1
|
Madden C, Lydon S, Murphy AW, O'Connor P. Patients' perception of safety climate in Irish general practice: a cross-sectional study. BMC FAMILY PRACTICE 2021; 22:257. [PMID: 34961484 PMCID: PMC8710927 DOI: 10.1186/s12875-021-01603-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although patients have the potential to provide important information on patient safety, considerably fewer patient-report measures of safety climate (SC) have been applied in the primary care setting as compared to secondary care. Our aim was to examine the application of a patient-report measure of safety climate in an Irish population to understand patient perceptions of safety in general practice and identify potential areas for improvement. Specifically, our research questions were: 1. What are patients' perceptions of SC in Irish general practice? 2. Do patient risk factors impact perceptions of SC? 3. Do patient responses to an open-ended question about safety enhance our understanding of patient safety beyond that obtained from a quantitative measure of SC? METHODS The Patient Perspective of Safety in General Practice (PPS-GP) survey was distributed to primary care patients in Ireland. The survey consisted of both Likert-response items, and free-text entry questions in relation to the safety of care. A series of five separate hierarchical regressions were used to examine the relationship between a range of patient-related variables and each of the survey subscales. A deductive content analysis approach was used to code the free-text responses. RESULTS A total of 584 completed online and paper surveys were received. Respondents generally had positive perceptions of safety across all five SC subscales of the PPS-GP. Regarding patient risk factors, younger age and being of non-Irish nationality were consistently associated with more negative SC perceptions. Analysis of the free-text responses revealed considerably poorer patient perceptions (n = 85, 65.4%) of the safety experience in primary care. CONCLUSION Our findings indicate that despite being under-utilised, patients' perceptions are a valuable source of information for measuring SC, with promising implications for safety improvement in general practice. Further consideration should be given to how best to utilise this data in order to improve safety in primary care.
Collapse
Affiliation(s)
- Caoimhe Madden
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland.
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland.
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Andrew W Murphy
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
| |
Collapse
|
2
|
Litchfield I, Marsden K, Doos L, Perryman K, Avery A, Greenfield S. A comparative assessment of two tools designed to support patient safety culture in UK general practice. BMC FAMILY PRACTICE 2021; 22:98. [PMID: 34020597 PMCID: PMC8138091 DOI: 10.1186/s12875-021-01438-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The NHS has recognised the importance of a high quality patient safety culture in the delivery of primary health care in the rapidly evolving environment of general practice. Two tools, PC-SafeQuest and MapSaf, were developed with the intention of assessing and improving patient safety culture in this setting. Both have been made widely available through their inclusion in the Royal College of General Practitioners' Patient Safety Toolkit and our work offerss a timely exploration of the tools to inform practice staff as to how each might be usefully applied and in which circumstances. Here we present a comparative analysis of their content, and describe the perspectives of staff on their design, outputs and the feasibility of their sustained use. METHODS We have used a content analysis to provide the context for the qualitative study of staff experiences of using the tools at a representative range of practices recruited from across the Midlands (UK). Data was collected through moderated focus groups using an identical topic guide. RESULTS A total of nine practices used the PC-SafeQuest tool and four the MapSaf tool. A total of 159 staff completed the PC-SafeQuest tool 52 of whom took part in the subsequent focus group discussions, and 25 staff completed the MapSaf tool all of whom contributed to the focus group discussions. PC-SafeQuest was perceived as quick and easy to use with direct questions pertinent to the work of GP practices providing useful quantitative insight into important areas of safety culture. Though MaPSaF was more logistically challenging, it created a forum for synchronous cross- practice discussions raising awareness of perceptions of safety culture across the practice team. CONCLUSIONS Both tools were able to promote reflective and reflexive practice either in individual staff members or across the broader practice team and the oversight they granted provided useful direction for senior staff looking to improve patient safety. Because PC SafeQuest can be easily disseminated and independently completed it is logistically suited to larger practice organisations, whereas the MapSaf tool lends itself to smaller practices where assembling staff in a single workshop is more readily achieved.
