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Salehnejad R, Ali M, Proudlove NC. The impact of management practices on relative patient mortality: Evidence from public hospitals. Health Serv Manage Res 2022; 35:240-250. [PMID: 35175160 PMCID: PMC9574893 DOI: 10.1177/09514848211068627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A small, but growing, body of empirical evidence shows that the material and
persistent variation in many aspects of the performance of healthcare
organisations can be related to variation in their management practices. This
study uses public data on hospital patient mortality outcomes, the Summary
Hospital-level Mortality Indicator (SHMI) to extend this programme of research.
We assemble a five-year dataset combining SHMI with potential confounding
variables for all English NHS non-specialist acute hospital trusts. The large
number of providers working within a common system provides a powerful
environment for such investigations. We find considerable variation in SHMI
between trusts and a high degree of persistence of high- or low performance.
This variation is associated with a composite metric for management practices
based on the NHS National Staff Survey. We then use a machine learning technique
to suggest potential clusters of individual management practices related to
patient mortality performance and test some of these using traditional
multivariate regression. The results support the hypothesis that such clusters
do matter for patient mortality, and so we conclude that any systematic effort
at improving patient mortality should consider adopting an optimal cluster of
management practices.
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Affiliation(s)
- Reza Salehnejad
- 66058University of Manchester Alliance Manchester Business School, Manchester, UK
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Isonne C, Nardi A, de Soccio P, Zerbetto A, Giffi M, Sindoni A, Marotta D, Baccolini V, Migliara G, Mete R, Marzuillo C, Villari P, Salis G, Moirano F, De Vito C. Job Satisfaction Among Employees After a Merger: A Cross-Sectional Survey in the Local Health Unit of Sardinia Region, Italy. Front Public Health 2021; 9:798084. [PMID: 34993172 PMCID: PMC8725631 DOI: 10.3389/fpubh.2021.798084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Job satisfaction plays an important role in healthcare organization and management; it is critical for maintaining and improving staff efficiency and consequently the quality of care provided. Organizational restructuring processes, including mergers, are likely to affect job satisfaction levels, but evidence of the impact they have is surprisingly scarce. The aim of the study was to describe a methodology used to measure job satisfaction of the employees at a Local Health Unit (LHU) in Italy immediately after a merger and to assess the determinants associated with any reduction in worker satisfaction. The study was conducted among employees of the LHU of the Sardinia Region in July 2018, after a merger of eight subregional LHUs had taken place. The entire staff was enrolled, of which a total of 1,737 employees were surveyed. We used a questionnaire exploring socio-demographic and working characteristics of the employees, the various areas related to job satisfaction and interviewee opinions on the merger process. Multivariable stepwise backward logistic regression models were built to identify factors independently associated with lower job satisfaction. The results of a multivariable analysis showed that lower job satisfaction was more likely in employees with an administrative role (aOR: 2.34, 95% CI: 1.37-4.00) or a career demotion (aOR: 1.84, 95%CI: 1.11-3.03). High levels of mental stress were strongly associated with lower job satisfaction (aOR: 5.64, 95%CI: 4.16-7.64). "More equity of employee rewards" was the only example of a set of responder suggestions found to be associated with lower job satisfaction (aOR: 2.30, 95%CI: 1.51-3.47). Generally, responders showed a good level of job satisfaction-and this was also the case following the merger-but some job profile determinants were strongly associated with low employee satisfaction. The results of the study highlighted several challenging areas and critical issues relating to working conditions. Further surveys are required to confirm these results and to monitor their evolution over time.
