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Müller BS, Lüttel D, Schütze D, Blazejewski T, Pommée M, Müller H, Rubin K, Thomeczek C, Schadewitz R, Heuzeroth R, Schwappach D, Güthlin C, Paulitsch M, Gerlach FM. Supporting Error Management and Safety Climate in Ambulatory Care Practices: The CIRSforte Study. J Patient Saf 2024:01209203-990000000-00206. [PMID: 38489154 DOI: 10.1097/pts.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND To improve patient safety, it is important that healthcare facilities learn from critical incidents. Tools such as reporting and learning systems and team meetings structure error management and promote learning from incidents. To enhance error management in ambulatory care practices, it is important to promote a climate of safety and ensure personnel share views on safety policies and procedures. In contrast to the hospital sector, little research has been dedicated to developing feasible approaches to supporting error management and safety climate in ambulatory care. In this study, we developed, implemented, and evaluated a multicomponent intervention to address how error management and safety climate can be improved in ambulatory care practices. METHODS In a prospective 1-group pretest-posttest implementation study, we sought to encourage teams in German ambulatory practices to use proven methods such as guidelines, workshops, e-learning, (online) meetings, and e-mail newsletters. A pretest-posttest questionnaire was used to evaluate level and strength of safety climate and psychological behavioral determinants for systematic error management. Using 3 short surveys, we also assessed the state of error management in the participating practices. In semistructured interviews, we asked participants for their views on our intervention measures. RESULTS Overall, 184 ambulatory care practices nationwide agreed to participate. Level of safety climate and safety climate strength (rwg) improved significantly. Of psychological behavioral determinants, significant improvements could be seen in "action/coping planning" and "action control." Seventy-six percent of practices implemented a new reporting and learning system or modified their existing system. The exchange of information between practices also increased over time. Interviews showed that the introductory workshop and provided materials such as report forms or instructions for team meetings were regarded as helpful. CONCLUSIONS A significant improvement in safety climate level and strength, as well as participants' knowledge of how to analyze critical incidents, derive preventive measures and develop concrete plans suggest that it is important to train practice teams, to provide practical tips and tools, and to facilitate the exchange of information between practices. Future randomized and controlled intervention trials should confirm the effectiveness of our multicomponent intervention.Trial registration: Retrospectively registered on 18. November 2019 in German Clinical Trials Register No. DRKS00019053.
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Affiliation(s)
| | | | - Dania Schütze
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Tatjana Blazejewski
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | | | | | | | | | | | | | - David Schwappach
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Corina Güthlin
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Michael Paulitsch
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
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Ahmed SS, van Rijswijk SP, Farooq A. Work Climate, Improved Communication, and Cohesive Work Linked with Patient Safety Culture: Findings from a Sports Medicine Hospital. Healthcare (Basel) 2023; 11:3109. [PMID: 38131999 PMCID: PMC10742733 DOI: 10.3390/healthcare11243109] [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: 10/12/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study aims to investigate the patient safety culture at a sports medicine hospital and explore the quality of healthcare and associated factors. METHODS In a cross-sectional study design, the Hospital Survey on Patient Safety Culture (HSOPC) tool was administered online among staff at a sports medicine hospital in Doha, Qatar. Out of 898 staff who received an email invitation, 504 participated (56.1%). RESULTS The results showed that 48.0% of the staff rated the patient safety grade as excellent and 37.5% as very good, totaling 85.5%. Factors associated with excellent or very good patient safety grades were management support OR 4.7 95% CI (1.8 to 12.3); team communication OR 3.0 95% CI (1.4 to 6.3), supervisor action supporting patient safety OR 3.5 95% CI (1.7 to 7.0) and other items related to work area such as working together: OR 3.0 95% CI (1.2 to 7.6), helping out busy areas OR 2.5 95% CI (1.1 to 5.5) and having good procedures and systems: OR 2.8 95% CI (1.4 to 5.8). CONCLUSIONS Addressing management support, enhancing communication, and cohesive work within the work area facilitates a culture of trust that improves patient safety grades.
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Affiliation(s)
- Syed Sajid Ahmed
- Quality Management, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha 29222, Qatar
| | | | - Abdulaziz Farooq
- Research and Scientific Support, Aspetar, FIFA Medical Centre of Excellence, Orthopaedic and Sports Medicine Hospital, Doha 29222, Qatar;
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Pfeiffer Y, Atkinson A, Maag J, Lane MA, Schwappach D, Marschall J. Are cross-sectional safety climate survey results in operating room staff associated with the surgical site infection rates in Swiss hospitals? BMJ Open 2023; 13:e066514. [PMID: 37076144 PMCID: PMC10124250 DOI: 10.1136/bmjopen-2022-066514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association between surgical site infections (SSIs), a major source of patient harm, and safety and teamwork climate. Prior research has been unclear regarding this relationship. DESIGN Based on the Swiss national SSI surveillance and a survey study assessing (a) safety climate and (b) teamwork climate, associations were analysed for three kinds of surgical procedures. SETTING AND PARTICIPANTS SSI surveillance data from 20 434 surgeries for hip and knee arthroplasty from 41 hospitals, 8321 for colorectal procedures from 28 hospitals and 4346 caesarean sections from 11 hospitals and survey responses from Swiss operating room personnel (N=2769) in 54 acute care hospitals. PRIMARY AND SECONDARY OUTCOMES The primary endpoint of the study was the 30-day (all types) or 1-year (knee/hip with implants) National Healthcare Safety Network-adjusted SSI rate. Its association with climate level and strength was investigated in regression analyses, accounting for respondents' professional background, managerial role and hospital size as confounding factors. RESULTS Plotting climate levels against infection rates revealed a general trend with SSI rate decreasing as the safety climate increased, but none of the associations were significant (5% level). Linear models for hip and knee arthroplasties showed a negative association between SSI rate and climate perception (p=0.02). For climate strength, there were no consistent patterns, indicating that alignment of perceptions was not associated with lower infection rates. Being in a managerial role and being a physician (vs a nurse) had a positive effect on climate levels regarding SSI in hip and knee arthroplasties, whereas larger hospital size had a negative effect. CONCLUSIONS This study suggests a possible negative correlation between climate level and SSI rate, while for climate strength, no associations were found. Future research should study safety climate more specifically related to infection prevention measures to establish clearer links.
