1
|
Brown A, La J, Keri MI, Hillis C, Razack S, Korah N, Karpinski J, Frank JR, Wong B, Goldman J. In EPAs we trust, is quality and safety a must? A cross-specialty analysis of entrustable professional activity guides. MEDICAL TEACHER 2024:1-9. [PMID: 38527417 DOI: 10.1080/0142159x.2024.2323177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/21/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE The inclusion of quality improvement (QI) and patient safety (PS) into CanMEDS reflects an expectation that graduating physicians are competent in these areas upon training completion. To ensure that Canadian postgraduate specialty training achieves this, the translation of QI/PS competencies into training standards as part of the implementation of competency-based medical education requires special attention. METHODS We conducted a cross-specialty, multi-method analysis to examine how QI/PS was incorporated into the EPA Guides across 11 postgraduate specialties in Canada. RESULTS We identify cross-specialty variability in how QI/PS is incorporated, positioned, and emphasized in EPAs and milestones. QI/PS was primarily referenced alongside clinical activities rather than as a sole competency or discrete activity. Patterns were characterized in how QI/PS became incorporated into milestones through repetition and customization. QI/PS was also decoupled, conceptualized, and emphasized differently across specialties. CONCLUSIONS Variability in the inclusion of QI/PS in EPAs and milestones has important implications considering the visibility and influence of EPA Guides in practice. As specialties revisit and revise EPA Guides, there is a need to balance the standardization of foundational QI/PS concepts to foster shared understanding while simultaneously ensuring context-sensitive applications across specialties. Beyond QI/PS, this study illuminates the challenges and opportunities that lie in bridging theoretical frameworks with practical implementation in medical education, prompting broader consideration of how intrinsic roles and emergent areas are effectively incorporated into competency-based medical education.
Collapse
Affiliation(s)
- Allison Brown
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Julie La
- Graduate Program in Health Quality, Queen's University, Kingston, Canada
- Department of Surgery, Queen's University, Kingston, Canada
| | | | - Chris Hillis
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Saleem Razack
- Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Nadine Korah
- Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Jason R Frank
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Brian Wong
- Centre for Quality Improvement and Patient Safety, Toronto, Canada
- Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Joanne Goldman
- Centre for Quality Improvement and Patient Safety, Toronto, Canada
- Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| |
Collapse
|
2
|
Jalali M, Habibi E, Khakzad N, Aval SB, Dehghan H. A novel framework for human factors analysis and classification system for medical errors (HFACS-MES)-A Delphi study and causality analysis. PLoS One 2024; 19:e0298606. [PMID: 38394116 PMCID: PMC10889608 DOI: 10.1371/journal.pone.0298606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
The healthcare system (HCS) is one of the most crucial and essential systems for humanity. Currently, supplying the patients' safety and preventing the medical adverse events (MAEs) in HCS is a global issue. Human and organizational factors (HOFs) are the primary causes of MAEs. However, there are limited analytical methods to investigate the role of these factors in medical errors (MEs). The aim of present study was to introduce a new and applicable framework for the causation of MAEs based on the original HFACS. In this descriptive-analytical study, HOFs related to MEs were initially extracted through a comprehensive literature review. Subsequently, a Delphi study was employed to develop a new human factors analysis and classification system for medical errors (HFACS-MEs) framework. To validate this framework in the causation and analysis of MEs, 180 MAEs were analyzed by using HFACS-MEs. The results showed that the new HFACS-MEs model comprised 5 causal levels and 25 causal categories. The most significant changes in HFACS-MEs compared to the original HFACS included adding a fifth causal level, named "extra-organizational issues", adding the causal categories "management of change" (MOC) and "patient safety culture" (PSC) to fourth causal level", adding "patient-related factors (PRF)" and "task elements" to second causal level and finally, appending "situational violations" to first causal level. Causality analyses among categories in the HFACS-MEs framework showed that the new added causal level (extra-organizational issues) have statistically significant relationships with causal factors of lower levels (Φc≤0.41, p-value≤0.038). Other new causal category including MOC, PSC, PRF and situational violations significantly influenced by the causal categories of higher levels and had an statistically significant effect on the lower-level causal categories (Φc>0.2, p-value<0.05). The framework developed in this study serves as a valuable tool in identifying the causes and causal pathways of MAEs, facilitating a comprehensive analysis of the human factors that significantly impact patient safety within HCS.
Collapse
Affiliation(s)
- Mahdi Jalali
- Department of Occupational Health Engineering, Student Research Committee, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsanollah Habibi
- Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nima Khakzad
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Canada
| | - Shapour Badiee Aval
- Department of Complementary and Chinese Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Dehghan
- Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
3
|
Laza R, Lustrea A, Lazureanu VE, Marinescu AR, Nicolescu N, Herlo A, Cut TG, Porosnicu TM, Papava I, Romosan RS, Romosan AM, Bondrescu M, Dimeny CZ, Nica-Bacaiteanu CB, Andor M, Dehelean L. Untangling the Professional Web: Understanding the Impact of Work-Related Factors on the Mental Health of Healthcare Professionals During the Late Stages of Covid-19 Pandemic. J Multidiscip Healthc 2023; 16:2391-2404. [PMID: 37609050 PMCID: PMC10441651 DOI: 10.2147/jmdh.s424563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose The COVID-19 pandemic has determined an extraordinary challenge to healthcare systems worldwide. The extraordinary circumstances, characterized by elevated stress levels, prolonged working hours, new medical procedures, media attention, and high population expectations, have created an extremely stressful situation for healthcare professionals. This period has offered a unique opportunity to examine the medical system and the responses of healthcare practitioners to stress. This research aimed to identify the work-related factors that significantly impact the mental health of healthcare professionals. Patients and Methods Three mental health variables were assessed: anxiety, depression and stress. The work-related factors considered were professional degree, type of medical unit (COVID or non-COVID), the number of hours spent at work in a single shift, type of shifts, monthly on-call frequency, and number of COVID-19 treated patients per month. In the spring of 2022, three inventories and a demographic survey were distributed and completed online by 300 healthcare professionals from Timisoara's public hospitals in Romania. Results Among the respondents, 47.7% reported mild symptoms of anxiety, 65.3% reported moderate levels of stress, and 33% of the participants reported mild symptoms of depression. The intensity of anxious, depressive, and stress symptoms varied significantly depending on the professional degree, number of on-calls per month, the type of medical unit where the participants worked, and the number of SARS CoV-2 patients treated in the previous month. Conclusion Current data underlines the urgency of implementing effective strategies to reduce the stress and anxiety of medical practitioners who work with COVID-19 patients. Possible interventions encompass a variety of approaches, such as improving working conditions, reducing working hours where possible, increasing access to mental health services, and promoting team-building activities to enhance social support among colleagues. Digital mental health interventions, including online counseling and stress management programs, have also shown promise in these challenging times. Sustaining the mental health of medical practitioners is vital to support the continued provision of first-rate care to patients and to build a resilient healthcare workforce capable of navigating future health crises.
Collapse
Affiliation(s)
- Ruxandra Laza
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Anca Lustrea
- Department of Educational Sciences, University Clinic of Therapies and Psycho-Pedagogical Counseling, West University of Timisoara, Timisoara, Romania
| | - Voichita Elena Lazureanu
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Adelina Raluca Marinescu
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Narcisa Nicolescu
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alexandra Herlo
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Talida Georgiana Cut
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Doctoral School Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Tamara Mirela Porosnicu
- Doctoral School Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Intensive Care Unit, Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology Timisoara, Timisoara, Romania
| | - Ion Papava
- Department of Neurosciences-Psychiatry, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Radu Stefan Romosan
- Department of Neurosciences-Psychiatry, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Ana-Maria Romosan
- Department of Neurosciences-Psychiatry, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Mariana Bondrescu
- Doctoral School Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurosciences-Psychiatry, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Cristian Zoltan Dimeny
- Department of Psychiatry, Timis County Emergency Clinical Hospital Pius Brinzeu, Timisoara, Romania
| | | | - Minodora Andor
- Department of Medical Semiology II, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Liana Dehelean
- Department of Neurosciences-Psychiatry, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| |
Collapse
|
4
|
Solms L, van Vianen AEM, Koen J, Kan KJ, de Hoog M, de Pagter APJ. Physician exhaustion and work engagement during the COVID-19 pandemic: A longitudinal survey into the role of resources and support interventions. PLoS One 2023; 18:e0277489. [PMID: 36724165 PMCID: PMC9891506 DOI: 10.1371/journal.pone.0277489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Physicians increasingly show symptoms of burnout due to the high job demands they face, posing a risk for the quality and safety of care. Job and personal resources as well as support interventions may function as protective factors when demands are high, specifically in times of crisis such as the COVID-19 pandemic. Based on the Job Demands-Resources theory, this longitudinal study investigated how monthly fluctuations in job demands and job and personal resources relate to exhaustion and work engagement and how support interventions are associated with these outcomes over time. METHODS A longitudinal survey consisting of eight monthly measures in the period 2020-2021, completed by medical specialists and residents in the Netherlands. We used validated questionnaires to assess job demands (i.e., workload), job resources (e.g., job control), personal resources (e.g., psychological capital), emotional exhaustion, and work engagement. Additionally, we measured the use of specific support interventions (e.g., professional support). Multilevel modeling and longitudinal growth curve modeling were used to analyze the data. RESULTS 378 medical specialists and residents were included in the analysis (response rate: 79.08%). Workload was associated with exhaustion (γ = .383, p < .001). All job resources, as well as the personal resources psychological capital and self-judgement were associated with work engagement (γs ranging from -.093 to .345, all ps < .05). Job control and psychological capital attenuated the workload-exhaustion relationship while positive feedback and peer support strengthened it (all ps < .05). The use of professional support interventions (from a mental health expert or coach) was related to higher work engagement (estimate = .168, p = .032) over time. Participation in organized supportive group meetings was associated with higher exhaustion over time (estimate = .274, p = .006). CONCLUSIONS Job and personal resources can safeguard work engagement and mitigate the risk of emotional exhaustion. Professional support programs are associated with higher work engagement over time, whereas organized group support meetings are associated with higher exhaustion. Our results stress the importance of professional individual-level interventions to counteract a loss of work engagement in times of crisis.