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Affiliation(s)
- Claudia Isonne
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Angelo Nardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Pasquale de Soccio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Zerbetto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Monica Giffi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Daniela Marotta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Rosario Mete
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giovanni Salis
- Complex Structure Director for Training, Research and Organizational Change, ATS Sardinia, Nuoro, Italy
| | - Fulvio Moirano
- Complex Structure Director for Training, Research and Organizational Change, ATS Sardinia, Nuoro, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Montgomery A, Panagopoulou E, Esmail A, Richards T, Maslach C. Burnout in healthcare: the case for organisational change. BMJ 2019; 366:l4774. [PMID: 31362957 DOI: 10.1136/bmj.l4774] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - E Panagopoulou
- Hygiene Laboratory, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Esmail
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | | | - C Maslach
- University of California, Berkeley, CA, USA
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Salehnejad R, Ali M, Proudlove N. Combining regression trees and panel regression for exploring and testing the impact of complementary management practices on short-notice elective operation cancellation rates. Health Syst (Basingstoke) 2019; 9:326-344. [PMID: 33354324 PMCID: PMC7738292 DOI: 10.1080/20476965.2019.1596338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/20/2018] [Accepted: 03/11/2019] [Indexed: 10/27/2022] Open
Abstract
Variation in the performance of providers across healthcare systems is pervasive. It is recognised as both a major concern and an opportunity for learning and improvement. Variation between providers is broadly considered to be due to management practices and contextual factors such as catchment-area demographics. However, there is little understanding of the ways in which these impact on performance and how they can be measured. We use recent developments in both regression trees and panel regression techniques to explore and then statistically test complementary alignments of management practices whilst taking into account contextual factors. We apply this to 5 years of NHS hospital trust data, examining performance on short-notice cancellation rates. We find that different alignments of management practices give rise to quite different short-notice cancellation rates between trusts, with some being substantially lower. Our research offers a data-driven approach for identifying optimal clusters of management practices.
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Affiliation(s)
- Reza Salehnejad
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Manhal Ali
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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Wilberforce M, Poll S, Langham H, Worden A, Challis D. Measuring the patient experience in community mental health services for older people: A study of the Net Promoter Score using the Friends and Family Test in England. Int J Geriatr Psychiatry 2019; 34:31-37. [PMID: 30247775 DOI: 10.1002/gps.4978] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/06/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The research aimed to explore the value of the Net Promoter Score as a service improvement tool and an outcome measure. The study objectives were to (1) explore associations between the Net Promoter Score with patient and service-receipt characteristics; (2) evaluate the strength of association between the Net Promoter Score and a satisfaction score; and (3) evaluate its test-retest reliability. METHODS A postal survey was sent to service users on caseloads of community mental health teams for older people in four localities of England. The survey collected the Net Promoter Score, a single satisfaction question, and data on socio-demographics, clinical profile, and service receipt. Analysis used non-parametric tests of association and exploratory least squares regression. A second survey was administered for test-retest reliability analysis. Fieldwork concluded in April 2016. RESULTS For 352 respondents, the Net Promoter Score was negatively related to age and was lowest for those still within 6 months of their initial referral. Receiving support from a psychiatrist and/or support worker was linked to higher scores. A strong but imperfect correlation coefficient with the satisfaction score indicates they evaluate related but distinct constructs. It had a reasonable test-retest reliability, with a weighted kappa of 0.706. CONCLUSIONS Despite doubts over its validity in community mental health services, the Net Promoter Score may produce results of value to researchers, clinicians, service commissioners, and managers, if part of wider data collection. However, multi-item measures would provide greater breadth and improved reliability.
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Affiliation(s)
- Mark Wilberforce
- Personal Social Services Research Unit, University of Manchester, UK.,Social Policy Research Unit, University of York, UK
| | - Sarah Poll
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | | | - Angela Worden
- Personal Social Services Research Unit, University of Manchester, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, UK
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Improving quality and safety of care in nursing homes by team support for strengths use: A survey study. PLoS One 2018; 13:e0200065. [PMID: 29966013 PMCID: PMC6028145 DOI: 10.1371/journal.pone.0200065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 06/19/2018] [Indexed: 11/24/2022] Open
Abstract
Growing evidence suggests that workload has an adverse effect on quality of care and patient safety in nursing homes. A novel job resource that may improve quality of care and patient safety and alleviate the negative effect of workload in nursing homes is team support for strengths use. This refers to team members’ beliefs concerning the extent to which the team they work in actively supports them in applying their individual strengths at work. The objective was to investigate the relationships between workload, team support for strengths use, quality of care, and patient safety in nursing homes. We collected (cross-sectional) survey data from 497 caregivers from 74 teams in seven different nursing homes. The survey included measures on perceived workload, team support for strengths use, caregivers’ perception of the quality of care provided by the team and four safety incidents (i.e. fall incidents, medication errors, pressure ulcers, incidents of aggression). After controlling for age, team size, team tenure, organizational tenure, and nursing home, multilevel regression analyses (i.e. individual and team level) showed that perceived workload was not significantly related to perceived team-based quality of care and the frequency of safety incidents. Team support for strengths use was positively related to perceived team-based quality of care, negatively related to medication errors, but not significantly related to fall incidents, pressure ulcers, and aggression incidents. Finally, we found that perceived workload had a negative effect on perceived team-based quality of care when team support for strengths use is low and no significant effect on perceived team-based quality of care when team support for strengths use is high. This study provides promising evidence for a novel avenue for promoting team-based quality of care in nursing homes.