Collapse
Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Kate Marsden
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Doos
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Katherine Perryman
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Anthony Avery
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
3
|
Pohlman KA, Salsbury SA, Funabashi M, Holmes MM, Mior S. Patient safety in chiropractic teaching programs: a mixed methods study. Chiropr Man Therap 2020; 28:50. [PMID: 32943068 PMCID: PMC7500017 DOI: 10.1186/s12998-020-00339-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Patient safety research has lagged within academic settings, including chiropractic teaching institutions. To develop a robust patient safety culture, the Institute of Medicine emphasized the need for employee’s attitudes to be understanding and positive. To initiate the assessment of the current culture and future needs, this study evaluated patient safety attitudes among chiropractic teaching clinic stakeholders (supervising clinicians, student interns, and administrative staff) and compared their standardized survey scores to established medical survey databases. Methods We conducted a cross-sectional, mixed methods survey design with quantitative analytic priority. Chiropractic interns, clinical faculty, and clinic staff of 5 international chiropractic educational programs completed a modified version of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture for Medical Offices Survey with open-ended comment fields between 2014 and 2016. Composite means of positive responses were calculated and compared to patient safety, quality of care, and overall self-ratings benchmarks from Canadian providers and academic settings in the AHRQ database. Qualitative responses were thematically categorized for a convergent analysis of quantitative results for the chiropractic sample. Results Chiropractic survey response rate was 45.3% (n = 645). Quantitative survey results indicated moderate scores and ranges (57–85%) on all patient safety dimensions for the chiropractic samples. Academic medicine and chiropractic providers’ benchmarks scored higher positive responses than chiropractic teaching clinics on most quantitative dimensions, except for work pressure/pace. Teamwork, organizational learning, and patient tracking/follow-up were the most positively endorsed quantitative dimensions, with communication, staff training, office standardization, and leadership support considered areas for improvement in both settings. Qualitative responses for the chiropractic clinics identified a need for open communication; additional staff training and student involvement in creating safety cultures; standardization of office processes including information exchange, scheduling, and equipment maintenance; and leadership support that focused on decreasing work pressure/pace and setting safety priorities. Conclusion As the first report of patient safety attitudes from stakeholders in chiropractic teaching clinics, specific areas of improvement were identified. Chiropractic teaching programs might consider incorporating these and related patient safety concepts into their formal curricula. Mixed methods approach offers teaching clinics opportunities to assess stakeholders’ insights and enhance safe delivery of chiropractic care.
Collapse
Affiliation(s)
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, 52803, USA
| | - Martha Funabashi
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Michelle M Holmes
- AECC University College, Parkwood Campus, Parkwood Rd, Bournemouth, BH5 2DF, UK
| | - Silvano Mior
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| |
Collapse
|
4
|
de Wet C, Bowie P, O'Donnell CA. Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory. BMJ Open 2019; 9:e029914. [PMID: 31537569 PMCID: PMC6756363 DOI: 10.1136/bmjopen-2019-029914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Patient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting. DESIGN Qualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT). SETTING Scottish general practice. PARTICIPANTS We conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland. RESULTS We identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants' involvement; (3) the characteristics of the reviewers-implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful. CONCLUSIONS This study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors.
Collapse
Affiliation(s)
- Carl de Wet
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Paul Bowie
- Patient Safety Research, NHS Education for Scotland, Glasgow, UK
| | | |
Collapse
|
5
|
Wang YW, Chia SL, Chou CM, Chen MS, Pelikan JM, Chu C, Wang MH, Lee CB. Development and Validation of a Self-Assessment Tool for an Integrative Model of Health Promotion in Hospitals: Taiwan's Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111953. [PMID: 31159421 PMCID: PMC6603959 DOI: 10.3390/ijerph16111953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022]
Abstract
The Health Promotion Administration of Taiwan launched an integrative certification initiative in 2016 to streamline a plural system of certifications of health promotion in hospitals. It endeavored to replace original certifications, thereby establishing the proposal of a self-assessment instrument to aid in this integration. This study aimed to verify the robustness of this self-assessment tool by conducting exploratory factor analyses through stratification, reliability tests, content and construct validity tests, and specialist evaluations, which were convened to judge the comprehensibility, applicability, and importance of the standards and measures of this tool. A stratified random sampling of 46 hospitals was performed to confirm the validity of this tool. The tool rendered a floor effect of 0% and a ceiling effect of 13%. A valid factor structure and internal consistency (α ranged from 0.88 to 0.96) in each standard were verified. Hospitals with previous certificates or with 300+ beds achieved high compliance scores. A majority of experts agreed that the sub-standards were comprehensible (≥80%), applicable (≥70%), and important (≥70%). Finally, we conclude that the self-assessment tool is valid and can serve as a reference for other countries with hospitals committed to health promotion in hospital settings.
Collapse
Affiliation(s)
- Ying-Wei Wang
- Health Promotion Administration, Ministry of Health and Welfare, Taipei 10341, Taiwan.
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan.
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taipei 10341, Taiwan.
| | - Chien-Ming Chou
- Health Promotion Administration, Ministry of Health and Welfare, Taipei 10341, Taiwan.
| | - Michael S Chen
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan.
- Department of Social Welfare, National Chung Cheng University, Chiayi 62102, Taiwan.
| | - Jürgen M Pelikan
- CC Collaborating Centre for Health Promotion in Hospitals and Health Care, Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010 Vienna, Austria.
- Department of Sociology, University of Vienna, 1090 Vienna, Austria.
| | - Cordia Chu
- Center for Environment and Population Health, Griffith University, Brisbane 4111, Australia.
| | - Mei-Hsiu Wang
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan.
| | - Chiachi Bonnie Lee
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan.
| |
Collapse
|
6
|
Madden C, Lydon S, Cupples ME, Hart ND, Curran C, Murphy AW, O’Connor P. Safety in primary care (SAP-C): a randomised, controlled feasibility study in two different healthcare systems. BMC FAMILY PRACTICE 2019; 20:22. [PMID: 30700257 PMCID: PMC6352328 DOI: 10.1186/s12875-019-0909-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 01/16/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2% of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice. METHODS A randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention's perceived usefulness and feasibility were explored via an end-of-study questionnaire and semi-structured interviews. RESULTS Thirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8% of intervention practice staff (39/46) and 77.8% (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3% (36/46) of intervention practice staff and 68.5% (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19.1% (36/188). Overall, 59% of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention's usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback. CONCLUSION This feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention. TRIAL REGISTRATION The trial registration number is: ISRCTN11426121 (retrospectively registered 12th June 2018).