Collapse
Affiliation(s)
- Lara Solms
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Annelies E. M. van Vianen
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jessie Koen
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Sustainable Productivity and Employability, Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands
| | - Kees-Jan Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs de Hoog
- Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne P. J. de Pagter
- Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
5
|
Vindrola-Padros C, Ledger J, Hill M, Tomini S, Spencer J, Fulop NJ. The Special Measures for Quality and Challenged Provider Regimes in the English NHS: A Rapid Evaluation of a National Improvement Initiative for Failing Healthcare Organisations. Int J Health Policy Manag 2022; 11:2917-2926. [PMID: 35490260 PMCID: PMC10105181 DOI: 10.34172/ijhpm.2022.6619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/10/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is limited knowledge about interventions used for the improvement of low-performing healthcare organisations and their unintended consequences. Our evaluation sought to understand how healthcare organisations in the National Health Service (NHS) in England responded to a national improvement initiative (the Special Measures for Quality [SMQ] and challenged provider [CP] regimes) and its perceived impact on achieving quality improvements (QIs). METHODS Our evaluation included national-level interviews with key stakeholders involved in the delivery of SMQ (n=6); documentary analysis (n=20); and a qualitative study based on interviews (n=60), observations (n=8) and documentary analysis (n=291) in eight NHS case study sites. The analysis was informed by literature on failure, turnaround and QI in organisations in the public sector. RESULTS At the policy level, SMQ/CP regimes were intended to be "support" programmes, but perceptions of the interventions at hospital level were mixed. The SMQ/CP regimes tended to consider failure at an organisational level and turnaround was visualised as a linear process. There was a negative emotional impact reported by staff, especially in the short-term. Key drivers of change included: engaged senior leadership teams, strong clinical input and supportive external partnerships within local health systems. Trusts focused efforts to improve across multiple domains with particular investment in improving overall staff engagement, developing an open, listening organisational culture and better governance to ensure clinical safety and reporting. CONCLUSION Organisational improvement in healthcare requires substantial time to embed and requires investment in staff to drive change and cultivate QI capabilities at different tiers. The time this takes may be underestimated by external 'turn-around' interventions and performance regimes designed to improve quality in the short-term and which come at an emotional cost for staff. Shifting an improvement focus to the health system or regional level may promote sustainable improvement across multiple organisations over the long-term.
Collapse
Affiliation(s)
- Cecilia Vindrola-Padros
- Department of Applied Health Research, University College London, London, UK
- Department of Targeted Intervention, University College London, London, UK
| | - Jean Ledger
- Department of Applied Health Research, University College London, London, UK
| | - Melissa Hill
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK
| | - Sonila Tomini
- Department of Applied Health Research, University College London, London, UK
| | | | - Naomi J. Fulop
- Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
6
|
Tran Y, Liao HH, Yeh EH, Ellis LA, Clay-Williams R, Braithwaite J. Examining the pathways by which work-life balance influences safety culture among healthcare workers in Taiwan: path analysis of data from a cross-sectional survey on patient safety culture among hospital staff. BMJ Open 2021; 11:e054143. [PMID: 34728459 PMCID: PMC8565544 DOI: 10.1136/bmjopen-2021-054143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study is to examine the pathways by which work-life balance influences safety climate in hospital settings. DESIGN A national cross-sectional survey on patient safety culture. SETTINGS Healthcare workers from 56 hospitals in Taiwan, covering three work settings: intensive care units, operation rooms and emergency departments. PARTICIPANTS 14 345 healthcare workers took part in the survey and were included in the present analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The Safety Attitudes, Maslach's Burn-out Inventory and Work-life balance questionnaires were used to measure patient safety culture, teamwork, leadership, emotional exhaustion and work-life balance. Path analysis was conducted to determine the relationship between work-life balance and safety climate. We tested for mediating and moderating factors influencing this relationship. RESULTS The path between work-life balance and safety climate was found to be significant (b=0.32, p<0.001) and explained through a serial mediation. This relationship was found to be mediated by emotional exhaustion followed by teamwork climate in a full mediation. Leadership factors such as identifying as a manager, moderated the indirect pathway between work-life balance and safety climate through teamwork climate (index of moderation: b=0.083, bias corrected 95% CI 0.044 to 0.120) but not through emotional exhaustion or the serial pathway. Subgroup analysis from non-managers on their perception of management was also found to moderate this relationship. CONCLUSION We found work-life balance to be associated with safety climate through a fully mediated model. The mediation pathways are moderated by self-identified leadership and perceptions of leadership. Understanding the pathways on how work-life balance influences safety climate provides an explanatory model that can be used when designing effective interventions for implementation in system-based approaches to improve patient safety culture in hospital settings.
Collapse
Affiliation(s)
- Yvonne Tran
- MU Hearing, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Hsun-Hsiang Liao
- Joint Commission of Taiwan, Banciao, Taiwan
- Departmment of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - En-Hui Yeh
- Joint Commission of Taiwan, Banciao, Taiwan
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Brubakk K, Svendsen MV, Deilkås ET, Hofoss D, Barach P, Tjomsland O. Hospital work environments affect the patient safety climate: A longitudinal follow-up using a logistic regression analysis model. PLoS One 2021; 16:e0258471. [PMID: 34653217 PMCID: PMC8519418 DOI: 10.1371/journal.pone.0258471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/28/2021] [Indexed: 01/21/2023] Open
Abstract
Background Occupational worker wellness and safety climate are key determinants of healthcare organizations’ ability to reduce medical harm to patients while supporting their employees. We designed a longitudinal study to evaluate the association between work environment characteristics and the patient safety climate in hospital units. Methods Primary data were collected from Norwegian hospital staff from 970 clinical units in all 21 hospitals of the South-Eastern Norway Health Region using the validated Norwegian Work Environment Survey and the Norwegian version of the Safety Attitudes Questionnaire. Responses from 91,225 surveys were collected over a three year period. We calculated the factor mean score and a binary outcome to measure study outcomes. The relationship between the hospital unit characteristics and the observed changes in the safety climate was analyzed by linear and logistic regression models. Results A work environment conducive to safe incident reporting, innovation, and teamwork was found to be significant for positive changes in the safety climate. In addition, a work environment supportive of patient needs and staff commitment to their workplace was significant for maintaining a mature safety climate over time. Conclusions A supportive work environment is essential for patient safety. The characteristics of the hospital units were significantly associated with the unit’s safety climate scores, hence improvements in working conditions are needed for enhancing patient safety.