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Affiliation(s)
- Yvonne Pfeiffer
- Research department, Stiftung fur Patientensicherheit, Zurich, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
| | - Judith Maag
- Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
- Swissnoso, National Center for Infection Control, Bern, Switzerland
| | - Michael A Lane
- Quality & Safety Operations, Parkland Health, Dallas, Texas, USA
| | - David Schwappach
- Institute of Social and Preventive Medicine, Universität Bern, Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
- Swissnoso, National Center for Infection Control, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
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Preventing Surgical Site Infections: Are Safety Climate Level and Its Strength Associated With Self-reported Commitment To, Subjective Norms Toward, and Knowledge About Preventive Measures? J Patient Saf 2023; 19:264-270. [PMID: 36849420 DOI: 10.1097/pts.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVES Surgical site infections (SSIs) represent a major source of preventable patient harm. Safety climate in the operating room personnel is assumed to be an important factor, with scattered supporting evidence for the association between safety climate and infection outcome so far. This study investigated perceptions and knowledge specific to infection prevention measures and their associations with general assessments of safety climate level and strength. METHODS We invited operating room personnel of hospitals participating in the Swiss SSI surveillance program to take a survey (response rate, 38%). A total of 2769 responses from 54 hospitals were analyzed. Two regression analyses were performed to identify associations between subjective norms toward, commitment to, as well as knowledge about prevention measures and safety climate level and strength, taking into account professional background and number of responses per hospital. RESULTS Commitment to perform prevention measures even when situational pressures exist, as well as subjective norm of perceiving the expectation of others to perform prevention measures were significantly (P < 0.05) related to safety climate level, while for knowledge about preventative measures this was not the case. None of the assessed factors was significantly associated with safety climate strength. CONCLUSIONS While pertinent knowledge did not have a significant impact, the commitment and the social norms to maintain SSI prevention activities even in the face of other situational demands showed a strong influence on safety climate. Assessing the knowledge about measures to prevent SSIs in operating room personnel opens up opportunities for designing intervention efforts in reducing SSIs.
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De Miguel MS, de Elguea JO, Gómez-Gastiasoro A, Urcola F, Cid-Expósito MG, Torres-Enamorado D, Orkaizagirre-Gomara A. Patient safety and its relationship with specific self-efficacy, competence, and resilience among nursing students: A quantitative study. NURSE EDUCATION TODAY 2023; 121:105701. [PMID: 36563588 DOI: 10.1016/j.nedt.2022.105701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/01/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Patient safety is a relevant subject in the nursing curriculum. Each university programs patient safety teaching and practical training differently. However, few studies have sought to explore the relationship between patient safety as perceived by nursing students and other important psychosocial competencies in the nursing curriculum, such as self-efficacy, competence, and resilience. OBJECTIVES To analyze differential patient safety integration into three nursing education programs, and to assess agreement levels regarding patient safety climate, students' knowledge of patient safety and correlations with specific self-efficacy, competence and resilience. METHODS Participants were 647 undergraduate students from three universities. Patient safety climate and knowledge of patient safety (good praxis) were measured using the Hospital Survey on Patient Safety Culture for nursing students, and other psychosocial variables were also analyzed using other instruments: specific self-efficacy, perceived competence and resilience. Nursing education programs and patient safety climate were analyzed using the Rwg(j) and ICC measures of inter-rater agreement across different academic levels. RESULTS The ICC and Rwg indexes revealed high inter-rate agreement in all three universities. Differences were observed between Univ-2 and Univ-3 in patient safety climate scores and agreement values between academic levels. Differences in good praxis were found when academic levels were compared in Univ1-and Univ-2. Patient safety climate was found to correlate significantly with the psychosocial variables studied, but only in Univ-1. CONCLUSIONS Perceived patient safety climate differs between universities and academic levels. This competency is related to self-efficacy, competence and resilience, which endorses the assessment of patient safety integration from a broader perspective.
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Affiliation(s)
- Manuel Sánchez De Miguel
- Faculty of Psychology, University of the Basque Country UPV/EHU, San Sebastián, Gipuzkoa, Spain; Biodonostia Health Research Institute, San Sebastián, Gipuzkoa, Spain.
| | - Javier Ortiz de Elguea
- Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, San Sebastián, Gipuzkoa, Spain; Donostia University Hospital (Osakidetza, Basque Health Service), San Sebastián, Gipuzkoa, Spain
| | | | - Fernando Urcola
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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Ghasemi F, Babamiri M, Pashootan Z. A comprehensive method for the quantification of medication error probability based on fuzzy SLIM. PLoS One 2022; 17:e0264303. [PMID: 35213625 PMCID: PMC8880918 DOI: 10.1371/journal.pone.0264303] [Citation(s) in RCA: 1] [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: 11/16/2021] [Accepted: 02/09/2022] [Indexed: 12/28/2022] Open
Abstract
Medication errors can endanger the health and safety of patients and need to be managed appropriately. This study aimed at developing a new and comprehensive method for estimating the probability of medication errors in hospitals. An extensive literature review was conducted to identify factors affecting medication errors. Success Likelihood Index Methodology was employed for calculating the probability of medication errors. For weighting and rating of factors, the Fuzzy multiple attributive group decision making methodology and Fuzzy analytical hierarchical process were used, respectively. A case study in an emergency department was conducted using the framework. A total number of 17 factors affecting medication error were identified. Workload, patient safety climate, and fatigue were the most important ones. The case study showed that subtasks requiring nurses to read the handwritten of other nurses and physicians are more prone to human error. As there is no specific method for assessing the risk of medication errors, the framework developed in this study can be very useful in this regard. The developed technique was very easy to administer.
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Affiliation(s)
- Fakhradin Ghasemi
- Department of Occupational Health and Safety Engineering, Abadan University of Medical Sciences, Abadan, Iran
- Department of Ergonomics, Occupational Health & Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Babamiri
- Department of Ergonomics, Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Pashootan
- Department of Ergonomics, Occupational Health & Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- * E-mail:
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Leslie HH, Lee HY, Blouin B, García PJ, Kruk ME. Evaluating patient-reported outcome measures in Peru: a cross-sectional study of satisfaction and net promoter score using the 2016 EnSuSalud survey. BMJ Qual Saf 2022; 31:599-608. [PMID: 35121652 PMCID: PMC9304114 DOI: 10.1136/bmjqs-2021-014095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patient-reported measures attempt to quantify the value health services provide to users. Satisfaction is a common summative measure, but often has limited utility in identifying poor quality care. We compared satisfaction and the net promoter score (NPS), which was developed to help businesses quantify consumer sentiment, in a nationally representative survey in Peru. We aimed to compare NPS and satisfaction as individual ratings of care, assess the relationship of patient-reported experience ratings to these outcome measures and consider the utility of these measures as indicators of facility performance based on reliability within facilities and capacity to discriminate between facilities. METHODS We analysed the 2016 National Survey on User Satisfaction of Health Services, a cross-sectional outpatient exit survey. We assessed ratings by patient characteristics and compared the distributions of satisfaction and NPS categories. We tested the association of patient-reported experience measures with each outcome using multilevel ordinal logistic regression. We used intraclass correlation (ICC) from these models to predict minimum sample for reliable assessment and compared patient-reported experience measures in facilities with average satisfaction but below or above average NPS. RESULTS 13 434 individuals rated services at 184 facilities. Satisfaction (74% satisfied) and NPS (17% reported at least 9 out of 10) were largely concordant within individuals but weakly correlated (0.37). Ratings varied by individual factors such as age and visit purpose. Most domains of patient-reported experience were associated with both outcomes. Adjusted ICC was higher for NPS (0.26 vs 0.11), requiring a minimum of 7 (vs 20) respondents for adequate reliability. Within the 70% of facilities classified as average based on satisfaction, NPS-based classification revealed systematic differences in patient-reported experience measures. CONCLUSION While satisfaction and NPS were broadly similar at an individual level, this evidence suggests NPS may be useful for benchmarking facility performance as part of national efforts in Peru and throughout Latin America to identify deficits in health service quality.