Collapse
Affiliation(s)
- Caoimhe Madden
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
| | - Margaret E. Cupples
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- Centre for Public Health, School of Medicine, Dentristry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Nigel D. Hart
- Centre for Medical Education, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ciara Curran
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
| | - Andrew W. Murphy
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Paul O’Connor
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
| |
Collapse
|
7
|
Curran C, Lydon S, Kelly ME, Murphy AW, Madden C, O'Connor P. Perceived safety climate in Irish primary care settings-a comparison with Scotland and England. Eur J Gen Pract 2019; 24:252-257. [PMID: 30381979 PMCID: PMC6211251 DOI: 10.1080/13814788.2018.1524002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Safety climate (SC) measurement is a key component of quality and safety initiatives in primary healthcare. Objectives: To (1) measure perceived SC in Irish primary care; (2) examine whether perceptions of safety varied according to respondent characteristics; and (3) compare responses from our Irish sample to data from England and Scotland. Methods: PC-SafeQuest Survey was administered to all practice staff in Irish general practices between March and May 2016. This survey consists of 30 items across five safety domains (workload, communication, leadership, teamwork, and safety systems). Multiple regression analysis was used to identify predictor variables of perceived safety. The effect size of the difference between the Irish sample’s scores and published English and Scottish data were calculated. Results: A total of 231 questionnaires (38.5%) were returned. Generally, positive perceptions of perceived safety were identified among Irish respondents, but workload had the lowest overall mean score (M = 4.3, SD = 1.2) of the five domains. Comparisons across the Irish, English and Scottish samples identified a medium size effect difference in workload; Scottish respondents perceived workload to have less of a negative impact on safety than Irish or English counterparts (Cohen’s d = 0.602, 0.67 respectively). Analyses indicated that Irish GP principals perceived a more negative impact of workload on safety than administrative staff (β = 0.28, P = 0.03). Conclusion: Irish SC data are largely similar to those of England and Scotland. The perceived potential for workload to negatively impact upon safety emerged within each country. In Ireland, GP principals perceive this as a greater threat than practice administrators do.
Collapse
Affiliation(s)
- Ciara Curran
- a Discipline of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b Irish Centre for Applied Patient Safety and Simulation , National University of Ireland Galway , Galway , Ireland
| | - Sinéad Lydon
- a Discipline of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b Irish Centre for Applied Patient Safety and Simulation , National University of Ireland Galway , Galway , Ireland
| | - Maureen E Kelly
- a Discipline of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland
| | - Andrew W Murphy
- a Discipline of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland
| | - Caoimhe Madden
- a Discipline of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b Irish Centre for Applied Patient Safety and Simulation , National University of Ireland Galway , Galway , Ireland.,c HRB Primary Care Clinical Trials Network Ireland , National University of Ireland-Galway, School of Medicine , Galway , Galway , Ireland
| | - Paul O'Connor
- a Discipline of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b Irish Centre for Applied Patient Safety and Simulation , National University of Ireland Galway , Galway , Ireland
| |
Collapse
|
8
|
Klemenc-Ketis Z, Makivić I, Poplas Susic A. The development and validation of a new interprofessional team approach evaluation scale. PLoS One 2018; 13:e0201385. [PMID: 30092005 PMCID: PMC6084891 DOI: 10.1371/journal.pone.0201385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
A team approach in health care involves an interprofessional approach to patient care. We wanted to develop and validate a tool that would evaluate the interprofessional team approach to patients of a family medicine team. We performed a descriptive study in three consecutive phases: a literature review, consensus development panels, and a cross-sectional validation study. Three rounds of consensus development panels were carried out in order to evaluate and adapt the initial scale. The cross-sectional study was carried out in all Slovenian family medicine practices, each invited 10 consecutive patients. In the quantitative study, 3,292 patients participated (a 50.7% response rate), of which 1,810 (55.0%) were women. The mean age of the sample was 53.1 ± 1.2 years. The final Cronbach’s alpha was 0.901. A factor analysis of the 9-item scale put forward two factors (Team Approach and Person-Centred approach) which explained 68.6% of the variance. This study provided a new scale for the evaluation of patient satisfaction with the interprofessional family medicine team from the patients’ point of view. It opened the question of family medicine team competencies and pointed towards the need to develop a family medicine interprofessional team competency framework and a comprehensive tool for its assessment.