Collapse
Affiliation(s)
- Kirsten Brubakk
- Department of Human Resources, South Eastern Norway Regional Health Authority, Hamar, Norway
- Institute for Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Martin Veel Svendsen
- Department of Occupational and Environmental Medicine, Telemark Hospital Trust, Skien, Norway
| | - Ellen Tveter Deilkås
- Department of Quality Improvement and Patient Safety, Norwegian Directorate of Health, Oslo, Norway
- Unit for Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Dag Hofoss
- Department of Health and Inequality, National Institute of Public Health, Oslo, Norway
| | - Paul Barach
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United States of America
- Jefferson College of Population Health, Philadelphia, Pennsylvania, United States of America
- Sigmund Freud University, Vienna, Austria
| | - Ole Tjomsland
- Department of Health, South Eastern Norway Regional Health Authority, Hamar, Norway
| |
Collapse
|
8
|
Gauld R, Horsburgh S. Did healthcare professional perspectives on the quality and safety environment in New Zealand public hospitals change from 2012 to 2017? J Health Organ Manag 2021; 34:775-788. [PMID: 32979044 DOI: 10.1108/jhom-11-2019-0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The work environment is known to influence professional attitudes toward quality and safety. This study sought to measure these attitudes amongst health professionals working in New Zealand District Health Boards (DHBs), initially in 2012 and again in 2017. DESIGN/METHODOLOGY/APPROACH Three questions were included in a national New Zealand health professional workforce survey conducted in 2012 and again in 2017. All registered health professionals employed with DHBs were invited to participate in an online survey. Areas of interest included teamwork amongst professionals; involvement of patients and families in efforts to improve patient care and ease of speaking up when a problem with patient care is perceived. FINDINGS In 2012, 57% of respondents (58% in 2017) agreed health professionals worked as a team; 71% respondents (73% in 2017) agreed health professionals involved patients and families in efforts to improve patient care and 69% (65% in 2017) agreed it was easy to speak up in their clinical area, with none of these changes being statistically significant. There were some response differences by respondent characteristics. PRACTICAL IMPLICATIONS With no change over time, there is a demand for improvement. Also for leadership in policy, management and amongst health professionals if goals of improving quality and safety are to be delivered upon. ORIGINALITY/VALUE This study provides a simple three-question method of probing perceptions of quality and safety and an important set of insights into progress in New Zealand DHBs.
Collapse
Affiliation(s)
- Robin Gauld
- Dean's Office and Centre for Health Systems and Technology, School of Business, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Preventive and Social Medicine and Centre for Health Systems and Technology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
9
|
Yuce TK, Yang AD, Johnson JK, Odell DD, Love R, Kreutzer L, Schlick CJR, Zambrano MI, Shan Y, O'Leary KJ, Halverson A, Bilimoria KY. Association Between Implementing Comprehensive Learning Collaborative Strategies in a Statewide Collaborative and Changes in Hospital Safety Culture. JAMA Surg 2021; 155:934-940. [PMID: 32805054 DOI: 10.1001/jamasurg.2020.2842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Hospital safety culture remains a critical consideration when seeking to reduce medical errors and improve quality of care. Little is known regarding whether participation in a comprehensive, multicomponent, statewide quality collaborative is associated with changes in hospital safety culture. Objective To examine whether implementation of a comprehensive, multicomponent, statewide surgical quality improvement collaborative is associated with changes in hospital safety culture. Design, Setting, and Participants In this survey study, the Safety Attitudes Questionnaire, a 56-item validated survey covering 6 culture domains (teamwork, safety, operating room safety, working conditions, perceptions of management, and employee engagement), was administered to a random sample of physicians, nurses, operating room staff, administrators, and leaders across Illinois hospitals to assess hospital safety culture prior to launching a new statewide quality collaborative in 2015 and then again in 2017. The final analysis included 1024 respondents from 36 diverse hospitals, including major academic, community, and rural centers, enrolled in ISQIC (Illinois Surgical Quality Improvement Collaborative). Exposures Participation in a comprehensive, multicomponent statewide surgical quality improvement collaborative. Key components included enrollment in a common standardized data registry, formal quality and process improvement training, participation in collaborative-wide quality improvement projects, funding support for local projects, and guidance provided by surgeon mentors and process improvement coaches. Main Outcomes and Measures Perception of hospital safety culture. Results The overall survey response rate was 43.0% (580 of 1350 surveys) in 2015 and 39.0% (444 of 1138 surveys) in 2017 from 36 hospitals. Improvement occurred in all the overall domains, with significant improvement in teamwork climate (change, 3.9%; P = .03) and safety climate (change, 3.2%; P = .02). The largest improvements occurred in individual measures within domains, including physician-nurse collaboration (change, 7.2%; P = .004), reporting of concerns (change, 4.7%; P = .009), and reduction in communication breakdowns (change, 8.4%; P = .005). Hospitals with the lowest baseline safety culture experienced the largest improvements following collaborative implementation (change range, 11.1%-14.9% per domain; P < .05 for all). Although several hospitals experienced improvement in safety culture in 1 domain, most hospitals experienced improvement across several domains. Conclusions and Relevance This survey study found that hospital enrollment in a statewide quality improvement collaborative was associated with overall improvement in safety culture after implementing multiple learning collaborative strategies. Hospitals with the poorest baseline culture reported the greatest improvement following implementation of the collaborative.
Collapse
Affiliation(s)
- Tarik K Yuce
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Anthony D Yang
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Julie K Johnson
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - David D Odell
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Remi Love
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Lindsey Kreutzer
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Cary Jo R Schlick
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Marina I Zambrano
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Ying Shan
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Kevin J O'Leary
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Karl Y Bilimoria
- Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago.,Surgical Outcomes and Quality Improvement Center, Department of Surgery (SOQIC), Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| |
Collapse
|
10
|
Fulop N, Barbosa EC, Hill M, Ledger J, Sherlaw-Johnson C, Spencer J, Vindrola-Padros C, Morris S. Special Measures for Quality and Challenged Providers: Study Protocol for Evaluating the Impact of Improvement Interventions in NHS Trusts. Int J Health Policy Manag 2020; 9:143-151. [PMID: 32331494 PMCID: PMC7182148 DOI: 10.15171/ijhpm.2019.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Healthcare organisations in England rated as inadequate in terms of leadership and one other domain enter the Special Measures for Quality (SMQ) regime to receive increased support and oversight. There is also a ‘watch list’ of challenged National Health Service (NHS) providers at risk of going into SMQ that receive support. There is limited knowledge about whether the interventions used to deliver this support drive improvements in quality, their costs, and whether they strike the right balance between support and scrutiny. The study will seek to determine how provider organisations respond to these interventions, and whether and how these interventions impact organisations’ capacity to achieve and sustain quality improvements over time.
Methods: This is a multi-site, mixed methods study. We will carry out interviews at national level to understand the programme theory underpinning the interventions. We will conduct 8 NHS case studies to explore the impact and implementation of the interventions that form part of the SMQ and challenged providers programme. We will use a conceptual framework based on models of organisational readiness for change and draw on board maturity research for implementing quality improvement. We will also review the use of quantitative metrics and data for tracking the progress of improvements in quality of care and sustainability upon leaving SMQ, as well as the costs and benefits of the interventions through a cost-consequence analysis (CCA).
Discussion: High-quality interventions that successfully support struggling healthcare organisations are essential and an issue that is an international concern. Our study will allow a greater understanding of the programme theory, impact, and staff views and experiences of the SMQ and challenged providers regime. Formative feedback will be reported to key stakeholders.
Collapse
Affiliation(s)
- Naomi Fulop
- Department of Applied Health Research, University College London, London, UK
| | | | - Melissa Hill
- Department of Applied Health Research, University College London, London, UK
| | - Jean Ledger
- Department of Applied Health Research, University College London, London, UK
| | | | | | | | - Steve Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
11
|
Bing-You R, Ramani S, Ramesh S, Hayes V, Varaklis K, Ward D, Blanco M. The interplay between residency program culture and feedback culture: a cross-sectional study exploring perceptions of residents at three institutions. MEDICAL EDUCATION ONLINE 2019; 24:1611296. [PMID: 31038417 PMCID: PMC6493320 DOI: 10.1080/10872981.2019.1611296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/24/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Giving and receiving feedback that changes performance is influenced significantly by the clinical learning environment. This environment is multi-dimensional but includes both organizational and feedback specific dimensions. OBJECTIVE The objectives of this research were to investigate the relationship between residents' perceptions of residency program culture and feedback culture; and whether there were differences in resident perceptions of their programs' and feedback cultures based on their disciplines and institution. We hypothesized that residents preferred certain program culture types and that certain aspects of a residency program's culture were related to the feedback culture. DESIGN Residents from six specialties at three institutions voluntarily completed two validated survey instruments (Organizational Culture Assessment Instrument [OCAI] and Feedback in Medical Education [FEEDME]-Culture survey) to assess the residency program and feedback cultures, respectively. Descriptive statistics were calculated and non-parametric tests were used to analyze the data. RESULTS The overall response rate was 37.9% (116/306 residents). 'Clan' culture was both the current and preferred culture by 49.3% and 56.8%, respectively, of the residents overall. There were differences across programs with more current 'clan' culture in pediatrics than in surgery (P = 0.01). Multiple regression analysis showed the Hierarchy Now culture type was significantly related to the feedback culture mean score (p = <.01). For every one unit increase in the Hierarchy Now culture type, the FEEDME-Culture mean score decreases by 0.023 units. CONCLUSIONS The findings of this study add to the literature by describing residents' preferences of their residency program's culture, and providing insights into the interplay between the residency program and feedback cultures.