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Leggat SG. Understanding the perspectives of health service staff on the Friends and Family Test. AUST HEALTH REV 2017; 40:299-305. [PMID: 26387081 DOI: 10.1071/ah15034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/26/2015] [Indexed: 11/23/2022]
Abstract
Objectives The present study was designed to determine what staff consider when asked to respond to the Friends and Family Test question. Methods Over 300 health service staff responded to an online questionnaire exploring whether they would recommend treatment at their organisation to friends and family (Friends and Family Test). Results Staff identified staff attitudes and behaviours, the busyness of the health service and quality of care as themes that affected their recommendation. A considerable number of staff also identified factors largely outside the control of the health service as influencing their response. Conclusions Majority of respondents based their perceptions on personal expectations, with smaller numbers citing personal experience and hearsay. Staff would need to see changes both in the quality of care and management practice to amend their recommendation on the Friends and Family Test. What is known about the topic? The Friends and Family Test is seen as a useful tool to gather the opinions of patients and staff on the patient experience, yet there has been little validation of this question. What does this paper add? The present study suggests that, as currently worded, the question does not reliably report staff perceptions regarding patient experience. The study illustrates that the relationship with the organisation and perceptions of effective management are linked to staff responses. What are the implications for practitioners? The Family and Friends Test question may need to be more clearly focused to gather the desired information. Improvement on this indicator is only likely to be seen when management teams are meeting the expectations of staff for good management practice.
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Affiliation(s)
- Sandra G Leggat
- La Trobe University, Department of Public Health, Bundoora, Vic. 3086, Australia. Email
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Kapur N, Ibrahim S, While D, Baird A, Rodway C, Hunt IM, Windfuhr K, Moreton A, Shaw J, Appleby L. Mental health service changes, organisational factors, and patient suicide in England in 1997-2012: a before-and-after study. Lancet Psychiatry 2016; 3:526-34. [PMID: 27107805 DOI: 10.1016/s2215-0366(16)00063-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample. METHODS We did a before-and-after analysis of service delivery data and an ecological analysis of organisational characteristics, in relation to suicide rates, in providers of mental health care in England. We also investigated whether the effect of service changes varied according to markers of organisational functioning. FINDINGS Overall, 19 248 individuals who died by suicide within 12 months of contact with mental health services were included (1997-2012). Various service changes related to ward safety, improved community services, staff training, and implementation of policy and guidance were associated with a lower suicide rate after the introduction of these changes (incidence rate ratios ranged from 0·71 to 0·79, p<0·0001). Some wider organisational factors, such as non-medical staff turnover (Spearman's r=0·34, p=0·01) and incident reporting (0·46, 0·0004), were also related to suicide rates but others, such as staff sickness (-0·12, 0·37) and patient satisfaction (-0·06, 0·64), were not. Service changes had more effect in organisations that had low rates of staff turnover but high rates of overall event reporting. INTERPRETATION Aspects of mental health service provision might have an effect on suicide rates in clinical populations but the wider organisational context in which service changes are made are likely to be important too. System-wide change implemented across the patient care pathway could be a key strategy for improving patient safety in mental health care. FUNDING The Healthcare Quality Improvement Partnership commissions the Mental Health Clinical Outcome Review Programme, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety, and the States of Jersey and Guernsey.
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Affiliation(s)
- Nav Kapur
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Manchester Mental Health and Social Care Trust, Manchester, UK.