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Affiliation(s)
- Hannah H Leslie
- Division of Prevention Science, University of California San Francisco, San Francisco, California, USA.,Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Hwa-Young Lee
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.,Convergence Science Academy, Institute of Convergence Science (ICONS), Yonsei University, Seoul, South Korea
| | - Brittany Blouin
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia J García
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Desmedt M, Petrovic M, Beuckelaere P, Vandijck D. Assessing Resident Safety Culture in Six Nursing Homes in Belgium. J Patient Saf 2021; 17:e1209-e1215. [PMID: 29596134 DOI: 10.1097/pts.0000000000000476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary aim was to measure resident safety culture in six nursing homes in northern Belgium (Flanders). In addition, differences in safety culture perceptions between professions were also examined. Finally, results of the present study were compared with the Nursing Home Comparative Database from the Agency for Healthcare Research and Quality (USA). METHODS A cross-sectional study was conducted by administering the Nursing Home Survey on Patient Safety Culture in six nursing homes in Belgium (Flanders). Each nursing home has 92 to 170 licensed nursing home beds. Data collection occurred between December 2016 and January 2017. RESULTS Highest mean scores were found for "feedback and communication about incidents" (mean [SD] = 4.20 [0.58]), "overall perceptions of resident safety" (mean [SD] = 4.07 [0.52]), and "supervisor expectations and actions promoting resident safety" (mean [SD] = 4.04 [0.70]). The lowest mean score was found for "staffing" (mean [SD] = 2.99 [0.61]). In addition, managers/supervisors scored significantly higher on all resident safety dimensions, with the exception of the dimensions "teamwork" and "supervisor expectations and actions promoting resident safety." Finally, the present study scored higher on the dimensions "teamwork," "nonpunitive response to mistakes," "handoffs," "feedback and communication about incidents," and "communication openness" than the benchmarking data from the Nursing Home Comparative Database. CONCLUSIONS More work is necessary to improve the safety of resident care in nursing homes, especially regarding staffing issues and turnover rates. The present research findings serve to shine a light on an often-overlooked patient population and emphasize the need to develop improvement strategies for preventing resident safety incidents in nursing homes.
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Affiliation(s)
- Melissa Desmedt
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | - Mirko Petrovic
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Petra Beuckelaere
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dominique Vandijck
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
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Desmedt M, Bergs J, Willaert B, Schrooten W, Vlayen A, Hellings J, Claes N, Vandijck D. Exploring and Evaluating Patient Safety Culture in a Community-Based Primary Care Setting. J Patient Saf 2021; 17:e1216-e1222. [PMID: 29394195 DOI: 10.1097/pts.0000000000000458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary aim was to measure patient safety culture in two home care services in Belgium (Flanders). In addition, variability based on respondents' profession was examined. METHODS A cross-sectional study was conducted by administering the SCOPE-Primary Care questionnaire in two home care service organizations. RESULTS In total, 1875 valid questionnaires were returned from 2930 employees, representing a response rate of 64%. The highest mean patient safety culture score was found for "organizational learning" (mean [SD] = 3.81 [0.53]), followed by "support and fellowship" (mean [SD] = 3.76 [0.61]), "open communication and learning from error" (mean [SD] = 3.73 [0.64]), and "patient safety management" (mean [SD] = 3.71 [0.60]). The lowest mean scores were found for "handover and teamwork" (mean [SD] = 3.28 [0.58]) and "adequate procedures and working conditions" (mean [SD] = 3.30 [0.56]). Moreover, managers/supervisors scored significantly higher on the dimensions "open communication and learning from error," "adequate procedures and working conditions," "patient safety management," "support and fellowship," and "organizational learning" than clinical and nonclinical staff. CONCLUSIONS In conclusion, organizational learning is perceived as most positive. However, large gaps remain in the continuity of care as "handover and teamwork" is perceived as the most negative safety culture dimension. With knowledge of the current patient safety culture, organizations can redesign processes or implement improvement strategies to avoid patient safety incidents and patient harm in the future.
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Affiliation(s)
- Melissa Desmedt
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | - Jochen Bergs
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | | | - Ward Schrooten
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | - Annemie Vlayen
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | - Johan Hellings
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | - Neree Claes
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Dominique Vandijck
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
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Aljaffary A, Al Yaqoub F, Al Madani R, Aldossary H, Alumran A. Patient Safety Culture in a Teaching Hospital in Eastern Province of Saudi Arabia: Assessment and Opportunities for Improvement. Risk Manag Healthc Policy 2021; 14:3783-3795. [PMID: 34548827 PMCID: PMC8447945 DOI: 10.2147/rmhp.s313368] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The objective of the present study is to explore the perceptions of patient safety culture (PSC) among King Fahd University Hospital’s (KFUH) employees and to develop recommendations to overcome the factors that impede the integration of PSC in the study setting. Methods This is a cross-sectional study that assessed the level of PSC at KFUH. This study used the Hospital Survey on Patient Safety Culture tool from all KFUH healthcare workers (n=900) in 2018. Findings The response rate of the study was 67%. Findings show that KFUH excelled in three PSC composites: continuous organizational learning, feedback and communication about error, and frequency of events reported. In contrast, staffing, teamwork within units, and non-punitive response to error yielded low composite scores. Originality/Value The strength of the present study was the use of a valid questionnaire that has been used widely in the literature with a large sample size, which yielded valid results. It is, to our knowledge, the first research study that analyzes health workers’ perceptions on patient safety culture in a teaching hospital in Eastern Province in KSA and compares it with Agency for Healthcare Research and Quality (AHRQ) and Saudi Hospital Survey on Patient Safety Culture (HSPSC). Results from the study highlight the need to employ an adequate number of workers, implement continuous patient safety training programs, and adopt safety programs and policies.