Collapse
Affiliation(s)
- Zalika Klemenc-Ketis
- Community Health Centre Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- * E-mail:
| | - Irena Makivić
- Community Health Centre Ljubljana, Ljubljana, Slovenia
| | | |
Collapse
|
9
|
de Wet C, Bowie P, O'Donnell C. 'The big buzz': a qualitative study of how safe care is perceived, understood and improved in general practice. BMC FAMILY PRACTICE 2018; 19:83. [PMID: 29885654 PMCID: PMC5994252 DOI: 10.1186/s12875-018-0772-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/21/2018] [Indexed: 12/04/2022]
Abstract
Background Exploring frontline staff perceptions of patient safety is important, because they largely determine how improvement interventions are understood and implemented. However, research evidence in this area is very limited. This study therefore: explores participants’ understanding of patient safety as a concept; describes the factors thought to contribute to patient safety incidents (PSIs); and identifies existing improvement actions and potential opportunities for future interventions to help mitigate risks. Methods A total of 34 semi-structured interviews were conducted with 11 general practitioners, 12 practice nurses and 11 practice managers in the West of Scotland. The data were thematically analysed. Results Patient safety was considered an important and integral part of routine practice. Participants perceived a proportion of PSIs as being inevitable and therefore not preventable. However, there was consensus that most factors contributing to PSIs are amenable to improvement efforts and acknolwedgement that the potential exists for further enhancements in care procedures and systems. Most were aware of, or already using, a wide range of safety improvement tools for this purpose. While the vast majority was able to identify specific, safety-critical areas requiring further action, this was counter-balanced by the reality that additional resources were a decisive requirment. Conclusion The perceptions of participants in this study are comparable with the international patient safety literature: frontline staff and clinicians are aware of and potentially able to address a wide range of safety threats. However, they require additional resources and support to do so.
Collapse
Affiliation(s)
- Carl de Wet
- Medical Directorate, NHS Education for Scotland, Glasgow, UK. .,General Practice & Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Science, University of Glasgow, Glasgow, Scotland. .,School of Medicine, Griffith University, Southport, Gold Coast, Australia.
| | - Paul Bowie
- Medical Directorate, NHS Education for Scotland, Glasgow, UK.,General Practice & Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Science, University of Glasgow, Glasgow, Scotland
| | - Catherine O'Donnell
- General Practice & Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Science, University of Glasgow, Glasgow, Scotland
| |
Collapse
|
10
|
Marlow S, Bisbey T, Lacerenza C, Salas E. Performance Measures for Health Care Teams: A Review. SMALL GROUP RESEARCH 2018. [DOI: 10.1177/1046496417748196] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interest in effective health care teamwork has advanced in recent years. To ensure these teams are performing effectively, valid and reliable measurement is necessary. This review identifies and organizes information about measures of health care team performance by addressing the following objectives: (a) identify existing measures of health care team performance ( k = 70), (b) summarize validity evidence (i.e., construct and content validity), (c) summarize reliability information (i.e., interrater/interobserver reliability and internal consistency), (d) summarize information pertaining to the use and implementation of the measures (i.e., generalizability, instrument type, and clarity of language), and (e) identify the teamwork content included in the measures. These findings can aid researchers and practitioners in selecting a measure that is appropriate for a specific context. This review also illuminates areas where future research is needed by identifying types of reliability, validity, and teamwork content that have been largely unaddressed.
Collapse
|
11
|
Never Events in UK General Practice: A Survey of the Views of General Practitioners on Their Frequency and Acceptability as a Safety Improvement Approach. J Patient Saf 2017; 15:334-342. [PMID: 28452916 PMCID: PMC5542029 DOI: 10.1097/pts.0000000000000380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental digital content is available in the text. Background Never events (NEs) are serious preventable patient safety incidents and are a component of formal quality and safety improvement (Q&SI) policies in the United Kingdom and elsewhere. A preliminary list of NEs for UK general practice has been developed, but the frequency of these events, or their acceptability to general practitioner (GPs) as a Q&SI approach, is currently unknown. The study aims to estimate (1) the frequency of 10 NEs occurring within GPs' own practices and (2) the extent to which the NE approach is perceived as acceptable for use. Methods General practitioners were surveyed, and mixed-effects logistic regression models examined the relationship between GP opinions of NE, estimates of NE frequency, and the characteristics of the GPs and their practices. Results Responses from 556 GPs in 412 practices were analyzed. Most participants (70%–88%, depending on the NE) agreed that the described incident should be designated as a NE. Three NEs were estimated to have occurred in less than 4% of practices in the last year; however, two NEs were estimated to have occurred in 45% to 61% of the practices. General practitioners reporting that a NE had occurred in their practice in the last year were significantly less likely to agree with the designation as a NE compared with GPs not reporting a NE (odds ratio, 0.42; 95% CI = 0.36–0.49). Conclusions The NE approach may have Q&SI potential for general practice, but further work to adapt the concept and content is required.