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - David While
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Alison Baird
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Isabelle M Hunt
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Adam Moreton
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Chew BH, Cheong AT, Ismail M, Hamzah Z, A-Rashid MR, Md-Yasin M, Ali N, Mohd-Salleh N, Bashah B. A nationwide survey of public healthcare providers' impressions of family medicine specialists in Malaysia: a qualitative analysis of written comments. BMJ Open 2016; 6:e009375. [PMID: 26743703 PMCID: PMC4716204 DOI: 10.1136/bmjopen-2015-009375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To examine impressions of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. DESIGN Cross-sectional study. SETTING This study is part of a larger national study on the perception of Malaysian public healthcare professionals on FMSs (PERMFAMS). PARTICIPANTS PHCPs from three categories of health facility: hospitals, health clinics and health offices. MAIN OUTCOME MEASURES Qualitative analyses of written comments of respondents' general impression of FMSs. RESULTS The participants' response rate was 58.0% (780/1345), with almost equal proportions from each public healthcare facility. A total of 23 categories for each of the 648 impression comments were identified. The six emerging themes were: (1) importance of FMSs; (2) roles of FMSs; (3) clinical performance of FMSs; (4) attributes of FMSs; (5) FMS practice challenges; (6) misconception of FMS roles. Overall, FMS practice was perceived to be safe and able to provide effective treatments in a challenging medical discipline that was in line with the current standards of medical care and ethical and professional values. The areas of concern were in clinical performance expressed by PHCPs from some hospitals and the lack of personal attributes and professionalism among FMSs mentioned by PHCPs from health clinics and offices. CONCLUSIONS FMSs were perceived to be capable of providing effective treatment and were considered to be important primary care physicians. There were a few negative impressions in some areas of FMS practice, which demanded attention by the FMSs themselves and the relevant authorities in order to improve efficiency and safeguard the fraternity's reputation.
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Affiliation(s)
- Boon-How Chew
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra, Putrajaya, Malaysia
| | - Ai-Theng Cheong
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra, Putrajaya, Malaysia
| | | | - Zuhra Hamzah
- Faculty of Medicine, Department of Family Medicine, Universiti Kebangsaan, Cheras, Kuala Lumpur, Malaysia
| | - Mohd-Radzniwan A-Rashid
- Faculty of Medicine, Department of Family Medicine, Universiti Kebangsaan, Cheras, Kuala Lumpur, Malaysia
| | - Mazapuspavina Md-Yasin
- Faculty of Medicine, Primary Care Medicine Discipline, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Norsiah Ali
- Health Clinic Masjid Tanah Melaka, Melaka, Malaysia
| | - Noridah Mohd-Salleh
- Family Health Development Division, Ministry of Health, Wilayah Persekutuan Putrajaya, Putrajaya, Malaysia
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Howell AM, Burns EM, Bouras G, Donaldson LJ, Athanasiou T, Darzi A. Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data. PLoS One 2015; 10:e0144107. [PMID: 26650823 PMCID: PMC4674095 DOI: 10.1371/journal.pone.0144107] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 11/15/2015] [Indexed: 01/12/2023] Open
Abstract
Background The National Reporting and Learning System (NRLS) collects reports about patient safety incidents in England. Government regulators use NRLS data to assess the safety of hospitals. This study aims to examine whether annual hospital incident reporting rates can be used as a surrogate indicator of individual hospital safety. Secondly assesses which hospital characteristics are correlated with high incident reporting rates and whether a high reporting hospital is safer than those lower reporting hospitals. Finally, it assesses which health-care professionals report more incidents of patient harm, which report more near miss incidents and what hospital factors encourage reporting. These findings may suggest methods for increasing the utility of reporting systems. Methods This study used a mix methods approach for assessing NRLS data. The data were investigated using Pareto analysis and regression models to establish which patients are most vulnerable to reported harm. Hospital factors were correlated with institutional reporting rates over one year to examine what factors influenced reporting. Staff survey findings regarding hospital safety culture were correlated with reported rates of incidents causing harm; no harm and death to understand what barriers influence error disclosure. Findings 5,879,954 incident reports were collected from acute hospitals over the decade. 