Collapse
Affiliation(s)
- Robert Bing-You
- Department of Medical Education, Maine Medical Center, Portland, ME, USA
| | - Subha Ramani
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Saradha Ramesh
- Office of Educational Affairs, Tufts University School of Medicine, Boston, MA, USA
| | - Victoria Hayes
- Department of Medical Education, Maine Medical Center, Portland, ME, USA
| | - Kalli Varaklis
- Department of Medical Education, Maine Medical Center, Portland, ME, USA
| | - Denham Ward
- Department of Medical Education, Maine Medical Center, Portland, ME, USA
| | - Maria Blanco
- Office of Educational Affairs, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
12
|
Validation of the Indonesian version of the Safety Attitudes Questionnaire: A Rasch analysis. PLoS One 2019; 14:e0215128. [PMID: 30970024 PMCID: PMC6457536 DOI: 10.1371/journal.pone.0215128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 03/24/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Safety climate, which provides a snapshot of safety culture, is rarely measured in Indonesian healthcare organisations because there are no validated surveys that can be administered in its native language, Bahasa Indonesia. The objectives of this study were to translate and linguistically adapt the Safety Attitudes Questionnaire into Bahasa Indonesia, and investigate the internal construct validity and reliability of the translated survey. Methods The Safety Attitudes Questionnaire was translated into Indonesian language through forward and backward translation. The internal construct validity and reliability of the translated survey was assessed using Rasch analysis which examines overall model fit, unidimensionality, response format, targeting, internal consistency reliability and item bias. Results A total of 279 nurses (response rate 82%) completed the Indonesian version of the Safety Attitudes Questionnaire. Most respondents were Division 2 registered nurses (n = 209; 75%), female (n = 174; 62%), and aged less than 30 years (n = 187; 67%). All six domains of the Indonesian version of the Safety Attitudes Questionnaire demonstrated unidimensionality (t-test less than 0.05 threshold value). However, suboptimal targeting (ceiling effect) was observed in all domains, and had at least one misfitting item (item fit residual beyond ±2.5) Item bias was also evident in most domains. Conclusion This study has translated and validated an Indonesian version of the Safety Attitudes Questionnaire for the first time. Whilst there was general support to sum items to obtain domain scores, further work is required to refine the response options as well as the wording and number of items in this survey to improve its overall measurement properties.
Collapse
|
13
|
Kava CM, Parker EA, Baquero B, Curry SJ, Gilbert PA, Sauder M, Sewell DK. Associations Between Organizational Culture, Workplace Health Climate, and Employee Smoking at Smaller Workplaces. Tob Use Insights 2019; 12:1179173X19835842. [PMID: 30906195 PMCID: PMC6421609 DOI: 10.1177/1179173x19835842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Smaller workplaces frequently employ low-wage earners, who have higher smoking rates. Organizational culture and workplace health climate are two characteristics that could influence employee smoking. The purpose of this study was to examine the associations between organizational culture, workplace health climate, and smoking among employees at small (20-99 employees) and very small (<20 employees) workplaces. We proposed the following hypotheses: a stronger clan culture will be associated with a better workplace health climate (HP1); a better workplace health climate will be associated with lower odds of current smoking (HP2); and there will be an association between workplace health climate and smoking intensity (HP3) and between workplace health climate and quit intention (HP4). Methods: Executives and employees completed separate online questionnaires. Data collection occurred between June and October 2017. We used regression and Fisher’s exact tests to answer study hypotheses. Results: Workplaces with stronger clan cultures had a better workplace health climate (b = 0.27, P < .05), providing support for HP1. A better workplace health climate was associated with lower odds of being a current smoker (odds ratio [OR] = 0.08; 95% confidence interval [CI]: 0.01, 0.53), providing support for HP2. No significant relationship existed between workplace health climate and smoking intensity (P = .50) or between workplace health climate and intention to quit smoking (P = .32); therefore, HP3 and HP4 were not supported. Conclusion: Certain culture types may inform an organization’s health climate. Despite a lower likelihood of current smoking in workplaces with better health climates, a better health climate may not be sufficient to produce changes in smoking behavior and intentions.
Collapse
Affiliation(s)
- Christine M Kava
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA.,Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Edith A Parker
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Barbara Baquero
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Susan J Curry
- Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Paul A Gilbert
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Michael Sauder
- Department of Sociology, The University of Iowa, Iowa City, IA, USA
| | - Daniel K Sewell
- Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA, USA
| |
Collapse
|
14
|
Jiang K, Tian L, Yan C, Li Y, Fang H, Peihang S, Li P, Jia H, Wang Y, Kang Z, Cui Y, Liu H, Zhao S, Anastasia G, Jiao M, Wu Q, Liu M. A cross-sectional survey on patient safety culture in secondary hospitals of Northeast China. PLoS One 2019; 14:e0213055. [PMID: 30893337 PMCID: PMC6426212 DOI: 10.1371/journal.pone.0213055] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/14/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aims to investigate patient safety culture in secondary hospitals of Heilongjiang, Northeast China, and explore the implications of patient safety culture and practices through the perspectives of various healthcare workers. METHODS A cross-sectional survey using the Safety Attitude Questionnaire (SAQ) was conducted to ascertain the status of patient safety culture in nine secondary hospitals across the six dimensions of the SAQ. Among the 900 staff members who were invited to participate, 665 completed the questionnaire. Descriptive statistics were used to calculate the general means and standard deviations of the patient safety culture dimensions and other numerical variables, and F-test and a multivariate regression analysis were used to statistically analyze the differences in perceptions of safety culture considering the differences in demographic characteristics. All statistical analyses were performed using SPSS v. 22.0. RESULTS The respondents rated job satisfaction as the highest among all six dimensions of the SAQ, followed in order by teamwork climate, working conditions, and stress recognition (the lowest). There were significant differences among the dimensions of patient safety culture and other factors, such as gender, age, job position, and education. Compared with previous studies, teamwork climate and working conditions scores were quite high, while stress recognition score was very low. We also found differences in patient safety culture by demographic characteristics. CONCLUSIONS The findings revealed the patient safety culture attitudes of healthcare workers in secondary hospitals of Heilongjiang, and provided baseline data for related future research. This evidence may also help government health policymakers and hospital administrators understand related challenges and develop strategies to improve patient safety culture in secondary hospitals of China and perhaps also in other developing countries.
Collapse
Affiliation(s)
- Kexin Jiang
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Linli Tian
- Head and Neck Surgery, Department of Otorhinolaryngology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Cunling Yan
- Department of Medical, Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Ying Li
- Department of Organization, General Hospital of Benxi Iron and Steel Co, Benxi, China
| | - Huiying Fang
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Sun Peihang
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Peng Li
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Haonan Jia
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Yameng Wang
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Zheng Kang
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Yu Cui
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - He Liu
- Office of Academic Affairs, Hebei Medical University, Chang’an District, Shijiazhuang, China
| | - Siqi Zhao
- Department of Nursing Psychology and Humanities, Hebei Medical University, Yuhua District, Shijiazhuang, China
| | - Gamburg Anastasia
- Department of Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Mingli Jiao
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
- Chinese Academy of Social Science, Institute of Quantitative & Technical Economics, Dongcheng District, Beijing, China
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Ming Liu
- Otorhinolaryngology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
15
|
Association Between Hospital Safety Culture and Surgical Outcomes in a Statewide Surgical Quality Improvement Collaborative. J Am Coll Surg 2019; 229:175-183. [PMID: 30862538 DOI: 10.1016/j.jamcollsurg.2019.02.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/11/2018] [Accepted: 02/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The "safety culture" within hospital systems is increasingly recognized as important to delivery of high-quality care. We examine the safety culture in a statewide hospital quality improvement collaborative and its associations with surgical outcomes. STUDY DESIGN A modified Safety Attitudes Questionnaire was sent to administrators, quality improvement teams, nurses, anesthesiologists, and surgeons in 49 hospitals participating in the Illinois Surgical Quality Improvement Collaborative in 2015. Associations between positive safety culture, as measured by percentage of positive responses on the Safety Attitudes Questionnaire, and the following NSQIP 30-day adverse outcomes: hospital-level risk-adjusted morbidity, mortality, death, or serious morbidity and readmission rates. Linear regression models with hospitals clustered by system were used to assess the relationship between safety culture and patient outcomes. RESULTS Operating room safety culture scores were highest (97.7% positive) compared with the other domains, and ratings of hospital management were lowest (75.9% positive). Hospital administrators consistently had the most positive perception of the safety culture (90.5% positive) and front-line providers were less positive: physicians (85.3%), advanced practice providers (88.1%), and nurses (80%). Teamwork was rated as a strength by patient care providers (physicians 88.3%, advanced practice providers 90.2%, and nurses 82.2%), but was perceived as weakest by administrators. Higher percentage of positive Safety Attitudes Questionnaire responses was significantly associated with lower risk of postoperative morbidity (p = 0.007) and death or serious morbidity (p = 0.04). No significant association between safety culture and the risk of mortality (p = 0.23) or readmissions (p = 0.52) was observed. CONCLUSIONS Hospital safety culture can influence certain surgical patient outcomes. Improving the safety culture within a hospital can represent a previously unrecognized approach that can be leveraged to strengthen surgical quality improvement efforts at the hospital level.
