient benefit and care; practice to enhance nursing care and satisfaction; and practice to enhance organisational safety. CONCLUSION The findings have implications for the understanding of influences on medicines safety in clinical practice and for hospice policy makers.
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Affiliation(s)
- Vanessa Taylor
- Senior Lecturer, School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | | | - Sally Carding
- Specialist Registrar in Palliative Medicine, Sue Ryder St John's Hospice, Moggerhanger, Bedford
| | - Paul Perkins
- Consultant in Palliative Medicine, Sue Ryder Leckhampton Court Hospice, Cheltenham
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Duffield S, Whitty SJ. Developing a systemic lessons learned knowledge model for organisational learning through projects. INTERNATIONAL JOURNAL OF PROJECT MANAGEMENT 2015. [DOI: 10.1016/j.ijproman.2014.07.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Verbeek-van Noord I, de Bruijne MC, Twisk JWR, van Dyck C, Wagner C. More explicit communication after classroom-based crew resource management training: results of a pragmatic trial. J Eval Clin Pract 2015; 21:137-44. [PMID: 25314899 DOI: 10.1111/jep.12261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Aviation-based crew resource management trainings to optimize non-technical skills among professionals are often suggested for health care as a way to increase patient safety. Our aim was to evaluate the effect of a 2-day classroom-based crew resource management (CRM) training at emergency departments (EDs) on explicit professional oral communication (EPOC; non-technical skills). METHOD A pragmatic controlled before-after trial was conducted. Four EDs of general teaching hospitals were recruited (two intervention and two control departments). ED nurses and ED doctors were observed on their non-technical skills by means of a validated observation tool (EPOC). Our main outcome measure was the amount of EPOC observed per interaction in 30 minutes direct observations. Three outcome measures from EPOC were analysed: human interaction, anticipation on environment and an overall EPOC score. Linear and logistic mixed model analyses were performed. Models were corrected for the outcome measurement at baseline, days between training and observation, patient safety culture and error management culture at baseline. RESULTS A statistically significant increase after the training was found on human interaction (β=0.27, 95% CI 0.08-0.49) and the overall EPOC score (β=0.25, 95% CI 0.06-0.43), but not for anticipation on environment (OR=1.19, 95% CI .45-3.15). This means that approximately 25% more explicit communication was shown after CRM training. CONCLUSIONS We found an increase in the use of CRM skills after classroom-based crew resource management training. This study adds to the body of evidence that CRM trainings have the potential to increase patient safety by reducing communication flaws, which play an important role in health care-related adverse events.
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Affiliation(s)
- Inge Verbeek-van Noord
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Montassier E, Labady J, Andre A, Potel G, Berthier F, Jenvrin J, Penverne Y. The effect of work shift configurations on emergency medical dispatch center response. PREHOSP EMERG CARE 2014; 19:254-9. [PMID: 25295382 DOI: 10.3109/10903127.2014.959217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE It has been proved that emergency medical dispatch centers (EMDC) save lives by promoting an appropriate allocation of emergency medical service resources. Indeed, optimal dispatcher call duration is pivotal to reduce the time gap between the time a call is placed and the delivery of medical care. However, little is known about the impact of work shift configurations (i.e., work shift duration and work shift rotation throughout the day) and dispatcher call duration. Thus, the objective of our study was to assess the effect of work shift configurations on dispatcher call duration. METHODS During a 1-year study period, we analyzed the dispatcher call durations for medical and trauma calls during the 4 different work shift rotations (day, morning, evening, and night) and during the 10-hour work shift of each dispatcher in the EMDC of Nantes. We extracted dispatcher call durations from our advanced telephone system, configured with CC Pulse + (Genesys, Alcatel Lucent), and collected them in a custom designed database (Excel, Microsoft). Afterward, we analyzed these data using linear mixed effects models. RESULTS During the study period, our EMDC received 408,077 calls. Globally, the mean dispatcher call duration was 107 ± 45 seconds. Based on multivariate linear mixed effects models, the dispatcher call duration was affected by night work shift and work shift duration greater than 8 hours, increasing it by about 10 ± 1 seconds and 4 ± 1 seconds, respectively (both p < 0.001). CONCLUSION Our study showed that there was a statistically significant difference in dispatcher call duration over work shift rotation and duration, with longer durations seen over night shifts and shifts over 8 hours. While these differences are small and may not have clinical significance, they may have implications for EMDC efficiency.