Collapse
|
12
|
Lydon S, Cupples ME, Hart N, Murphy AW, Faherty A, O'Connor P. The safety climate in primary care (SAP-C) study: study protocol for a randomised controlled feasibility study. Pilot Feasibility Stud 2016; 2:56. [PMID: 27965872 PMCID: PMC5154125 DOI: 10.1186/s40814-016-0096-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Research on patient safety has focused largely on secondary care settings, and there is a dearth of knowledge relating to safety culture or climate, and safety climate improvement strategies, in the context of primary care. This is problematic given the high rates of usage of primary care services and the myriad of opportunities for clinical errors daily. The current research programme aimed to assess the effectiveness of an intervention derived from the Scottish Patient Safety Programme in Primary Care. The intervention consists of safety climate measurement and feedback and patient chart audit using the trigger review method. The purpose of this paper is to describe the background to this research and to present the methodology of this feasibility study in preparation for a future definitive RCT. Methods The SAP-C study is a feasibility study employing a randomised controlled pretest-posttest design that will be conducted in 10 general practices in the Republic of Ireland and Northern Ireland. Five practices will receive the safety climate intervention over a 9-month period. The five practices in the control group will continue care as usual but will complete the GP-SafeQuest safety climate questionnaire at baseline (month 1) and at the terminus of the intervention (month 9). The outcomes of the study include process evaluation metrics (i.e. rates of participant recruitment and retention, rates of completion of safety climate measures, qualitative data regarding participants’ perceptions of the intervention’s potential efficacy, acceptability, and sustainability), patient safety culture in intervention and control group practices at posttest, and instances of undetected patient harm identified through patient chart audit using the trigger review method. Discussion The planned study investigates an intervention to improve safety climate in Irish primary care settings. The resulting data may inform our knowledge of the frequency of undetected patient safety incidents in primary care, may contribute to improved patient safety practices in primary care settings, and may inform future research on patient safety improvement initiatives. Electronic supplementary material The online version of this article (doi:10.1186/s40814-016-0096-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sinéad Lydon
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Margaret E Cupples
- Department of General Practice and Primary Care, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK ; UKCRC Centre of Excellence for Public Health Research (NI), Queen's University, Belfast, UK
| | - Nigel Hart
- Department of General Practice and Primary Care, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Aileen Faherty
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| |
Collapse
|
13
|
Ricci-Cabello I, Avery AJ, Reeves D, Kadam UT, Valderas JM. Measuring Patient Safety in Primary Care: The Development and Validation of the "Patient Reported Experiences and Outcomes of Safety in Primary Care" (PREOS-PC). Ann Fam Med 2016; 14:253-61. [PMID: 27184996 PMCID: PMC4868564 DOI: 10.1370/afm.1935] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/21/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We set out to develop and validate a patient-reported instrument for measuring experiences and outcomes related to patient safety in primary care. METHOD The instrument was developed in a multistage process supported by an international expert panel and informed by a systematic review of instruments, a meta-synthesis of qualitative studies, 4 patient focus groups, 18 cognitive interviews, and a pilot study. The trial version of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) covered 5 domains and 11 scales: practice activation (1 scale); patient activation (1 scale); experiences of patient safety events (1 scale); harm (6 scales); and general perceptions of patient safety (2 scales). The questionnaire was posted to 6,736 patients in 45 practices across England. We used "gold standard" psychometric methods to evaluate its acceptability, reliability, structural and construct validity, and ability to discriminate among practices. RESULTS 1,244 completed questionnaires (18.5%) were returned. Median item-specific response rate was 91.3% (interquartile range 28.0%). No major ceiling or floor effects were observed. All 6 multi-item scales showed high internal consistency (Cronbach's α 0.75-0.96). Factor analysis, correlation between scales, and known group analyses generally supported structural and construct validity. The scales demonstrated a heterogeneous ability to discriminate between practices. The final version of PREOS-PC consisted of 5 domains, 8 scales, and 58 items. CONCLUSIONS PREOS-PC is a new multi-dimensional patient safety instrument for primary care developed with experts and patients. Initial testing shows its potential for use in primary care, and future developments will further address its use in actual clinical practice.
Collapse
Affiliation(s)
- Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Anthony J Avery
- Division of Primary Care, School of Medicine, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - David Reeves
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Umesh T Kadam
- Arthritis Primary Care Research Centre, Institute for Primary Care and Health Sciences, University of Keele, Keele, United Kingdom Health Services Research Unit, Institute for Science and Technology in Medicine, University of Keele, Keele, United Kingdom
| | - Jose M Valderas
- Health Services & Policy Research Group, Patient Centred Care, University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| |
Collapse
|
14
|
Bowie P, Halley L, Blamey A, Gillies J, Houston N. Qualitative evaluation of the Safety and Improvement in Primary Care (SIPC) pilot collaborative in Scotland: perceptions and experiences of participating care teams. BMJ Open 2016; 6:e009526. [PMID: 26826149 PMCID: PMC4735198 DOI: 10.1136/bmjopen-2015-009526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To explore general practitioner (GP) team perceptions and experiences of participating in a large-scale safety and improvement pilot programme to develop and test a range of interventions that were largely new to this setting. DESIGN Qualitative study using semistructured interviews. Data were analysed thematically. SUBJECTS AND SETTING Purposive sample of multiprofessional study participants from 11 GP teams based in 3 Scottish National Health Service (NHS) Boards. RESULTS 27 participants were interviewed. 3 themes were generated: (1) programme experiences and benefits, for example, a majority of participants referred to gaining new theoretical and experiential safety knowledge (such as how unreliable evidence-based care can be) and skills (such as how to search electronic records for undetected risks) related to the programme interventions; (2) improvements to patient care systems, for example, improvements in care systems reliability using care bundles were reported by many, but this was an evolving process strongly dependent on closer working arrangements between clinical and administrative staff; (3) the utility of the programme improvement interventions, for example, mixed views and experiences of participating in the safety climate survey and meeting to reflect on the feedback report provided were apparent. Initial theories on the utilisation and potential impact of some interventions were refined based on evidence. CONCLUSIONS The pilot was positively received with many practices reporting improvements in safety systems, team working and communications with colleagues and patients. Barriers and facilitators were identified related to how interventions were used as the programme evolved, while other challenges around spreading implementation beyond this pilot were highlighted.