Collapse
|
16
|
Smith SN, Almirall D, Prenovost K, Goodrich DE, Abraham KM, Liebrecht C, Kilbourne AM. Organizational culture and climate as moderators of enhanced outreach for persons with serious mental illness: results from a cluster-randomized trial of adaptive implementation strategies. Implement Sci 2018; 13:93. [PMID: 29986765 PMCID: PMC6038326 DOI: 10.1186/s13012-018-0787-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/26/2018] [Indexed: 01/05/2023] Open
Abstract
Background Organizational culture and climate are considered key factors in implementation efforts but have not been examined as moderators of implementation strategy comparative effectiveness. We investigated organizational culture and climate as moderators of comparative effectiveness of two sequences of implementation strategies (Immediate vs. Delayed Enhanced Replicating Effective Programs [REP]) combining Standard REP and REP enhanced with facilitation on implementation of an outreach program for Veterans with serious mental illness lost to care at Veterans Health Administration (VA) facilities nationwide. Methods This study is a secondary analysis of the cluster-randomized Re-Engage implementation trial that assigned 3075 patients at 89 VA facilities to either the Immediate or Delayed Enhanced REP sequences. We hypothesized that sites with stronger entrepreneurial culture, task, or relational climate would benefit more from Enhanced REP than Standard REP. Veteran- and site-level data from the Re-Engage trial were combined with site-aggregated measures of entrepreneurial culture and task and relational climate from the 2012 VA All Employee Survey. Longitudinal mixed-effects logistic models examined whether the comparative effectiveness of the Immediate vs. Delayed Enhanced REP sequences were moderated by culture or climate measures at 6 and 12 months post-randomization. Three Veteran-level outcomes related to the engagement with the VA system were assessed: updated documentation, attempted contact by coordinator, and completed contact. Results For updated documentation and attempted contact, Veterans at sites with higher entrepreneurial culture and task climate scores benefitted more from Enhanced REP compared to Standard REP than Veterans at sites with lower scores. Few culture or climate moderation effects were detected for the comparative effectiveness of the full sequences of implementation strategies. Conclusions Implementation strategy effectiveness is highly intertwined with contextual factors, and implementation practitioners may use knowledge of contextual moderation to tailor strategy deployment. We found that facilitation strategies provided with Enhanced REP were more effective at improving uptake of a mental health outreach program at sites with stronger entrepreneurial culture and task climate; Veterans at sites with lower levels of these measures saw more similar improvement under Standard and Enhanced REP. Within resource-constrained systems, practitioners may choose to target more intensive implementation strategies to sites that will most benefit from them. Trial registration ISRCTN: ISRCTN21059161. Date registered: April 11, 2013. Electronic supplementary material The online version of this article (10.1186/s13012-018-0787-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Daniel Almirall
- Institute for Social Research and Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Katherine Prenovost
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kristen M Abraham
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychology, University of Detroit Mercy, Detroit, MI, USA
| | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Health Services Research and Development, Veterans Health Administration, US Department of Veterans, Washington DC, USA
| |
Collapse
|
17
|
Rose A, Uebel KE, Rae WI. Interventionalists' perceptions on a culture of radiation protection. SA J Radiol 2018; 22:1285. [PMID: 31754493 PMCID: PMC6837825 DOI: 10.4102/sajr.v22i1.1285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/21/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Occupational exposure to ionising radiation poses potential health risks to radiation workers unless adequate protection is in place. The catheterisation laboratory is a highly contextualised workplace with a distinctive organisational and workplace culture. OBJECTIVE This study was conducted to understand the culture of radiation protection (CRP). METHODS This study was a qualitative study and data were collected through 30 in-depth and 6 group interviews with 54 purposively selected South African interventionalists (interventional radiologists and cardiologists). The participants included a diversity of interventionalists who varied in sex, geographic location and years of experience with fluoroscopy. The transcribed data were analysed thematically using a deductive and inductive approach. RESULTS 'Culture of radiation protection' emerged as a complex theme that intersected with other themes: 'knowledge and awareness of radiation', 'radiation safety practice', 'personal protective equipment (PPE) utilisation' and 'education and training'. CONCLUSION Establishing and sustaining a CRP provides an opportunity to mitigate the potentially detrimental health effects of occupational radiation exposure. Education and training are pivotal to establishing a CRP. The time to establish a culture of radiation in the catheterisation laboratory is now.
Collapse
Affiliation(s)
- André Rose
- Department of Community Health, University of the Free State, South Africa
| | - Kerry E. Uebel
- Department of Internal Medicine, University of the Free State, South Africa
| | - William I. Rae
- Department of Medical Physics, University of the Free State, South Africa
| |
Collapse
|
18
|
Blumenthal DM, Olenski AR, Tsugawa Y, Jena AB. Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries. JAMA 2017; 318:2119-2129. [PMID: 29209722 PMCID: PMC5820716 DOI: 10.1001/jama.2017.17925] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. OBJECTIVE To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. DESIGN, SETTING, AND PARTICIPANTS A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. EXPOSURES Treatment by locum tenens general internal medicine physicians. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. RESULTS Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154), significantly longer mean length of stay (5.64 days vs 5.21 days; adjusted difference, 0.43 days; 95% CI, 0.34 to 0.52), and significantly lower 30-day readmissions (22.80% vs 23.83%; adjusted difference, -1.00%; 95% CI -1.57% to -0.54%). CONCLUSIONS AND RELEVANCE Among hospitalized Medicare beneficiaries treated by a general internist, there were no significant differences in overall 30-day mortality rates among patients treated by locum tenens compared with non-locum tenens physicians. Additional research may help determine hospital-level factors associated with the quality and costs of care related to locum tenens physicians.
Collapse
Affiliation(s)
- Daniel M. Blumenthal
- Cardiology Division, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | - Yusuke Tsugawa
- Department of Medicine, University of California, Los Angeles
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- National Bureau of Economic Research, Cambridge, Massachusetts
| |
Collapse
|
19
|
Weng SJ, Kim SH, Wu CL. Underlying influence of perception of management leadership on patient safety climate in healthcare organizations - A mediation analysis approach. Int J Qual Health Care 2017; 29:111-116. [PMID: 27920245 DOI: 10.1093/intqhc/mzw145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
Objective We aim to draw insights on how medical staff's perception of management leadership affects safety climate with key safety related dimensions-teamwork climate, job satisfaction and working conditions. Design/Setting A cross-sectional survey using Safety Attitude Questionnaire (SAQ) was performed in a medical center in Taichung City, Taiwan. The relationships among the dimensions in SAQ were then analyzed by structural equation modeling with a mediation analysis. Participants 2205 physicians and nurses of the medical center participated in the survey. Because not all questions in the survey are suitable for entire hospital staff, only the valid responses (n = 1596, response rate of 72%) were extracted for analysis. Main Outcome Measure(s) Key measures are the direct and indirect effects of teamwork climate, job satisfaction, perception of management leadership, and working conditions on safety climate. Results Outcomes show that effect of perception of management leadership on safety climate is significant (standardized indirect effect of 0.892 with P-value 0.002) and fully mediated by other dimensions, where 66.9% is mediated through teamwork climate, 24.1% through working conditions and 9.0% through job satisfaction. Conclusions Our findings point to the importance of management leadership and the mechanism of its influence on safety climate. To improve safety climate, the implication is that commitment by management on leading safety improvement needs to be demonstrated when it implements daily supportive actions for other safety dimensions. For future improvement, development of a management system that can facilitate two-way trust between management and staff over the long term is recommended.