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Abecassis ZA, McElroy LM, Patel RM, Khorzad R, Carroll C, Mehrotra S. Applying fault tree analysis to the prevention of wrong-site surgery. J Surg Res 2014; 193:88-94. [PMID: 25277361 DOI: 10.1016/j.jss.2014.08.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/15/2014] [Accepted: 08/28/2014] [Indexed: 11/30/2022]
Abstract
Wrong-site surgery (WSS) is a rare event that occurs to hundreds of patients each year. Despite national implementation of the Universal Protocol over the past decade, development of effective interventions remains a challenge. We performed a systematic review of the literature reporting root causes of WSS and used the results to perform a fault tree analysis to assess the reliability of the system in preventing WSS and identifying high-priority targets for interventions aimed at reducing WSS. Process components where a single error could result in WSS were labeled with OR gates; process aspects reinforced by verification were labeled with AND gates. The overall redundancy of the system was evaluated based on prevalence of AND gates and OR gates. In total, 37 studies described risk factors for WSS. The fault tree contains 35 faults, most of which fall into five main categories. Despite the Universal Protocol mandating patient verification, surgical site signing, and a brief time-out, a large proportion of the process relies on human transcription and verification. Fault tree analysis provides a standardized perspective of errors or faults within the system of surgical scheduling and site confirmation. It can be adapted by institutions or specialties to lead to more targeted interventions to increase redundancy and reliability within the preoperative process.
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Affiliation(s)
- Zachary A Abecassis
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Lisa M McElroy
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ronak M Patel
- Division of Sports Medicine, Illinois Bone and Joint Institute, LLC, Morton Grove, Illinois
| | - Rebeca Khorzad
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Charles Carroll
- Department of Orthopaedic Surgery, NOI NorthShore Orthopedics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sanjay Mehrotra
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Waring J, Marshall F, Bishop S, Sahota O, Walker M, Currie G, Fisher R, Avery T. An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02290] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundHospital discharge is a vulnerable stage in the patient pathway. Research highlights communication failures and the problems of co-ordination as resulting in delayed, poorly timed and unsafe discharges. The complexity of hospital discharge exemplifies the threats to patient safety found ‘between’ care processes and organisations. In developing this perspective, safe discharge is seen as relying upon enhanced knowledge sharing and collaboration between stakeholders, which can mitigate system complexity and promote safety.AimTo identify interventions and practices that support knowledge sharing and collaboration in the processes of discharge planning and care transition.SettingThe study was undertaken between 2011 and 2013 in two English health-care systems, each comprising an acute health-care provider, community and primary care providers, local authority social services and social care agencies. The study sites were selected to reflect known variations in local population demographics as well as in the size and composition of the care systems. The study compared the experiences of stroke and hip fracture patients as exemplars of acute care with complex discharge pathways.DesignThe study involved in-depth ethnographic research in the two sites. This combined (a) over 180 hours of observations of discharge processes and knowledge-sharing activities in various care settings; (b) focused ‘patient tracking’ to trace and understand discharge activities across the entire patient journey; and (c) qualitative interviews with 169 individuals working in health, social and voluntary care sectors.FindingsThe study reinforces the view of hospital discharge as a complex system involving dynamic and multidirectional patterns of knowledge sharing between multiple groups. The study shows that discharge planning and care transitions develop through a series of linked ‘situations’ or opportunities for knowledge sharing. It also shows variations in these situations, in terms of the range of actors, forms of knowledge shared, and media and resources used, and the wider culture and organisation of discharge. The study also describes the threats to patient safety associated with hospital discharge, as perceived by participants and stakeholders. These related to falls, medicines, infection, clinical procedures, equipment, timing and scheduling of discharge, and communication. Each of these identified risks are analysed and explained with reference to the observed patterns of knowledge sharing to elaborate how variations in knowledge sharing can hinder or promote safe discharge.ConclusionsThe study supports the view of hospital discharge as a complex system involving tightly coupled and interdependent patterns of interaction between multiple health and social care agencies. Knowledge sharing can help to mitigate system complexity through supporting collaboration and co-ordination. The study suggests four areas of change that might enhance knowledge sharing, reduce system complexity and promote safety. First, knowledge brokers in the form of discharge co-ordinators can facilitate knowledge sharing and