Collapse
Affiliation(s)
- Paul Bowie
- NHS Education for Scotland, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | | | | |
Collapse
|
15
|
Samra R, Bottle A, Aylin P. Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews. BMJ Open 2015; 5:e008128. [PMID: 26362663 PMCID: PMC4577973 DOI: 10.1136/bmjopen-2015-008128] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore how information and data are used to monitor patient safety and quality of primary care by professionals working in, or supporting, primary healthcare. DESIGN Qualitative study of semistructured interviews with a directed content analysis of transcripts. SETTING North-West London, UK. PARTICIPANTS 21 individuals from various levels of the primary healthcare system were recruited, including general practitioners, practice nurses, practice managers, members of Clinical Commissioning Group (CCG) governing bodies, and senior members of regional patient safety teams. RESULTS Participants described being overwhelmed with complicated data which lacked any meaningful analyses about safety and quality. There was also a lack of clarity over which patient safety events are expected to be reported or monitored. Participants also reported uncertainty on whose responsibility it was to act on patient safety information or concerns. At the practice level, there was a range of disincentives for responding to and acting on safety issues and concerns, with few reported benefits. Participants made recommendations to improve future monitoring. CONCLUSIONS There is a need for clearer information in the form of specific guidelines, policies and procedures with regard to who monitors patient safety in primary care, what is monitored and how it should be monitored.
Collapse
Affiliation(s)
- Rajvinder Samra
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Alex Bottle
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Paul Aylin
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| |
Collapse
|
16
|
Evaluating ambulatory practice safety: the PROMISES project administrators and practice staff surveys. Med Care 2015; 53:141-52. [PMID: 25464161 DOI: 10.1097/mlr.0000000000000269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ambulatory practices deliver most health care services and contribute to malpractice risk. Yet, policymakers and practitioners often lack information about safety and malpractice risk needed to guide improvement. OBJECTIVE To assess staff and administrator perceptions of safety and malpractice risk in ambulatory settings. RESEARCH DESIGN We administered surveys in small-sized to medium-sized primary care practices in Massachusetts as part of a randomized controlled trial to reduce ambulatory malpractice risk. SUBJECTS Twenty-five office practice managers/administrators and 482 staff, including [physicians, physician assistants, and nurse practitioners (MD/PA/NPs)], nurses, other clinicians, managers, and administrators. MEASURES Surveys included structured questions about 3 high-risk clinical domains: referral, test result, and medication management, plus communication with patients and among staff. The 30-item administrator survey evaluated the presence of organizational safety structures and processes; the 63-item staff survey queried safety and communication concerns. RESULTS Twenty-two administrators (88%) and 292 staff (61%) responded. Administrators frequently reported important safety systems and processes were absent. Suboptimal or incomplete implementation of referral and test result management systems related to staff perceptions of their quality (P<0.05). Staff perceptions of suboptimal processes correlated with their concern about practice vulnerability to malpractice suits (P<0.05). Staff was least positive about referral management system safety, talking openly about safety problems, willingness to report mistakes, and feeling rushed. MD/PA/NPs viewed high-risk system reliability more negatively (P<0.0001) and teamwork more positively (P<0.03) than others. CONCLUSIONS Results show opportunities for improvement in closing informational loops and establishing more reliable systems and environments where staff feels respected and safe speaking up. Initiatives to transform primary care should emphasize improving communication among facilities and practitioners.
Collapse
|
17
|
Verbakel NJ, Zwart DLM, Langelaan M, Verheij TJM, Wagner C. Measuring safety culture in Dutch primary care: psychometric characteristics of the SCOPE-PC questionnaire. BMC Health Serv Res 2013; 13:354. [PMID: 24044750 PMCID: PMC3851468 DOI: 10.1186/1472-6963-13-354] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/12/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patient safety has been a priority in primary healthcare in the last years. The prevailing culture is seen as an important condition for patient safety in practice and several tools to measure patient safety culture have therefore been developed. Although Dutch primary care consists of different professions, such as general practice, dental care, dietetics, physiotherapy and midwifery, a safety culture questionnaire was only available for general practices. The purpose of this study was to modify and validate this existing questionnaire to a generic questionnaire for all professions in Dutch primary care. METHODS A validated Dutch questionnaire for general practices was modified to make it usable for all Dutch primary care professions. Subsequently, this questionnaire was administered to a random sample of 2400 practices from eleven primary care professions. The instrument's factor structure, reliability and validity were examined using confirmatory and explorative factor analyses. RESULTS 921 questionnaires were returned. Of these, 615 were eligible for factor analysis. The resulting SCOPE-PC questionnaire consisted of seven dimensions: 'open communication and learning from errors', 'handover and teamwork', 'adequate procedures and working conditions', 'patient safety management', 'support and fellowship', 'intention to report events' and 'organisational learning' with a total of 41 items. All dimensions had good reliability with Cronbach's alphas ranging from 0.70-0.90, and the questionnaire had a good construct validity. CONCLUSIONS The SCOPE-PC questionnaire has sound psychometric characteristics for use by the different professions in Dutch primary care to gain insight in their safety culture.