Collapse
Affiliation(s)
- Shao-Jen Weng
- Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung City 40704, Taiwan
| | - Seung-Hwan Kim
- Department of Business Administration, Ajou University, Suwon 443-749, South Korea
| | - Chieh-Liang Wu
- Center for Quality Management, Taichung Veterans General Hospital, Taichung City 40705, Taiwan
| |
Collapse
|
20
|
Abstract
Policy is a powerful motivator of clinical change, but implementation success can depend on organizational characteristics. This article used validated measures of organizational resources, culture, and climate to predict uptake of a nationwide Veteran's Health Administration (VA) policy aimed at implementing Re-Engage, a brief care management program that reestablishes contact with veterans with serious mental illness lost to care. Patient care databases were used to identify 2738 veterans lost to care. Local recovery coordinators (LRCs) were to update disposition for 2738 veterans at 158 VA facilities and, as appropriate, facilitate a return to care. Multivariable regression was used to assess organizational culture and climate as predictors of early policy compliance (via LRC presence) and uptake at 6 months. Higher composite climate and culture scores were associated with higher odds of having a designated LRC but were not predictive of higher uptake. Sites with LRCs had significantly higher rates of updated documentation than sites without LRCs.
Collapse
|
21
|
Soh SE, Barker A, Morello R, Dalton M, Brand C. Measuring safety climate in acute hospitals: Rasch analysis of the safety attitudes questionnaire. BMC Health Serv Res 2016; 16:497. [PMID: 27644437 PMCID: PMC5029072 DOI: 10.1186/s12913-016-1744-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Safety Attitudes Questionnaire (SAQ) is commonly used to assess staff perception of safety climate within their clinical environment. The psychometric properties of the SAQ have previously been explored with confirmatory factor analysis and found to have some issues with construct validity. This study aimed to extend the psychometric evaluations of the SAQ by using Rasch analysis. Methods Assessment of internal construct validity included overall fit to the Rasch model (unidimensionality), response formats, targeting, differential item functioning (DIF) and person-separation index (PSI). Results A total of 420 nurses completed the SAQ (response rate 60 %). Data showed overall fit to a Rasch model of expected item functioning for interval scale measurement. The questionnaire demonstrated unidimensionality confirming the appropriateness of summing the items in each domain. Score reliabilities were appropriate (internal consistency PSI 0.6–0.8). However, participants were not using the response options on the SAQ in a consistent manner. All domains demonstrated suboptimal targeting and showed compromised score precision towards higher levels of safety climate (substantial ceiling effects). Conclusion There was general support for the reliability of the SAQ as a measure of safety climate although it may not be able to detect small but clinically important changes in safety climate within an organisation. Further refinement of the SAQ is warranted. This may involve changing the response options and including new items to improve the overall targeting of the scale. Trial registration This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000332921 (21 March 2011). Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1744-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sze-Ee Soh
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia. .,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia. .,Department of Physiotherapy, Monash University, Melbourne, VIC, Australia.
| | - Anna Barker
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Renata Morello
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Megan Dalton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,School of Human, Health and Social Science, Central Queensland University, Rockhampton, QLD, Australia
| | - Caroline Brand
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia.,Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| |
Collapse
|
22
|
Alves D, Guirardello E. Safety climate, emotional exhaustion and job satisfaction among Brazilian paediatric professional nurses. Int Nurs Rev 2016; 63:328-35. [DOI: 10.1111/inr.12276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- D.F.S. Alves
- Clinical Hospital; State University of Campinas; Campinas Brazil
| | - E.B. Guirardello
- School of Nursing; State University of Campinas; Campinas Brazil
| |
Collapse
|
23
|
Kristensen S, Christensen KB, Jaquet A, Møller Beck C, Sabroe S, Bartels P, Mainz J. Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study. BMJ Open 2016; 6:e010180. [PMID: 27178969 PMCID: PMC4874125 DOI: 10.1136/bmjopen-2015-010180] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Current literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence patient outcomes. This paper aims to investigate staff's perceptions of patient safety culture in a Danish psychiatric department before and after a leadership intervention. METHODS A repeated cross-sectional experimental study by design was applied. In 2 surveys, healthcare staff were asked about their perceptions of the patient safety culture using the 7 patient safety culture dimensions in the Safety Attitudes Questionnaire. To broaden knowledge and strengthen leadership skills, a multicomponent programme consisting of academic input, exercises, reflections and discussions, networking, and action learning was implemented among the clinical area level leaders. RESULTS In total, 358 and 325 staff members participated before and after the intervention, respectively. 19 of the staff members were clinical area level leaders. In both surveys, the response rate was >75%. The proportion of frontline staff with positive attitudes improved by ≥5% for 5 of the 7 patient safety culture dimensions over time. 6 patient safety culture dimensions became more positive (increase in mean) (p<0.05). Frontline staff became more positive on all dimensions except stress recognition (p<0.05). For the leaders, the opposite was the case (p<0.05). Staff leaving the department after the first measurement had rated job satisfaction lower than the staff staying on (p<0.05). CONCLUSIONS The improvements documented in the patient safety culture are remarkable, and imply that strengthening the leadership can act as a significant catalyst for patient safety culture improvement. Further studies using a longitudinal study design are recommended to investigate the mechanism behind leadership's influence on patient safety culture, sustainability of improvements over time, and the association of change in the patient safety culture measures with change in psychiatric patient safety outcomes.
Collapse
Affiliation(s)
- Solvejg Kristensen
- The Danish Clinical Registries, Aarhus, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital—Psychiatric Hospital, Aalborg, Denmark
| | | | - Annette Jaquet
- Aalborg University Hospital—Psychiatric Hospital, Aalborg, Denmark
| | | | - Svend Sabroe
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Paul Bartels
- The Danish Clinical Registries, Aarhus, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Mainz
- Aalborg University Hospital—Psychiatric Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
24
|
Samsuri SE, Pei Lin L, Fahrni ML. Safety culture perceptions of pharmacists in Malaysian hospitals and health clinics: a multicentre assessment using the Safety Attitudes Questionnaire. BMJ Open 2015; 5:e008889. [PMID: 26610761 PMCID: PMC4663412 DOI: 10.1136/bmjopen-2015-008889] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To assess the safety attitudes of pharmacists, provide a profile of their domains of safety attitude and correlate their attitudes with self-reported rates of medication errors. DESIGN A cross-sectional study utilising the Safety Attitudes Questionnaire (SAQ). SETTING 3 public hospitals and 27 health clinics. PARTICIPANTS 117 pharmacists. MAIN OUTCOME MEASURES Safety culture mean scores, variation in scores across working units and between hospitals versus health clinics, predictors of safety culture, and medication errors and their correlation. RESULTS Response rate was 83.6% (117 valid questionnaires returned). Stress recognition (73.0±20.4) and working condition (54.8±17.4) received the highest and lowest mean scores, respectively. Pharmacists exhibited positive attitudes towards: stress recognition (58.1%), job satisfaction (46.2%), teamwork climate (38.5%), safety climate (33.3%), perception of management (29.9%) and working condition (15.4%). With the exception of stress recognition, those who worked in health clinics scored higher than those in hospitals (p<0.05) and higher scores (overall score as well as score for each domain except for stress recognition) correlated negatively with reported number of medication errors. Conversely, those working in hospital (versus health clinic) were 8.9 times more likely (p<0.01) to report a medication error (OR 8.9, CI 3.08 to 25.7). As stress recognition increased, the number of medication errors reported increased (p=0.023). Years of work experience (p=0.017) influenced the number of medication errors reported. For every additional year of work experience, pharmacists were 0.87 times less likely to report a medication error (OR 0.87, CI 0.78 to 0.98). CONCLUSIONS A minority (20.5%) of the pharmacists working in hospitals and health clinics was in agreement with the overall SAQ questions and scales. Pharmacists in outpatient and ambulatory units and those in health clinics had better perceptions of safety culture. As perceptions improved, the number of medication errors reported decreased. Group-specific interventions that target specific domains are necessary to improve the safety culture.