co-ordination; second, colocation and functional proximity of stakeholders can support knowledge sharing and mutual appreciation and alignment of divergent practices; third, local cultures should prioritise and value collaboration; and finally, organisational resources, procedures and leadership should be aligned to fostering knowledge sharing and collaborative working. These learning points provide insight for future interventions to enhance discharge planning and care transition. Future research might consider the implementation of interviews to mediate system complexity through fostering enhanced knowledge sharing across occupational and organisational boundaries. Research might also consider in more detail the underlying complexity of both health and social care systems and how opportunities for knowledge sharing might be engendered to promote patient safety in other areas.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Justin Waring
- Centre for Heath Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Fiona Marshall
- Centre for Heath Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Simon Bishop
- Centre for Heath Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Opinder Sahota
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Marion Walker
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | - Rebecca Fisher
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Tony Avery
- Community Health Sciences, University of Nottingham, Nottingham, UK
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Cure L, Zayas-Castro J, Fabri P. Challenges and opportunities in the analysis of risk in healthcare. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/19488300.2014.911786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Erler C, Edwards NE, Ritchey S, Pesut DJ, Sands L, Wu J. Perceived patient safety culture in a critical care transport program. Air Med J 2014; 32:208-15. [PMID: 23816215 DOI: 10.1016/j.amj.2012.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/25/2012] [Accepted: 11/09/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to examine the association among selected safety culture dimensions and safety outcomes in the context of a critical care transport (CCT) program. METHODS A descriptive cross-sectional correlational design used the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture to validate perceived safety culture among personnel (n = 76) in a large Midwestern CCT program. RESULTS Findings revealed significant associations between 1) teamwork and frequency of error reporting (r = .428, P < .001), overall perception of safety (r = .745, P < .001), and perceived patient safety grade (r = -.681, P < .001); 2) between perception of manager actions promoting safety and frequency of error reporting (r = .521, P < .001), overall perception of safety (r = .779, P < .001), and perceived patient safety grade (r = -.756, P < .001); and 3) between communication openness and frequency of error reporting (r = .575, P < .001), overall perception of safety (r = .588, P < .001), and perceived patient safety grade (r = -.627, P < .001). CONCLUSION The study supports other literature showing significant associations among safety culture dimensions and safety outcomes and provides a framework for future research on safety culture in CCT programs.
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Affiliation(s)
- Cheryl Erler
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA.
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Jones LJ, Levy LA. An educational model for patient safety and disclosure of medical error in podiatric medicine. J Am Podiatr Med Assoc 2013. [PMID: 23204203 DOI: 10.7547/1020505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Sandahl C, Gustafsson H, Wallin CJ, Meurling L, Øvretveit J, Brommels M, Hansson J. Simulation team training for improved teamwork in an intensive care unit. Int J Health Care Qual Assur 2013; 26:174-88. [PMID: 23534151 DOI: 10.1108/09526861311297361] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aims to describe implementation of simulator-based medical team training and the effect of this programme on inter-professional working in an intensive care unit (ICU). DESIGN/METHODOLOGY/APPROACH Over a period of two years, 90 percent (n = 152) of the staff of the general ICU at Karolinska University Hospital, Huddinge, Sweden, received inter-professional team training in a fully equipped patient room in their own workplace. A case study method was used to describe and explain the planning, formation, and results of the training programme. FINDINGS In interviews, the participants reported that the training had increased their awareness of the importance of effective communication for patient safety. The intervention had even had an indirect impact by creating a need to talk, not only about how to communicate efficaciously, but also concerning difficult care situations in general. This, in turn, had led to regular reflection meetings for nurses held three times a week. Examples of better communication in acute situations were also reported. However, the findings indicate that the observed improvements will not last, unless organisational features such as staffing rotas and scheduling of rounds and meetings can be changed to enable use of the learned behaviours in everyday work. Other threats to sustainability include shortage of staff, overtime for staff, demands for hospital beds, budget cuts, and poor staff communication due to separate meetings for nurses and physicians. ORIGINALITY/VALUE The present results broaden our understanding of how to create and sustain an organizational system that supports medical team training.