Collapse
Affiliation(s)
- Natasha J Verbakel
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dorien LM Zwart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maaike Langelaan
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Theo JM Verheij
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cordula Wagner
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Hoffmann B, Miessner C, Albay Z, Schröber J, Weppler K, Gerlach FM, Güthlin C. Impact of individual and team features of patient safety climate: a survey in family practices. Ann Fam Med 2013; 11:355-62. [PMID: 23835822 PMCID: PMC3704496 DOI: 10.1370/afm.1500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Knowledge about safety climate is fundamental to improving patient safety in health care organizations. Because individual and organizational factors influence the safety climate, we conducted a health care survey of German family practices so we could analyze the impact of the professional group, the professional experience of practice staff, and practice characteristics on perceptions of the safety climate. METHODS We wrote to health care assistants and doctors in 1,800 randomly selected family practices in Germany and asked them to complete a newly developed and validated Frankfurt Patient Safety Climate Questionnaire. We conducted a descriptive analyses of items and climate factors, as well as regression analysis, to identify potential predictors of the safety climate in family practice. RESULTS The response rate from the participating practices was 36.1%. Safety climate was perceived to be generally positive with the exception of the factors of error management and perception of the causes of errors. We discovered that whether or not the entire team had taken part in the survey had a positive influence on most factors. Doctors had more positive perceptions of 4 of 7 factors addressed to both professions. Male participants and doctors showed the most willingness to admit they had made an error. CONCLUSIONS Though the safety climate in German family practices was positive overall, health care professionals' use of incident reporting and a system's approach to errors was fairly rare. When evaluating the safety climate in primary health care practices, respondents' individual characteristics, as well as organizational features, should be taken into account.
Collapse
Affiliation(s)
- Barbara Hoffmann
- Institute of General Practice, Goethe, University Frankfurt, Germany.
| | | | | | | | | | | | | |
Collapse
|
19
|
Gehring K, Schwappach DLB, Battaglia M, Buff R, Huber F, Sauter P, Wieser M. Safety climate and its association with office type and team involvement in primary care. Int J Qual Health Care 2013; 25:394-402. [PMID: 23667155 DOI: 10.1093/intqhc/mzt036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess differences in safety climate perceptions between occupational groups and types of office organization in primary care. METHODS Primary care physicians and nurses working in outpatient offices were surveyed about safety climate. Explorative factor analysis was performed to determine the factorial structure. Differences in mean climate scores between staff groups and types of office were tested. Logistic regression analysis was conducted to determine predictors for a 'favorable' safety climate. RESULTS 630 individuals returned the survey (response rate, 50%). Differences between occupational groups were observed in the means of the 'team-based error prevention'-scale (physician 4.0 vs. nurse 3.8, P < 0.001). Medical centers scored higher compared with single-handed offices and joint practices on the 'team-based error prevention'-scale (4.3 vs. 3.8 vs. 3.9, P < 0.001) but less favorable on the 'rules and risks'-scale (3.5 vs. 3.9 vs. 3.7, P < 0.001). Characteristics on the individual and office level predicted favorable 'team-based error prevention'-scores. Physicians (OR = 0.4, P = 0.01) and less experienced staff (OR 0.52, P = 0.04) were less likely to provide favorable scores. Individuals working at medical centers were more likely to provide positive scores compared with single-handed offices (OR 3.33, P = 0.001). The largest positive effect was associated with at least monthly team meetings (OR 6.2, P < 0.001) and participation in quality circles (OR 4.49, P < 0.001). CONCLUSIONS Results indicate that frequent quality circle participation and team meetings involving all team members are effective ways to strengthen safety climate in terms of team-based strategies and activities in error prevention.