Collapse
Affiliation(s)
- Srima Elina Samsuri
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
- Department of Pharmacy Practice and Development,Malacca State Pharmaceutical Services Division, Ayer Keroh, Malacca, Malaysia
| | - Lua Pei Lin
- Community Health Research Cluster, Faculty of Health Sciences, Universiti Sultan Zainal Abidin (UniSZA), Kampus Gong Badak, Kuala Nerus, Terengganu, Malaysia
| | - Mathumalar Loganathan Fahrni
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
- Department of Pharmaceutical & Life Sciences, Communities of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| |
Collapse
|
25
|
Carvalho PA, Göttems LBD, Pires MRGM, de Oliveira MLC. Safety culture in the operating room of a public hospital in the perception of healthcare professionals. Rev Lat Am Enfermagem 2015; 23:1041-8. [PMID: 26625994 PMCID: PMC4664003 DOI: 10.1590/0104-1169.0669.2647] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/07/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the perception of healthcare professionals about the safety culture in the operating room of a public hospital, large-sized, according to the domains of the Safety Attitudes Questionnaire (SAQ). METHOD Descriptive, cross-sectional and quantitative research, with the application of the SAQ to 226 professionals. Descriptive data analysis, instrument consistency and exploratory factor analysis. RESULTS Participants were distributed homogeneously between females (49.6%) and males (50.4%); mean age of 39.6 (SD±9.9) years and length of professional experience of 9.9 (SD ± 9.2) years. And Cronbach's α of 0.84. It was identified six domains proposed in the questionnaire: stress perception (74.5) and job satisfaction (70.7) showed satisfactory results; teamwork environment (59.1) and climate of security (48.9) presented scores below the minimum recommended (75); unit's management perceptions (44.5), hospital management perceptions (34.9) and working conditions (41.9) presented the lowest averages. CONCLUSIONS The results showed that, from the perspective of the professionals, there is weakness in the values, attitudes, skills and behaviors that determine the safety culture in a healthcare organization.
Collapse
Affiliation(s)
| | - Leila Bernarda Donato Göttems
- PhD, Adjunct Professor, Escola Superior de Ciências da Saúde, Fundação
de Ensino e Pesquisa em Ciências da Saúde, Secretaria de Estado de Saúde, Brasília, DF,
Brazil
| | | | - Maria Liz Cunha de Oliveira
- PhD, Adjunct Professor, Fundação de Ensino e Pesquisa em Ciências da
Saúde, Secretaria de Estado de Saúde, Brasília, DF, Brazil
| |
Collapse
|
26
|
Guthrie B, Yu N, Murphy D, Donnan PT, Dreischulte T. Measuring prevalence, reliability and variation in high-risk prescribing in general practice using multilevel modelling of observational data in a population database. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundHigh-risk primary care prescribing is common and is known to vary considerably between practices, but the extent to which high-risk prescribing varies among individual general practitioners (GPs) is not known.ObjectivesTo create prescribing safety indicators usable in existing electronic clinical data and to examine (1) variation in high-risk prescribing between patients, GPs and practices including reliability of measurement and (2) changes over time in high-risk prescribing prevalence and variation between practices.DesignDescriptive analysis and multilevel logistic regression modelling of routine data.SettingUK general practice using routine electronic medical record data.Participants(1) For analysis of variation and reliability, 398 GPs and 26,539 patients in 38 Scottish practices. (2) For analysis of change in high-risk prescribing, ≈ 300,000 patients particularly vulnerable to adverse drug effects registered with 190 Scottish practices.Main outcome measuresFor the analysis of variation between practices and between GPs, five indicators of high-risk non-steroidal anti-inflammatory drug (NSAID) prescribing. For the analysis of change in high-risk prescribing, 19 previously validated indicators.ResultsMeasurement of high-risk prescribing at GP level was feasible only for newly initiated drugs and for drugs similar to NSAIDs which are usually initiated by GPs. There was moderate variation between practices in total high-risk NSAID prescribing [intraclass correlation coefficient (ICC) 0.034], but this indicator was highly reliable (> 0.8 for all practices) at distinguishing between practices because of the large number of patients being measured. There was moderate variation in initiation of high-risk NSAID prescribing between practices (ICC 0.055) and larger variation between GPs (ICC 0.166), but measurement did not reliably distinguish between practices and had reliability > 0.7 for only half of the GPs in the study. Between quarter (Q)2 2004 and Q1 2009, the percentage of patients exposed to high-risk prescribing measured by 17 indicators that could be examined over the whole period fell from 8.5% to 5.2%, which was largely driven by reductions in high-risk NSAID and antiplatelet use. Variation between practices increased for five indicators and decreased for five, with no relationship between change in the rate of high-risk prescribing and change in variation between practices.ConclusionsHigh-risk prescribing is common and varies moderately between practices. High-risk prescribing at GP level cannot be easily measured routinely because of the difficulties in accurately identifying which GP actually prescribed the drug and because drug initiation is often a shared responsibility with specialists. For NSAID initiation, there was approximately three times greater variation between GPs than between practices. Most GPs with above average high-risk prescribing worked in practices which were not themselves above average. The observed reductions in high-risk prescribing between 2004 and 2009 were largely driven by falls in NSAID and antiplatelet prescribing, and there was no relationship between change in rate and change in variation between practices. These results are consistent with improvement interventions in all practices being more appropriate than interventions targeted on practices or GPs with higher than average high-risk prescribing. There is a need for research to understand why high-risk prescribing varies and to design and evaluate interventions to reduce it.FundingFunding for this study was provided by the Health Services and Delivery Research programme of the National Institute for Health Research.
Collapse
Affiliation(s)
- Bruce Guthrie
- Quality, Safety and Informatics Research Group, Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
| | - Ning Yu
- Tayside Medicine Unit, NHS Tayside, Dundee, UK
- Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Douglas Murphy
- Quality, Safety and Informatics Research Group, Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Quality, Safety and Informatics Research Group, Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
| | | |
Collapse
|
27
|
Bredesen IM, Bjøro K, Gunningberg L, Hofoss D. Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis. BMJ Open 2015; 5:e007584. [PMID: 26316647 PMCID: PMC4554903 DOI: 10.1136/bmjopen-2015-007584] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. DESIGN Multilevel approach to data from 2 cross-sectional studies. SETTINGS 4 hospitals in Norway were studied. PARTICIPANTS 1056 patients at 84 somatic wards. PRIMARY OUTCOME MEASURE HAPU. RESULTS Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs <70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25-29.99 kg/m(2)) (OR 0.32 (95% CI 0.17 to 0.62)). CONCLUSIONS The fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients.
Collapse
Affiliation(s)
- Ida Marie Bredesen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Karen Bjøro
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
28
|
Kim SE, Kim CW, Lee SJ, Oh JH, Lee DH, Lim TH, Choi HJ, Chung HS, Ryu JY, Jang HY, Choi YH, Kim SJ, Jung JH. A questionnaire survey exploring healthcare professionals' attitudes towards teamwork and safety in acute care areas in South Korea. BMJ Open 2015; 5:e007881. [PMID: 26209120 PMCID: PMC4521544 DOI: 10.1136/bmjopen-2015-007881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Although human factors are important in terms of patient safety, there have been very few reports on the attitudes of healthcare professionals working in acute care settings in South Korea. In the present study, we investigated the attitudes of such professionals, their cultures and their management systems. DESIGN A questionnaire survey with 65 items covering nine themes affecting patient safety. Nine themes were compared via a three-or-more-way analysis of variance, with interaction, followed by multiple comparisons among several groups. SETTING Intensive care units, emergency departments and surgical units of nine urban hospitals. PARTICIPANTS 592 nurses and 160 physicians. INTERVENTION None. OUTCOME MEASURES Mean scores using a five-point scale and combined response scores for each of the nine themes. RESULTS The mean score for information-sharing was the highest (3.78±0.49) and that for confidence/assertion was the lowest (2.97±0.34). The mean scores for teamwork, error management, work value, organisational climate, leadership, stress and fatigue level, and error/procedural compliance were intermediate. Physicians showed lower scores in leadership and higher scores in information-sharing than nurses. Respondents with 24 months or less of a clinical career showed higher scores in leadership, stress and fatigue, and error scores and lower scores in work value than more experienced respondents. CONCLUSIONS Our results suggest that medical personnel in Korea are relatively reluctant to disclose error or assert their different opinions with others. Many did not adequately recognise the negative effects of fatigue and stress, attributed errors to personal incompetence, and error-management systems were inadequate. Discrepancies in leadership and information-sharing were evident between professional groups, and leadership, stress, fatigue level, work value and error scores varied with the length of work experience. These can be used as baseline data to establish training programmes for patient safety in Korea.