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Affiliation(s)
- Christer Sandahl
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Pysyk CL, Davies JM, Neil Armstrong J. Application of a modified surgical safety checklist: user beware! Can J Anaesth 2013; 60:513-8. [PMID: 23550064 DOI: 10.1007/s12630-013-9923-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/15/2013] [Indexed: 11/28/2022] Open
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Hartmann CW, Meterko M, Zhao S, Palmer JA, Berlowitz D. Validation of a novel safety climate instrument in VHA nursing homes. Med Care Res Rev 2013; 70:400-17. [PMID: 23401063 DOI: 10.1177/1077558712474349] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Improvements in nursing home safety climate could lead to enhanced resident safety. Yet safety climate has been little studied in the nursing home setting, and existing safety climate instruments have significant limitations. To investigate safety climate in Veterans Health Affairs nursing homes (Community Living Centers [CLCs]), this study had two objectives: (a) to develop a resident safety climate instrument for use in CLCs and (b) to assess this instrument's psychometric properties by administering it in a sample of CLCs. Using a standard conceptual framework, the CLC Employee Survey of Attitudes about Resident Safety was developed with the aid of an expert panel and multiple rounds of cognitive interviews. It was subsequently pilot tested in a sample of CLC employees. After refinement based on the pilot results, it was administered in a sample of five CLCs, where it was found to have adequate reliability and validity.
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Affiliation(s)
- Christine W Hartmann
- 1Center for Health Quality, Outcomes and Economic Research, A VA Center of Excellence, Bedford, MA 01730, USA.
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Clarke S. Safety leadership: A meta-analytic review of transformational and transactional leadership styles as antecedents of safety behaviours. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2012. [DOI: 10.1111/j.2044-8325.2012.02064.x] [Citation(s) in RCA: 291] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sharon Clarke
- Manchester Business School; University of Manchester; UK
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Cima RR, Deschamps C. Role of the surgeon in quality and safety in the operating room environment. Gen Thorac Cardiovasc Surg 2012; 61:1-8. [DOI: 10.1007/s11748-012-0111-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Indexed: 11/24/2022]
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High Reliability Organizations and Surgical Microsystems: Re-engineering Surgical Care. Surg Clin North Am 2012; 92:1-14. [DOI: 10.1016/j.suc.2011.12.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Quraishi SA, Kimatian SJ, Murray WB, Sinz EH. High-fidelity simulation as an experiential model for teaching root cause analysis. J Grad Med Educ 2011. [PMID: 23205203 PMCID: PMC3244320 DOI: 10.4300/jgme-d-11-00229.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the effectiveness of high-fidelity simulation for teaching root cause analysis (RCA) in graduate medical education. METHODS Thirty clinical anesthesiology-1 through clinical anesthesiology-3 residents were randomly assigned to 2 groups: group A participants received a 10-minute lecture on RCA and participated in a simulation exercise where a medical error occurs, and group B participants received the 10-minute lecture on RCA only. Participants completed baseline, postintervention, and 6-month follow-up assessments, and they were evaluated on their attitude toward as well as understanding of RCA and "systems-based" care. RESULTS All 30 residents completed the surveys. Baseline attitudes and knowledge scores were similar between groups. Postintervention knowledge scores were also similar between groups; however, group B was significantly more skeptical (P < .001) about the use of RCA and "systems improvement" strategies. Six months later, group A demonstrated retained knowledge scores and unchanged attitude, whereas group B demonstrated significantly worse knowledge scores (P = .001) as well as continued skepticism toward a systems-based approach (P < .001) to medical error reduction. CONCLUSION High-fidelity simulation in conjunction with focused didactics is an effective strategy for teaching RCA and systems theory in graduate medical education. Our findings also suggest that there is greater retention of knowledge and increased positive attitude toward systems improvement when focused didactics are coupled with a high-fidelity simulation exercise.
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Groves PS, Meisenbach RJ, Scott-Cawiezell J. Keeping patients safe in healthcare organizations: a structuration theory of safety culture. J Adv Nurs 2011; 67:1846-55. [DOI: 10.1111/j.1365-2648.2011.05619.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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