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Affiliation(s)
- Afnan Aljaffary
- Department of Health Information Management & Technology; College of Public Health; Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatemah Al Yaqoub
- Risk Management and Patient Safety Department; Dammam Medical Complex, Dammam, Saudi Arabia
| | - Reem Al Madani
- Risk Management Unit, Directorate of Quality and Safety, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hessa Aldossary
- Department of Health Information Management & Technology; College of Public Health; Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Alumran
- Department of Health Information Management & Technology; College of Public Health; Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Draganović Š, Offermanns G, Davis RE. Adaptation of the Agency for Healthcare Research and Quality's 'Hospital Survey on Patient Safety Culture' to the Bosnia and Herzegovina context. BMJ Open 2021; 11:e045377. [PMID: 34385231 PMCID: PMC8362708 DOI: 10.1136/bmjopen-2020-045377] [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: 11/13/2022] Open
Abstract
OBJECTIVES Measuring staff perspectives on patient safety culture (PSC) can identify areas of concern that, if addressed, could lead to improvements in healthcare. To date, there is no validated measure to assess PSC that has been tested and adapted for use in Bosnia and Herzegovina (BiH). This research addresses the gap in the evidence through the psychometric assessment of the Agency for Healthcare Research and Quality's: 'Hospital Survey on Patient Safety Culture' (HSOPSC), to determine its suitability for the health system in BiH. SETTING Nine hospitals. PARTICIPANTS Healthcare professionals (n=1429); nurse (n=823), doctors (n=328), other clinical personnel (n=111), non-clinical personnel (n=60), other (n=64), no response (n=43). PRIMARY AND SECONDARY OUTCOME MEASURES A translated version of HSOPSC was used to conduct psychometric evaluation including exploratory factor analysis and confirmatory factor analysis (CFA). Comparison between the original HSOPSC and the newly adapted 'Hospital Survey on Patient Safety Culture for Bosnia and Herzegovina' (HSOPSC-BiH) was carried out. RESULTS Compared with the original survey, which has 12 factors (42 items), the adapted survey consisted of 9 factors (29 items). The following factors from the original survey were not included in their original form: Communication Openness, Feedback and Communications about error, Overall Perceptions of Patient Safety and Organisational learning-Continuous Improvement. The results of the CFA for HSOPSC-BiH showed a better model fit compared with the original HSOPSC. The absolute and relative fit indices showed excellent model adjustment. CONCLUSIONS The BiH version of Hospital Survey on Patient Safety Culture demonstrated satisfactory psychometric properties, with acceptable to good internal consistency and construct validity. Therefore, we recommend the HSOPSC-BiH as a basis for assessing PSC in BiH. This survey could provide insight into patient safety concerns in BiH so that strategies to overcome these issues could be formulated and implemented.
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Affiliation(s)
- Šehad Draganović
- Faculty of Management and Economics, Department of Human Resource Management, Leadership and Organizational Behavior, University of Klagenfurt, Klagenfurt, Austria
| | - Guido Offermanns
- Faculty of Management and Economics, Department of Human Resource Management, Leadership and Organizational Behavior, University of Klagenfurt, Klagenfurt, Austria
- Karl Landsteiner Society, Institute for Hospital Organization, Vienna, Austria
| | - Rachel E Davis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
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Braun BI, Chitavi SO, Suzuki H, Soyemi CA, Puig-Asensio M. Culture of Safety: Impact on Improvement in Infection Prevention Process and Outcomes. Curr Infect Dis Rep 2020; 22:34. [PMID: 33288982 PMCID: PMC7710367 DOI: 10.1007/s11908-020-00741-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
Purpose Safety culture is known to be related to a wide range of outcomes, and measurement of safety culture is now required for many hospitals in the U.S.A. In previous reviews, the association with outcomes has been limited by the research design and strength of the evidence. The goal of this review was to examine recent literature on the relationship between safety culture and infection prevention and control-related (IPC) processes and healthcare-associated infections (HAIs) in U.S. healthcare organizations. We also sought to quantitatively characterize the challenges to empirically establishing these relationships and limitations of current research. Recent Findings A PubMed search for U.S. articles published 2009–2019 on the topics of infection prevention, HAIs, and safety culture yielded 448 abstracts. After screening, 55 articles were abstracted for information on purpose, measurement, analysis, and conclusions drawn about the role of safety culture in the outcome. Approximately ½ were quality improvement (QI) initiatives and ½ were research studies. Overall, 51 (92.7%) concluded there was an association between safety culture and IPC processes or HAIs. However, only 39 studies measured safety culture and 26 statistically analyzed safety culture data for associations. Though fewer QI initiatives analyzed associations, a higher proportion concluded an association exists than among research studies. Summary Despite limited empirical evidence and methodologic challenges to establishing associations, most articles supported a positive relationship between safety culture, improvement in IPC processes, and decreases in HAIs. Authors frequently reported experiencing improvements in safety culture when not directly measured. The findings suggest that associations between improvement and safety culture may be bi-directional such that positive safety culture contributes to successful interventions and implementing effective interventions drives improvements in culture. Greater attention to article purpose, design, and analysis is needed to confirm these presumptive relationships.
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Affiliation(s)
- Barbara I Braun
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Salome O Chitavi
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Hiroyuki Suzuki
- Department of Internal Medicine - Infectious Diseases, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Caroline A Soyemi
- Neihoff School of Nursing, Loyola University Chicago, Chicago, IL USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, Iowa City, IA USA.,Present Address: Department of Infectious Diseases, Hospital Universitari de Bellvitge: L'Hospitalet de Llobregat, Barcelona, Catalunya Spain
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13
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Bamel UK, Pandey R, Gupta A. Safety climate: Systematic literature network analysis of 38 years (1980-2018) of research. ACCIDENT; ANALYSIS AND PREVENTION 2020; 135:105387. [PMID: 31838322 DOI: 10.1016/j.aap.2019.105387] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
The objective of this paper is to examine the safety climate knowledge epistemology using bibliometric and systematic literature network analysis. For this purpose, bibliometric information of research article published on safety climate topic was retrieved from Scopus databases. In total, 494 articles published between 1980 and 2018 were retrieved. These articles cover 1373 authors, 203 journals and 2511 keywords. Information collected was analyzed employing bibliometric and network analysis approach using an open source computer program R and VOSviewer. The main findings of the study reveal the publication trends in safety climate literature since 1980 to present, identifies most productive authors, and most influential research work. Our findings suggest that Huang and Zohar are the top publishing authors in safety climate domain. Zohar's work has the highest citations. The most influential articles have been published in Journals such as Accident Analysis and Prevention, Journal of Applied Psychology, Safety Science and Journal of Safety Research. Network analysis of these articles yielded co-citation networks of most influential works, bibliographical coupling network and keywords co-occurrence network yielded the structure of safety climate knowledge. Findings of our research have theoretical and practical implications in the area of safety climate.