70.3% of incidents produced no harm to the patient and 0.9% were judged by the reporter to have caused severe harm or death. Obstetrics and Gynaecology reported the most no harm events [OR 1.61(95%CI: 1.12 to 2.27), p<0.01] and pharmacy was the hospital location where most near-misses were captured [OR 3.03(95%CI: 2.04 to 4.55), p<0.01]. Clinicians were significantly more likely to report death than other staff [OR 3.04(95%CI: 2.43 to 3.80) p<0.01]. A higher ratio of clinicians to beds correlated with reduced rate of harm reported [RR = -1.78(95%Cl: -3.33 to -0.23), p = 0.03]. Litigation claims per bed were significantly negatively associated with incident reports. Patient satisfaction and mortality outcomes were not significantly associated with reporting rates. Staff survey responses revealed that keeping reports confidential, keeping staff informed about incidents and giving feedback on safety initiatives increased reporting rates [r = 0.26 (p<0.01), r = 0.17 (p = 0.04), r = 0.23 (p = 0.01), r = 0.20 (p = 0.02)]. Conclusion The NRLS is the largest patient safety reporting system in the world. This study did not demonstrate many hospital characteristics to significantly influence overall reporting rate. There were no association between size of hospital, number of staff, mortality outcomes or patient satisfaction outcomes and incident reporting rate. The study did show that hospitals where staff reported more incidents had reduced litigation claims and when clinician staffing is increased fewer incidents reporting patient harm are reported, whilst near misses remain the same. Certain specialties report more near misses than others, and doctors report more harm incidents than near misses. Staff survey results showed that open environments and reduced fear of punitive response increases incident reporting. We suggest that reporting rates should not be used to assess hospital safety. Different healthcare professionals focus on different types of safety incidents and focusing on these areas whilst creating a responsive, confidential learning environment will increase staff engagement with error disclosure.
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Affiliation(s)
- Ann-Marie Howell
- Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, United Kingdom
- * E-mail:
| | - Elaine M. Burns
- Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, United Kingdom
| | - George Bouras
- Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, United Kingdom
| | - Liam J. Donaldson
- Institute of Global Health Innovation, Imperial College, St Mary’s Hospital, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, London, United Kingdom
- Institute of Global Health Innovation, Imperial College, St Mary’s Hospital, London, United Kingdom
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Chew BH, Yasin MM, Cheong AT, Rashid MRA, Hamzah Z, Ismail M, Ali N, Bashah B, Mohd-Salleh N. A nationwide postal survey on the perception of Malaysian public healthcare providers on family medicine specialists' (PERMFAMS) clinical performance, professional attitudes and research visibility. SPRINGERPLUS 2015; 4:213. [PMID: 25992310 PMCID: PMC4431984 DOI: 10.1186/s40064-015-1004-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/28/2015] [Indexed: 02/08/2023]
Abstract
Perception of healthcare providers who worked with family medicine specialists (FMSs) could translate into the effectiveness of primary healthcare delivery in daily practices. This study examined perceptions of public healthcare providers/professionals (PHCPs) on FMSs at public health clinics throughout Malaysia. This was a cross-sectional study in 2012-2013 using postal method targeting PHCPs from three categories of health facilities, namely health clinics, health offices and hospitals. A structured questionnaire was developed to assess PHCP's perception of FMS's clinical competency, safety practice, ethical and professional values, and research involvement. It consists of 37 items with Likert scale of strongly disagree (a score of 1) to strongly agree (a score of 5). Interaction and independent effect of the independent variables were tested and adjusted means score were reported. The participants' response rate was 58.0% (780/1345) with almost equal proportion from each of the three public healthcare facilities. There were more positive perceptions than negative among the PHCPs. FMSs were perceived to provide effective and safe treatment to their patients equally disregards of patient's social background. However, there were some concerns of FMSs not doing home visits, not seeing walk-in patients, had long appointment time, not active in scientific research, writing and publication. There were significant differences in perception based on a respondent's health care facility (p < 0.0001) and frequency of encounter (p < 0.0001). PHCPs had overall positive perceptions on FMSs across all the domains investigated. PHCPs from different health care facilities and frequency of encounter with FMSs had different perception. Practicing FMSs could improve on the critical service areas that were perceived to be important but lacking. FMSs might need further support in conducting research and writing for publication.