Collapse
Affiliation(s)
- Katrin Gehring
- Swiss Patient Safety Foundation. Asylstr. 77. 8032 Zuerich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
20
|
Lee CB, Chen MS, Powell M, Chu CMY. Achieving organizational change: findings from a case study of health promoting hospitals in Taiwan. Health Promot Int 2012; 29:296-305. [DOI: 10.1093/heapro/das056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
21
|
Laos CM, DiStefano MC, Cruz AT, Caviness AC, Hsu DC, Patel B. Mobile pediatric emergency response team: patient satisfaction during the novel H1N1 influenza outbreak. Acad Emerg Med 2012; 19:274-9. [PMID: 22435859 DOI: 10.1111/j.1553-2712.2012.01289.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective was to determine child caregiver satisfaction with a nontraditional pediatric emergency department (ED) venue during the 2009 novel H1N1 influenza outbreak. METHODS Between May 1 and 7, 2009, the Texas Children's Hospital (TCH) ED used a six-bed outdoor facility, the Mobile Pediatric Emergency Response Team (MPERT), to evaluate patients with suspected novel H1N1 influenza. Parents and caregivers of patients evaluated in the MPERT were surveyed by telephone using a validated questionnaire to evaluate satisfaction with the facility. RESULTS Of 353 patients, 155 caregivers (44%) completed questionnaires; 127 had wrong numbers, 71 did not answer, and 15 were on a no-call list. Survey responders felt that nurses and doctors explained concepts well (nurses 92%, doctors 94%), 91% felt TCH prepared them well for taking care of their children at home, 94% were satisfied with the medical care received, and 88% were not bothered by the outdoor setting. When asked to rate their MPERT experience on a scale of 0 (worst possible) to 10 (best possible), the median score was 9 (range 1 to 10). CONCLUSIONS The MPERT facility alleviated patient volume surge and potentially prevented transmission during H1N1 outbreak. While these were health care provider goals, caregiver expectations were also met. Caregivers perceived MPERT as an acceptable alternative to receiving care in the regular ED, felt that physicians and nurses communicated well, and felt that medical care was good to excellent. Use of the MPERT did not negatively affect overall caregiver satisfaction with TCH. These findings suggest that families of pediatric patients are amenable to nontraditional ED venues during periods of ED crowding.
Collapse
Affiliation(s)
- Carla M Laos
- Dell Children's Medical Center, Pediatric Emergency Medicine, Austin, TX, USA
| | | | | | | | | | | |
Collapse
|
22
|
de Wet C, Johnson P, Mash R, McConnachie A, Bowie P. Measuring perceptions of safety climate in primary care: a cross-sectional study. J Eval Clin Pract 2012; 18:135-42. [PMID: 20860593 DOI: 10.1111/j.1365-2753.2010.01537.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Building a strong and positive safety culture in health care teams and organizations is essential for patient safety. Measuring individual perceptions of safety climate is an integral part of this process. Evidence of the successful application and potential usefulness of this approach is increasingly available for secondary care settings but little is known about the safety climate in UK primary care. We therefore aimed to measure perceptions of safety climate in primary care. Further aims were to determine whether perceptions varied significantly between practice teams and according to specific participant and practice characteristics. METHOD We undertook a cross-sectional, anonymous postal questionnaire survey of randomly selected west of Scotland primary care teams. Safety climate mean scores with standard deviations were calculated for respondents, practice teams and the region. RESULTS A total of 563 (84%) team members from 49 practices (24.5%) returned questionnaires. The overall safety climate mean score was 5.48 (0.78). Significant differences in safety climate perceptions were found at the practice team level (P < 0.001) and for specific characteristics: respondents' years of experience, whether they were community or practice based, their professional roles and practices' training status. Practice managers and general practitioners perceived the safety climate more positive than other respondents (P < 0.001). CONCLUSION This was the first known attempt to measure perceptions of safety climate in UK primary care with a validated instrument specifically developed for that purpose. Reported perceptions of the prevailing safety climate were generally positive. This may reflect ongoing efforts to build a strong safety culture in primary care or alternatively point to an overestimation of the effectiveness of local safety systems. The significant variation in perception between certain staff groups has potential safety implications and may have to be aligned for a positive and strong safety culture to be built. While safety climate measurement has various benefits at the individual, practice team and regional level, further research of its association with specific safety outcomes is required.
Collapse
|
23
|
Hsu DC, Macias CG. Rubric evaluation of pediatric emergency medicine fellows. J Grad Med Educ 2010; 2:523-9. [PMID: 22132272 PMCID: PMC3010934 DOI: 10.4300/jgme-d-10-00083.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/12/2010] [Accepted: 06/24/2010] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To develop and validate a rubric assessment instrument for use by pediatric emergency medicine (PEM) faculty to evaluate PEM fellows and for fellows to use to self-assess. METHODS This is a prospective study at a PEM fellowship program. The assessment instrument was developed through a multistep process: (1) development of rubric format items, scaled on the modified Dreyfus model proficiency levels, corresponding to the 6 Accreditation Council for Graduate Medical Education core competencies; (2) determination of content and construct validity of the items through structured input and item refinement by subject matter experts and focus group review; (3) collection of data using a 61-item form; (4) evaluation of psychometrics; (5) selection of items for use in the final instrument. RESULTS A total of 261 evaluations were collected from 2006 to 2007; exploratory factor analysis yielded 5 factors with Eigenvalues >1.0; each contained ≥4 items, with factor loadings >0.4 corresponding with the following competencies: (1) medical knowledge and practice-based learning and improvement, (2) patient care and systems-based practice, (3) interpersonal skills, (4) communication skills, and (5) professionalism. Cronbach α for the final 53-item instrument was 0.989. There was also significant responsiveness of the tool to the year of training. CONCLUSION A substantively and statistically validated rubric evaluation of PEM fellows is a reliable tool for formative and summative evaluation.
Collapse
Affiliation(s)
- Deborah C. Hsu
- Corresponding author: Deborah Hsu, MD, MEd, Pediatric Emergency Medicine, Texas Children's Hospital, 6621 Fannin St Ste A 210 MC1-1481, Houston, TX 77030, 832.824.5487,
| | | |
Collapse
|