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Affiliation(s)
| | - Ritesh Pandey
- Assistant Professor, Finance Area, IMT Ghaziabad, India
| | - Amit Gupta
- IIM Amritsar, PTU Capmus, 143105, Amritsar, Punjab, India
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14
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Tawfik DS, Thomas EJ, Vogus TJ, Liu JB, Sharek PJ, Nisbet CC, Lee HC, Sexton JB, Profit J. Safety climate, safety climate strength, and length of stay in the NICU. BMC Health Serv Res 2019; 19:738. [PMID: 31640679 PMCID: PMC6805564 DOI: 10.1186/s12913-019-4592-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022] Open
Abstract
Background Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs). Methods Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU’s respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (< 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality. Results NICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes. Conclusions Safety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, Suite 435, Stanford, CA, 94304, USA.
| | - Eric J Thomas
- The McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.,The University of Texas - Memorial Hermann Center for Healthcare Quality and Safety, Houston, TX, USA
| | - Timothy J Vogus
- Graduate School of Management, Vanderbilt University, Nashville, TN, USA
| | - Jessica B Liu
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Stanford, CA, USA
| | - Paul J Sharek
- California Perinatal Quality Care Collaborative, Stanford, CA, USA.,Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA, USA.,Division of Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Courtney C Nisbet
- California Perinatal Quality Care Collaborative, Stanford, CA, USA.,Division of Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Henry C Lee
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Stanford, CA, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University Health System, Duke University School of Medicine, Durham, NC, USA.,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Stanford, CA, USA
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Waterson P, Carman EM, Manser T, Hammer A. Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies. BMJ Open 2019; 9:e026896. [PMID: 31488465 PMCID: PMC6731893 DOI: 10.1136/bmjopen-2018-026896] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/10/2019] [Accepted: 07/22/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To carry out a systematic review of the psychometric properties of international studies that have used the Hospital Survey on Patient Safety Culture (HSPSC). DESIGN Literature review and an analysis framework to review studies. SETTING Hospitals and other healthcare settings in North and South America, Europe, the Near East, the Middle East and the Far East. DATA SOURCES A total of 62 studies and 67 datasets made up of journal papers, book chapters and PhD theses were included in the review. PRIMARY AND SECONDARY OUTCOME MEASURES Psychometric properties (eg, internal consistency) and sample characteristics (eg, country of use, participant job roles and changes made to the original version of the HSPSC). RESULTS Just over half (52%) of the studies in our sample reported internal reliabilities lower than 0.7 for at least six HSPSC dimensions. The dimensions 'staffing', 'communication openness', 'non-punitive response to error', 'organisational learning' and 'overall perceptions of safety' resulted in low internal consistencies in a majority of studies. The outcomes from assessing construct validity were reported in 60% of the studies. Most studies took place in a hospital setting (84%); the majority of survey participants (62%) were drawn from nursing and technical staff. Forty-two per cent of the studies did not state what modifications, if any, were made to the original US version of the instrument. CONCLUSIONS While there is evidence of a growing worldwide trend in the use of the HSPSC, particularly within Europe and the Near/Middle East, our review underlines the need for caution in using the instrument. Future use of the HSPSC needs to be sensitive to the demands of care settings, the target population and other aspects of the national and local healthcare contexts. There is a need to develop guidelines covering procedures for using, adapting and translating the HSPSC, as well as reporting findings based on its use.
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Affiliation(s)
- Patrick Waterson
- Human Factors and Complex Systems Group, Design School, Loughborough University, Loughborough, UK
| | - Eva-Maria Carman
- Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tanja Manser
- University of Applied Sciences and Arts Northwestern, Olten, Switzerland
| | - Antje Hammer
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
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16
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Deilkås ECT, Hofoss D, Husebo BS, Bondevik GT. Opportunities for improvement in nursing homes: Variance of six patient safety climate factor scores across nursing homes and wards-Assessed by the Safety Attitudes Questionnaire. PLoS One 2019; 14:e0218244. [PMID: 31216307 PMCID: PMC6584014 DOI: 10.1371/journal.pone.0218244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/30/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Safety climates are perceptions of safety culture shared by staff in organizational units. Measuring staff perceptions of patient safety culture by using safety climate surveys is a possible way of addressing patient safety. Studies have documented that patient safety climates vary significantly between work sites in hospitals. Across-ward variations in the measurements of safety climate factor scores may indicate ward-specific risk of adverse events related to patient care routines, work environment, staff behaviour, and patient results. Variation in patient safety climates has not yet been explored in nursing homes. OBJECTIVES To investigate whether the Norwegian translation of the Safety Attitudes Questionnaire-Ambulatory Version is useful to identify significant variation in the patient safety climate factor scores: Teamwork climate, Safety climate, Job satisfaction, Working conditions, Stress recognition, and Perceptions of management, across wards in nursing homes. METHODS Four hundred and sixty three employees from 34 wards in five nursing homes were invited to participate. Cronbach alphas were computed based on individual respondents' scores on the six patient safety climate factor scores. Intraclass correlation coefficients were calculated by multilevel analysis to measure patient safety climate variance at ward level. RESULTS Two hundred and eighty eight (62.2%) returned the questionnaire. At ward level Intraclass correlation coefficients (ICCs) for the factors were 10.2% or higher for the factors Safety climate, Working conditions and Perceptions of management, 2.4% or lower for Teamwork climate, Job satisfaction, and zero for Stress recognition. ICC for variance at nursing home level was zero or less than one per cent for all factor scores. CONCLUSIONS Staff perceptions of Safety climate, Working conditions and Perceptions of management varied significantly across wards. These factor scores may, therefore, be used to identify wards in nursing homes with high and low risk of adverse events, and guide improvement resources to where they are most needed.
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Affiliation(s)
- Ellen Catharina Tveter Deilkås
- The Norwegian Directorate of Health, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Dag Hofoss
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Bettina S. Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
| | - Gunnar Tschudi Bondevik
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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17
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Occelli P, Quenon JL, Kret M, Domecq S, Denis A, Delaperche F, Claverie O, Castets-Fontaine B, Amalberti R, Auroy Y, Parneix P, Michel P. Improving the safety climate in hospitals by a vignette-based analysis of adverse events: a cluster randomised study. Int J Qual Health Care 2019; 31:212-218. [PMID: 29917154 DOI: 10.1093/intqhc/mzy126] [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: 01/09/2017] [Revised: 03/20/2018] [Accepted: 05/26/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess the impact of a vignette-based analysis of adverse events (AEs) on the safety climate (SC) of care units. DESIGN Prospective, open, cluster (a unit) randomised controlled trial. SETTING Eighteen acute care units of seven hospitals in France. PARTICIPANTS Healthcare providers who worked in the units. INTERVENTION Vignette-based analyses of AEs were conducted with unit's providers once per month for six consecutive months. The AEs were real cases that occurred in other hospitals. The hospital risk manager conducted each analysis as follows: analysis of the immediate and root causes of the AE; assessment of the care unit's vulnerabilities and existing barriers in the occurrence of an identical AE and search for solutions. MAIN OUTCOME MEASURE SC was measured using the French version of the Hospital Survey on Patient Safety Culture questionnaire. The primary outcome was the difference in the 'Organisational learning and continuous improvement' dimension score, from before to after the analyses. RESULTS Median participation rate in the analyses was 20% (range: 7-45%). Before intervention, the response rate to the SC survey was 80% (n = 210) in the intervention group and 73% (n = 191) in the control group. After intervention, it was 59% (n = 141) and 63% (n = 148), respectively. The dimension score evolved differently for the groups from before to after intervention (intervention: +10.2 points ±8.8; control: -3.0 points ±8.5, P = 0.04). Side effects were not measured. CONCLUSIONS Vignette-based analysis was associated with the improvement of the perception of participants regarding their institution's capacity for organisational learning and continuous improvement.