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Affiliation(s)
- Boon-How Chew
- />Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Mazapuspavina Md Yasin
- />Primary Care Medicine Discipline, Level 7, Academic Block, Faculty of Medicine, UiTM Sg. Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | - Ai-Theng Cheong
- />Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Mohd-Radzniwan A Rashid
- />Jabatan Perubatan Keluarga, Fakulti Perubatan, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Zuhra Hamzah
- />Jabatan Perubatan Keluarga, Fakulti Perubatan, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Mastura Ismail
- />Klinik Kesihatan Seremban 2, Jalan S2 A2, 70300 Seremban 2, Negeri Sembilan Malaysia
| | - Norsiah Ali
- />Klinik Kesihatan Tampin, 73000 Tampin, Negeri Sembilan Malaysia
| | - Baizury Bashah
- />Klinik Kesihatan Putrajaya Precinct 9, 1, Jalan P9E, Presint 9, 62250 Putrajaya, Wilayah Persekutuan Putrajaya Malaysia
| | - Noridah Mohd-Salleh
- />Bahagian Pembangunan Kesihatan Keluarga, Kementerian Kesihatan Malaysia, Aras 7 & 8, Blok E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Wilayah Persekutuan Putrajaya Malaysia
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Lim KK. Impact of hospital mergers on staff job satisfaction: a quantitative study. HUMAN RESOURCES FOR HEALTH 2014; 12:70. [PMID: 25495151 PMCID: PMC4277837 DOI: 10.1186/1478-4491-12-70] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hospital mergers began in the UK in the late 1990s to deal with underperformance. Despite their prevalence, there is a lack of research on how such organizational changes affect the staff morale. This study aims to assess the impact of NHS hospital mergers between financial years 2009/10 and 2011/12 on staff job satisfaction and to identify factors contributing to satisfaction. METHODS Data on staff job satisfaction were obtained from the annual NHS Staff Survey. A list of mergers was compiled using data provided by the Cooperation and Competition Panel and the Department of Health. Other sources of data included the NHS Hospital Estates and Facilities Statistics, the NHS 'Quarter' publication, official reports from health service regulators, individual hospitals' annual accounts, data from the NHS Information Centre and the NHS Recurrent Revenue Allocations Exposition Book. Only full mergers of acute and mental health hospitals were analyzed. Propensity scores were generated using observable factors likely to affect merger decision to select three comparable hospitals for every constituent hospital in a merger to act as a control group. A difference-in-difference was estimated between baseline (3 years before merger approval) and each subsequent year up to 4 years post-merger, controlling for work environment, drivers of job satisfaction, data year, type of hospital and occupation group. RESULTS There were nine mergers during the study period. Only job satisfaction scores 1 to 2 years before (0.03 to 0.04 point) and 1 year after merger approval (0.06 point) were higher (P < 0.01) than baseline. Robustness testing produced consistent findings. Assuming other conditions were equal, an increase in autonomy, staff support, perceived quality and job clarity ratings would increase job satisfaction scores. Higher job satisfaction scores were also associated with being classified as medical, dental, management or administrative staff and working in a mental health trust. CONCLUSION Hospital mergers have a small, transient positive impact on staff job satisfaction in the year immediately before and after merger approval. Continuous staff support and management of staff expectations throughout a merger may help to increase staff job satisfaction during the challenging period of merger.
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Affiliation(s)
- Ka Keat Lim
- Healthcare Statistics Unit, Clinical Research Centre, National Institute of Health, Ministry of Health Malaysia, 3rd Floor, MMA House, 124 Jalan Pahang 53000 Kuala Lumpur, Malaysia.