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Affiliation(s)
- Pauline Occelli
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France.,Health Services and Performance Research (EA 7425 HESPER), Université de Lyon 1, Lyon, France
| | - Jean-Luc Quenon
- Comité de coordination de l'évaluation clinique et de la qualité en Aquitaine, Pessac, France
| | - Marion Kret
- Comité de coordination de l'évaluation clinique et de la qualité en Aquitaine, Pessac, France
| | - Sandrine Domecq
- Comité de coordination de l'évaluation clinique et de la qualité en Aquitaine, Pessac, France
| | - Angélique Denis
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France.,Health Services and Performance Research (EA 7425 HESPER), Université de Lyon 1, Lyon, France
| | - Florence Delaperche
- Comité de coordination de l'évaluation clinique et de la qualité en Aquitaine, Pessac, France
| | - Olivier Claverie
- Laboratoire des problèmes sociaux et de l'action collective département de sociologie, Université Victor Segalen, Bordeaux, France
| | - Benjamin Castets-Fontaine
- Laboratoire des problèmes sociaux et de l'action collective département de sociologie, Université Victor Segalen, Bordeaux, France
| | - René Amalberti
- Institut de médecine aérospatiale du service de santé des armées, Brétigny sur Orge, France.,Haute autorité de santé, Saint-Denis, France
| | - Yves Auroy
- Institut de médecine aérospatiale du service de santé des armées, Brétigny sur Orge, France.,Hôpital d'instruction des armées du Val de Grace, Paris, France
| | - Pierre Parneix
- Centre de coordination de la lutte contre les infections nosocomiales Sud-Ouest, Bordeaux, France
| | - Philippe Michel
- Health Services and Performance Research (EA 7425 HESPER), Université de Lyon 1, Lyon, France.,Comité de coordination de l'évaluation clinique et de la qualité en Aquitaine, Pessac, France.,Hospices Civils de Lyon, Lyon France
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18
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Assessment of the safety climate in outpatient diagnostic services: Development and psychometric evaluation of a questionnaire. Eur Radiol 2019; 29:1538-1545. [DOI: 10.1007/s00330-018-5646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 11/26/2022]
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19
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Kilpatrick K, Tchouaket É, Paquette L, Guillemette C, Jabbour M, Desmeules F, Landry V, Fernandez N. Measuring patient and family perceptions of team processes and outcomes in healthcare teams: questionnaire development and psychometric evaluation. BMC Health Serv Res 2019; 19:9. [PMID: 30612571 PMCID: PMC6322340 DOI: 10.1186/s12913-018-3808-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/11/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a lack of validated instruments examining dimensions of team functioning from the perspective of patients and families consistent with a conceptual framework. The study aimed to develop and assess the psychometric properties of the Patient-Perceptions of Team Effectiveness (PTE) questionnaire. METHODS A cross-sectional survey was undertaken in three studies. Data were collected from May-October 2016 for Study 1, April 2018-ongoing for Study 2, and October 2016 to June 2017 for Study 3. Online and paper versions of the self-administered questionnaire were available in English and in French. The initial questionnaire included 41 items. Study 1 included 320 respondents. Reliability was assessed using Cronbach alpha. Face validity (n = 250) was assessed using a structured questionnaire. Content validity was examined using subject matter experts and Spearman's item-total correlations. Construct validity was examined using known group comparisons (i.e., clinical specialty, education, length of follow-up, reason of consultation). Content analysis was used for open-ended questions. RESULTS The questionnaire took 10 to 15 min to complete. Positive assessments were noted for instructions, formatting, font size and logical ordering of questions. In Study 1, reliability indices for the PTE-Overall, Team Processes and Outcomes subscales ranged from 0.72 to 0.84. Item-total correlations ranged from 0.551 to 0.794 (p < 0.001). Differences were noted between clinical specialties, education, length of follow-up, reason of consultation, low and high functioning teams. No differences were noted between English and French language respondents. Psychometric properties were re-assessed in Study 2 and 3 after unclear questions were reworked. Reliability indices for the subscales ranged from 0.76 to 0.94 and differences remained significant between low and high functioning teams. CONCLUSION The final 43-item instrument is easy to administer to patients and families. The studies provide evidence of validity to support the propositions in the conceptual framework. The patient-level measures can be aggregated to the team, organizational or system level. The information can be used to assess healthcare team functioning in acute and primary care and determine the role patients and families are playing in teams. Further testing is needed with patients and families who are hospitalized or receiving care from teams in rural areas.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | | | - Lysane Paquette
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Claudel Guillemette
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Campbell PJ, Patel M, Martin JR, Hincapie AL, Axon DR, Warholak TL, Slack M. Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993-2015. BMJ Open Qual 2018; 7:e000193. [PMID: 30306141 PMCID: PMC6173242 DOI: 10.1136/bmjoq-2017-000193] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 07/19/2018] [Accepted: 08/21/2018] [Indexed: 11/04/2022] Open
Abstract
Importance While much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates. Objective The aim of this study was to determine the rate of community pharmacy dispensing errors in the USA. Methods English language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature. Studies with a denominator reflecting the total number of prescriptions in the sample were necessary for inclusion in the meta-analysis. A random effects meta-analysis was conducted to estimate an aggregate community pharmacy dispensing error rate. Heterogeneity was assessed using the I2 statistic prior to analysis. Results The search yielded a total of 8490 records, of which 11 articles were included in the systematic review. Two articles did not have adequate data components to be included in the meta-analysis. Dispensing error rates ranged from 0.00003% (43/1 420 091) to 55% (55/100). The meta-analysis included 1 461 128 prescriptions. The overall community pharmacy dispensing error rate was estimated to be 0.015 (95% CI 0.014 to 0.018); however, significant heterogeneity was observed across studies (I2=99.6). Stratification by study error identification methodology was found to have a significant impact on dispensing error rate (p<0.001). Conclusion and relevance There are few published articles that describe community pharmacy dispensing error rates in the USA. Thus, there is limited information about the current rate of community pharmacy dispensing errors. A robust investigation is needed to assess dispensing error rates in the USA to assess the nature and magnitude of the problem and establish prevention strategies.
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Affiliation(s)
- Patrick J Campbell
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Mira Patel
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Jennifer R Martin
- University of Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Ana L Hincapie
- Division of Pharmacy Practice and Administrative Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - David Rhys Axon
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Terri L Warholak
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Marion Slack
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
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21
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Lacour M, Caviezel C, Weder W, Schneiter D. Postoperative complications and management after lung volume reduction surgery. J Thorac Dis 2018; 10:S2775-S2779. [PMID: 30210831 DOI: 10.21037/jtd.2018.08.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of lung volume reduction surgery (LVRS) for patients suffering from severe emphysema is to improve lung function and palliate dyspnea. Careful patient selection in a multidisciplinary approach in a high-volume center is mandatory for a successful outcome. Pulmonary complications including air leak and pneumonia as well as cardiac complications are the most common complications after LVRS. The following article will focus on most common complications observed after LVRS and review the management strategies to improve surgical outcome.