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14
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Dixon-Woods M, Minion JT, McKee L, Willars J, Martin G. The friends and family test: a qualitative study of concerns that influence the willingness of English National Health Service staff to recommend their organisation. J R Soc Med 2014; 107:318-325. [PMID: 24781160 PMCID: PMC4128077 DOI: 10.1177/0141076814532392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The views of practitioners at the 'sharp end' of care provision are increasingly recognised as important indicators of quality of care. The National Health Service (NHS) Staff Survey in England has quantified employees' views on how far they would be happy with the standard of care provided by their organisation if a friend or family member needed treatment. We aimed to characterise the concerns that might affect the willingness of staff to recommend their own organisations. DESIGN Qualitative study involving semi-structured interviews. Data analysis based on the constant comparative method. PARTICIPANTS Members of clinical and managerial staff in four NHS organisations (n = 70), and senior stakeholders across the NHS including clinicians, managers and others with a strategic or senior-level perspective (n = 98). SETTING One hundred and sixty-eight interviews were conducted: 70 in four case study organisations and 98 across the wider English NHS. MAIN OUTCOME MEASURES Not applicable. RESULTS Asking study participants the 'if a friend…' question offered insider views on the quality of care. Some staff had no concerns, but others, identified significant problems with consistency, reliability and behaviour of staff. Participants identified reasons for poor care that included inadequate organisational systems; structural problems of understaffing and under-resourcing; weaknesses in professional cultures and professional competence and failure to deal with problems such as unacceptable conduct. Participants emphasised that staff were not always able to deliver high-quality care because they worked in difficult conditions. CONCLUSIONS Asking staff to give accounts of their willingness to recommend their organisation to family and friends elicits important insights into quality and safety of care. Such accounts might be able to provide warning signs that could signal organisational decline and avert healthcare scandals, but use outside a research context requires further evaluation.
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Affiliation(s)
- Mary Dixon-Woods
- SAPPHIRE group, Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK
| | - Joel T Minion
- Data to Knowledge group, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Janet Willars
- SAPPHIRE group, Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK
| | - Graham Martin
- SAPPHIRE group, Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK
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15
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Chew BH, Cheong AT, Ismail M, Hamzah Z, A-Rashid MR, Md-Yasin M, Ali N. A nationwide survey on the expectation of public healthcare providers on family medicine specialists in Malaysia-a qualitative analysis of 623 written comments. BMJ Open 2014; 4:e004645. [PMID: 24919639 PMCID: PMC4067837 DOI: 10.1136/bmjopen-2013-004645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/08/2014] [Accepted: 05/27/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To examine the expectation of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. DESIGN Cross-sectional study. SETTING This study is part of a larger national study on the perception of the Malaysian public healthcare professionals on FMSs. PARTICIPANTS PHCPs from three categories of health facilities, namely hospitals, health clinics and health offices. MAIN OUTCOME MEASURES Qualitative analysis of written comments of respondents' expectation of FMSs. RESULTS The participants' response rate was 58% (780/1345) with an almost equal proportion from each public healthcare facility. We identified 21 subthemes for the 623 expectation comments. The six emerging themes are (1) need for more FMSs, (2) clinical roles and functions of FMSs, (3) administrative roles of FMSs, (4) contribution to community and public health, (5) attributes improvement and (6) research and audits. FMSs were expected to give attention to clinical duty. Delivering this responsibility with competence included having the latest medical knowledge in their own and others' medical disciplines, practising evidence-based medicine in prehospital and posthospital care, better supervision of staff and doctors under their care, fostering effective teamwork, communicating more often with hospital specialists and making appropriate referral. Expectations ranged from definite and strong for more FMSs at the health clinics to low expectation for FMSs' involvement in research; to mal-expectation on FMSs' involvement in community and public health programmes. CONCLUSIONS There were some remarkable differences in expectations on FMSs from the three different PHCPs. These ranged from being clinically competent and administratively available for patients and staff at the health clinics, to mal-expectations on FMSs to engage in public health affairs. Relevant parties, including FMSs themselves, could take appropriate self-improvement initiatives to enhance public practice of family medicine and patient care. TRIAL REGISTRATION NUMBER NMRR ID 08-12-1167.
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Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Science, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ai-Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Science, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mastura Ismail
- Health Clinic Seremban 2, Ministry of Health, Seremban, Negeri Sembilan, Malaysia
| | - Zuhra Hamzah
- Department of Family Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd-Radzniwan A-Rashid
- Department of Family Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mazapuspavina Md-Yasin
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Norsiah Ali
- Health Clinic Tampin, Ministry of Health, Tampin, Negeri Sembilan, Malaysia
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16
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Tvedt C, Sjetne IS, Helgeland J, Bukholm G. An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities. BMJ Qual Saf 2014; 23:757-64. [PMID: 24728887 PMCID: PMC4145461 DOI: 10.1136/bmjqs-2013-002781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital. Methods In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined. Results Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival. Conclusions This study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals.
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Affiliation(s)
- Christine Tvedt
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingeborg Strømseng Sjetne
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Jon Helgeland
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Geir Bukholm
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Aas, Norway
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