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Affiliation(s)
- Max Lacour
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
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22
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Chang HY, Friesner D, Chu TL, Huang TL, Liao YN, Teng CI. The impact of burnout on self-efficacy, outcome expectations, career interest and nurse turnover. J Adv Nurs 2018; 74:2555-2565. [DOI: 10.1111/jan.13776] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/24/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Hao-Yuan Chang
- School of Nursing; National Taiwan University; Taipei Taiwan
- Department of Nursing; National Taiwan University Hospital; Taipei Taiwan
| | - Daniel Friesner
- College of Health Professions; North Dakota State University; Fargo North Dakota
| | - Tsung-Lan Chu
- Quality Management Department; Administration Center; Chang Gung Memorial Hospital; Taipei Taiwan
| | - Tzu-Ling Huang
- Department of Health Care Management; Chang Gung University; Taoyuan Taiwan
| | - Yen-Ni Liao
- Department of Health Care Management; Chang Gung University; Taoyuan Taiwan
| | - Ching-I Teng
- Graduate Institute of Business and Management; Chang Gung University; Taoyuan Taiwan
- Department of Rehabilitation; Chang Gung Memorial Hospital; Linkou Taiwan
- Department of Business and Management; Ming Chi University of Technology; Taishan Taiwan
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23
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Patient Safety Climate: A Study of Southern California Healthcare Organizations. J Healthc Manag 2018; 63:175-192. [PMID: 29734279 DOI: 10.1097/jhm-d-16-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
EXECUTIVE SUMMARY Human error remains the most important factor in unnecessary deaths and suffering in U.S. hospitals. Human error results from healthcare providers' attitudes and behaviors toward patients in different settings. Therefore, taking periodic snapshots of the attitudes and behaviors prevalent in an organization and manifested in its patient safety climate (PSC) is essential.We developed and tested a short survey instrument intended as an organization-level measure of PSC with good psychometric properties that can be used in hospitals, clinics, or other healthcare provider settings. Analysis of data from 61 Southern California healthcare organizations resulted in a PSC model with four distinct, reliable factors: (1) Assistance From Others and the Organization, (2) Leadership Messages of Support in Policy and Behavior, (3) Resources and Work Environment, and (4) Error Reporting Behavior. A PSC score, ranging from 0 to 100, was generated for each organization.For a subsample of hospitals in our study, preliminary results indicate a predictive quality of the model. The higher the PSC score, the lower the number of violations detected by the Centers for Medicare & Medicaid Services in complaint inspections, and the fewer the safety problems reported by The Leapfrog Group.Given the association between PSC and health outcomes, we urge healthcare leaders to use various means, such as our survey, to monitor the degree to which their organizations maintain a climate that fosters patient safety and use such data to pinpoint areas for improvement.
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Schwappach D, Richard A. Speak up-related climate and its association with healthcare workers' speaking up and withholding voice behaviours: a cross-sectional survey in Switzerland. BMJ Qual Saf 2018; 27:827-835. [PMID: 29572300 PMCID: PMC6166598 DOI: 10.1136/bmjqs-2017-007388] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/05/2018] [Accepted: 02/25/2018] [Indexed: 11/18/2022]
Abstract
Objectives To determine frequencies of healthcare workers (HCWs) speak up-related behaviours and the association of speak up-related safety climate with speaking up and withholding voice. Design Cross-sectional survey of doctors and nurses. Data were analysed using multilevel logistic regression models Setting 4 hospitals with a total of nine sites from the German, French and Italian speaking part of Switzerland. Participants Survey data were collected from 979 nurses and doctors. Main outcome measures Frequencies of perceived patient safety concerns, of withholding voice and of speaking up behaviour. Speak up-related climate measures included psychological safety, encouraging environment and resignation. Results Perceived patient safety concerns were frequent among doctors and nurses (between 62% and 80% reported at least one safety concern during the last 4 weeks depending on the single items). Withholding voice was reported by 19%–39% of HCWs. Speaking up was reported by more than half of HCWs (55%–76%). The frequency of perceived concerns during the last 4 weeks was positively associated with both speaking up (OR=2.7, p<0.001) and withholding voice (OR=1.6, p<0.001). An encouraging environment was related to higher speaking up frequency (OR=1.3, p=0.005) and lower withholding voice frequency (OR=0.82, p=0.006). Resignation was associated with withholding voice (OR=1.5, p<0.001). The variance in both voicing behaviours attributable to the hospital-site level was marginal. Conclusions Our results strengthen the importance of a speak up-supportive safety climate for staff safety-related communication behaviours, specifically withholding voice. This study indicates that a poor climate, in particular high levels of resignation among HCWs, is linked to frequent ‘silence’ of HCWs but not inversely associated with frequent speaking up. Interventions addressing safety-related voicing behaviours should discriminate between withholding voice and speaking up.
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Affiliation(s)
- David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Aline Richard
- Swiss Patient Safety Foundation, Zurich, Switzerland
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Swiger PA, Loan LA, Raju D, Breckenridge-Sproat ST, Miltner RS, Patrician PA. Relationships between Army nursing practice environments and patient outcomes. Res Nurs Health 2018; 41:131-144. [PMID: 29355993 DOI: 10.1002/nur.21855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/07/2017] [Indexed: 11/08/2022]
Abstract
Favorable nursing practice environments have been associated with lower patient mortality, failure to rescue, nurse-administered medication errors, infections, patient complaints, and patient falls. Favorable environments have also been associated with higher nurse-reported care quality and patient satisfaction in civilian hospitals. However, limited information exists on the relationship between favorable nursing practice environments and positive outcomes in military facilities. Using 4 years of secondary data collected from 45 units in 10 Army hospitals, generalized estimating equations were used to test the associations between nurses' scores on the Practice Environment Scale of the Nursing Work Index (PES-NWI) and patient outcomes of falls with and without injury, medication administration errors with and without harm, and patient experience. Four significant associations were found between the PES-NWI subscales and the patient outcomes under study. The Staffing and Resource Adequacy subscale was significantly associated with patient falls, the Collegial Nurse Physician Relations subscale was significantly associated with the rate of nurse-administered medication errors, and the Nursing Foundations for Quality Care and Collegial Nurse Physician Relations subscales were both significantly associated with patient experience with nursing care. As in civilian hospitals, favorable nursing practice environment was associated with improved patient outcomes within these military nursing units.
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Affiliation(s)
- Pauline A Swiger
- US Army Nurse Corps, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Lori A Loan
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Dheeraj Raju
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | | | - Rebecca S Miltner
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Patricia A Patrician
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
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St Pierre M, Gall C, Breuer G, Schüttler J. [Does annual simulation training influence the safety climate of a university hospital? : Prospective 5‑year investigation using dimensions of the safety attitude questionnaire]. Anaesthesist 2017; 66:910-923. [PMID: 28971216 DOI: 10.1007/s00101-017-0371-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simulation-based training with a focus on non-technical skills can have a positive influence on safety relevant attitudes of participants. If an organization succeeds in training sufficient staff, it may experience a positive change in the safety climate. As the effects of a single training are of a transient nature, annual training sessions may lead to an incremental improvement of safety relevant attitudes of employees over time. In spring 2012 the Department of Anesthesia at the University Hospital of Erlangen established an annual simulation-based training for staff members (e.g. consultants, trainee anesthetists and nurse anesthetists). OBJECTIVE The study aimed to test whether an annual simulation-based training would result in an incremental longitudinal improvement in attitudes towards teamwork, safety and stress recognition. METHODS A survey comprising three domains (teamwork climate, safety climate and stress recognition) of the safety attitudes questionnaire (SAQ) and items addressing briefing and speaking up was distributed to all participants in an annual in-house simulation training. Participants filled out the questionnaire in the morning of each training day. The attitudes were measured before the first training series in 2012, 6 months after the first training and then every year (2013-2016). Participants generated a personalized identification code which allowed individuals to be anonymously tracked over time. Results of the 5‑point Likert scale were transformed to a 100-point scale. Results were calculated at the group level and at the individual level. Univariable linear regression was used to calculate mean changes per year. RESULTS Over a period of 5 years (2012-2016) a total of 255 individuals completed the questionnaire. Each year, 14-20% of all nurse anesthetists and 81-90% of all anesthetists participated in the simulation-based training. As a result of annual staff turnover 16-24% of participants were new staff members. A personalized code allowed the before and after comparison of 99 staff members who had participated twice or more. Physicians had a higher mean score for teamwork climate before the first training (+8.7 p < 0.001). Mean teamwork climate and safety climate scores before the first training increased over a period of 5 years (3.11 for teamwork climate, p < 0.001 and 2.73 for safety climate, p < 0.001). Repeat participation led to a bigger mean change of individual attitudes in nurse anesthetists: teamwork climate 5.2 (nurses) vs. 1.4 (physicians) and safety climate 5.3 (nurses) vs. 2.8 (physicians) without reaching significance. Participants acknowledged the importance of briefings but confirmed their existence in less than half of the cases. The frequency of briefings increased over the 5‑year period. There were no changes in attitude towards speaking up. CONCLUSION Over a 5-year period, small positive changes in attitudes towards teamwork and safety occurred. Low participation of nurse anesthetists as well as personnel turnover may have weakened the impact of simulation-based training on the safety climate.
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Affiliation(s)
- M St Pierre
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
| | - C Gall
- Lehrstuhl für Medizininformatik, Biometrie & Epidemiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - G Breuer
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Schüttler
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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Chinthammit C, Rupp MT, Armstrong EP, Modisett T, Snead RP, Warholak TL. Evaluation of a guided continuous quality improvement program in community pharmacies. J Pharm Policy Pract 2017; 10:26. [PMID: 28878928 PMCID: PMC5584005 DOI: 10.1186/s40545-017-0114-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/29/2017] [Indexed: 11/17/2022] Open
Abstract
Background The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use. This study aims to assess changes in attitudes toward patient safety culture and frequency of quality-related event (QRE) reporting after guided implementation of a continuous quality improvement (CQI) program in a panel of community pharmacies in the United States (U.S.). Methods Twenty-one community pharmacies volunteered to participate in the project and were randomly assigned to intervention or control groups. Pharmacy staff in the intervention group received guided training to ensure full implementation of a CQI program while those in the control group partially implemented the program. Pharmacy staff in both groups completed retrospective pre-post safety culture questionnaires and reported medication errors and near misses that occurred in their practices. Rasch analysis was applied to assess questionnaire validity and reliability and to confirm if the ordinal level data approximated interval level measures. Paired t-tests and repeated measure analysis of covariance tests were subsequently used to compare observed changes in the attitudes of subjects and frequency of QREs reporting in intervention and control groups. Results Sixty-nine employees completed the questionnaire, a 43.9% response rate. Improvement in attitudes toward patient safety was statistically significant in the intervention group in six domains: staff, training, and skill (p = 0.017); patient counseling (p = 0.043); communication about mistakes (p < 0.001); response to mistakes (p < 0.001); organizational learning – continuous improvement (p < 0.001); and overall patient safety perceptions (p = 0.033). No significant differences were observed in QRE reporting rates between intervention and control groups. However, differences were observed in the types of QREs reported (e.g., incorrect safety cap) and the point in the prescription processing workflow where a QRE was detected (e.g., partner check station, and drug utilization review station) in the intervention group (p < 0.001). Conclusion Guided CQI program implementation increased the self-reported patient safety culture attitudes among staff. Electronic supplementary material The online version of this article (10.1186/s40545-017-0114-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chanadda Chinthammit
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arizona, Tucson, AZ USA
| | - Michael T Rupp
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ USA
| | - Edward P Armstrong
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arizona, Tucson, AZ USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ USA
| | - Tara Modisett
- Alliance for Patient Medication Safety, Richmond, VA USA
| | | | - Terri L Warholak
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arizona, Tucson, AZ USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ USA
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Patient safety climate profiles across time: Strength and level of safety climate associated with a quality improvement program in Switzerland-A cross-sectional survey study. PLoS One 2017; 12:e0181410. [PMID: 28753633 PMCID: PMC5533316 DOI: 10.1371/journal.pone.0181410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 07/01/2017] [Indexed: 11/19/2022] Open
Abstract
Safety Climate has been acknowledged as an unspecific factor influencing patient safety. However, studies rarely provide in-depth analysis of climate data. As a helpful approach, the concept of “climate strength” has been proposed. In the present study we tested the hypotheses that even if safety climate remains stable on mean-level across time, differences might be evident in strength or shape. The data of two hospitals participating in a large national quality improvement program were analysed for differences in climate profiles at two measurement occasions. We analysed differences on mean-level, differences in percent problematic response, agreement within groups, and frequency histograms in two large hospitals in Switzerland at two measurement occasions (2013 and 2015) applying the Safety Climate Survey. In total, survey responses of 1193 individuals were included in the analyses. Overall, small but significant differences on mean-level of safety climate emerged for some subgroups. Also, although agreement was strong at both time-points within groups, tendencies of divergence or consensus were present in both hospitals. Depending on subgroup and analyses chosen, differences were more or less pronounced. The present study illustrated that taking several measures into account and describing safety climate from different perspectives is necessary in order to fully understand differences and trends within groups and to develop interventions addressing the needs of different groups more precisely.
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Vogus TJ. Safety climate strength: a promising construct for safety research and practice. BMJ Qual Saf 2016; 25:649-52. [DOI: 10.1136/bmjqs-2015-004847] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/04/2022]
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