Collapse
Affiliation(s)
- Sung Eun Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chan Woong Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang Jin Lee
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Je Hyeok Oh
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yeong Ryu
- Department of Emergency Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, Seoul, Korea
| | - Hye Young Jang
- Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul Metropolitan Boramae Medical Center, Seoul, Korea
| |
Collapse
|
29
|
Nguyen G, Gambashidze N, Ilyas SA, Pascu D. Validation of the safety attitudes questionnaire (short form 2006) in Italian in hospitals in the northeast of Italy. BMC Health Serv Res 2015. [PMID: 26204957 PMCID: PMC4512154 DOI: 10.1186/s12913-015-0951-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Studying safety attitudes of front-line workers can help hospital managers take initiatives to improve patient safety. The Safety Attitudes Questionnaire, a psychometric tool that measures safety attitudes in health facilities, has been used and validated in several languages worldwide but there is no Italian version available. Hence, the study is aimed at cross-culturally validating the questionnaire (short form 2006) in Italian at two hospitals in the Veneto region (northeastern Italy). Methods The translation and linguistic adaptation process of the questionnaire followed the World Health Organization guidelines. The questionnaire was delivered to staff working in four departments in two hospitals. Confirmatory factor analysis was used to assess the content validity of a pre-specified factor model that recognizes seven safety factors of the SAQ. Retest was performed to assess reliability. Internal consistency of items and safety factors was evaluated via Cronbach’s alpha. Results Response rate was 60 % (n = 261/433). Test-retest correlation between items and factors showed a high degree of agreement. Goodness-of-fit indices demonstrated an acceptable hypothesis model with seven safety factors. Cronbach’s alpha of a whole questionnaire was 0.85, demonstrating a good internal consistency. Polychoric correlations showed that the factors are well correlated with each other. Stress recognition was found to have negative correlation with other safety factors. Conclusions The Safety Attitudes Questionnaire in Italian language has satisfactory psychometric characteristics and is a valid instrument to measure safety culture in Italian hospitals. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0951-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Giang Nguyen
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Strada Le Grazie 8, Verona, 37134, Italy.
| | | | | | - Diana Pascu
- Girolamo Fracastoro hospital, San Bonifacio, Verona, Italy.
| |
Collapse
|
30
|
Benn J, Arnold G, D’Lima D, Wei I, Moore J, Aleva F, Smith A, Bottle A, Brett S. Evaluation of a continuous monitoring and feedback initiative to improve quality of anaesthetic care: a mixed-methods quasi-experimental study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BackgroundThis study evaluated the impact of a continuous quality monitoring and feedback initiative in anaesthesia.ObjectivesTo conduct a quasi-experimental evaluation of the feedback initiative and its effect on quality of anaesthetic care and perioperative efficiency. To understand the longitudinal effects of passive and active feedback and investigate the mechanisms and interactions underpinning those effects.DesignMixed-methods evaluation with analysis and synthesis of data from longitudinal qualitative interviews, longitudinal evaluative surveys and an interrupted time series study.InterventionContinuous measurement of a range of anaesthetic quality indicators was undertaken in a London teaching hospital alongside monthly personal feedback from case summary data to a cohort of anaesthetists, with follow-up roll-out to the whole NHS trust. Basic feedback consisted of the provision of passive monthly personalised feedback reports containing summary case data. In the enhanced phase, data feedback consisted of more sophisticated statistical breakdown of data, comparative and longitudinal views, and was paired with an active programme of dissemination and professional engagement.MethodsBaseline data collection began in March 2010. Implementation of basic feedback took place in October 2010, followed by implementation of the enhanced feedback protocol in July 2012. Weekly aggregated quality indicator data, coupled with surgical site infection and mortality rates, was modelled using interrupted time series analyses. The study anaesthetist cohort comprised 50,235 cases, performed by 44 anaesthetists over the course of the study, with 22,670 cases performed at the primary site. Anaesthetist responses to the surveys were collected pre and post implementation of feedback at all three sites in parallel with qualitative investigation. Seventy anaesthetists completed the survey at one or more time points and 35 health-care professionals, including 24 anaesthetists, were interviewed across two time points.ResultsResults from the time series analysis of longitudinal variation in perioperative indicators did not support the hypothesis that implementation of basic feedback improved quality of anaesthetic care. The implementation of enhanced feedback was found to have a significant positive impact on two postoperative pain measures, nurse-recorded freedom from nausea, mean patient temperature on arrival in recovery and Quality of Recovery Scale scores. Analysis of survey data demonstrated that anaesthetists value perceived credibility of data and local relevance of quality indicators above other criteria when assessing utility of feedback. A significant improvement in the perceived value of quality indicators, feedback, data use and overall effectiveness was observed between baseline and implementation of feedback at the primary site, a finding replicated at the two secondary sites. Findings from the qualitative research elucidated processes of interaction between context, intervention and user, demonstrating a positive response by clinicians to this type of initiative and willingness to interact with a sustained and comprehensive feedback protocol to understand variations in care.ConclusionsThe results support the potential of quality monitoring and feedback interventions as quality improvement mechanisms and provide insight into the positive response of clinicians to this type of initiative, including documentation of the experiences of anaesthetists that participated as users and codesigners of the feedback. Future work in this area might usefully investigate how this type of intervention may be transferred to other areas of clinical practice and further explore interactions between local context and the successful implementation of quality monitoring and feedback systems.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Jonathan Benn
- Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Glenn Arnold
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - Danielle D’Lima
- Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Igor Wei
- Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Joanna Moore
- Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Floor Aleva
- IQ Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Andrew Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Stephen Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
31
|
Ovseiko PV, Melham K, Fowler J, Buchan AM. Organisational culture and post-merger integration in an academic health centre: a mixed-methods study. BMC Health Serv Res 2015; 15:25. [PMID: 25608775 PMCID: PMC4308851 DOI: 10.1186/s12913-014-0673-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around the world, the last two decades have been characterised by an increase in the numbers of mergers between healthcare providers, including some of the most prestigious university hospitals and academic health centres. However, many mergers fail to bring the anticipated benefits, and successful post-merger integration in university hospitals and academic health centres is even harder to achieve. An increasing body of literature suggests that organisational culture affects the success of post-merger integration and academic-clinical collaboration. METHODS This paper reports findings from a mixed-methods single-site study to examine 1) the perceptions of organisational culture in academic and clinical enterprises at one National Health Service (NHS) trust, and 2) the major cultural issues for its post-merger integration with another NHS trust and strategic partnership with a university. From the entire population of 72 clinician-scientists at one of the legacy NHS trusts, 38 (53%) completed a quantitative Competing Values Framework survey and 24 (33%) also provided qualitative responses. The survey was followed up by semi-structured interviews with six clinician-scientists and a group discussion including five senior managers. RESULTS The cultures of two legacy NHS trusts differed and were primarily distinct from the culture of the academic enterprise. Major cultural issues were related to the relative size, influence, and history of the legacy NHS trusts, and the implications of these for respective identities, clinical services, and finances. Strategic partnership with a university served as an important ameliorating consideration in reaching trust merger. However, some aspects of university entrepreneurial culture are difficult to reconcile with the NHS service delivery model and may create tension. CONCLUSIONS There are challenges in preserving a more desirable culture at one of the legacy NHS trusts, enhancing cultures in both legacy NHS trusts during their post-merger integration, and in aligning academic and clinical cultures following strategic partnership with a university. The seeds of success may be found in current best practice, good will, and a near identical ideal of the future preferred culture. Strong, fair leadership will be required both nationally and locally for the success of mergers and post-merger integration in university hospitals and academic health centres.
Collapse
Affiliation(s)
- Pavel V Ovseiko
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK.
| | - Karen Melham
- Centre for Health Law and Emerging Technologies (HeLEX), Department of Population Health, University of Oxford, Oxford, UK. .,Research Services, University of Oxford, Oxford, UK.
| | | | - Alastair M Buchan
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK. .,Oxford University Hospitals NHS Trust, Oxford, UK.
| |
Collapse
|
32
|
Alayed AS, Lööf H, Johansson UB. Saudi Arabian ICU safety culture and nurses' attitudes. Int J Health Care Qual Assur 2014; 27:581-93. [PMID: 25252564 DOI: 10.1108/ijhcqa-04-2013-0042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to examine nurses' attitudes towards safety culture in six Saudi Arabian intensive care units (ICUs). DESIGN/METHODOLOGY/APPROACH The study is descriptive with a cross-sectional design. The Safety Attitude Questionnaire (SAQ)-ICU version was distributed and 216 completed questionnaires were returned. FINDINGS The findings provide a basis for further research on Saudi Arabian ICU safety culture. This study showed that the SAQ-ICU can be used to measure safety climate to identify areas for improvement according to nurse attitudes and perceptions. Findings indicate that ICU safety culture is an important issue that hospital managers should prioritise. PRACTICAL IMPLICATIONS The SAQ-ICU questionnaire, used to measure safety climate in Saudi Arabian ICUs, identifies service strengths and improvement areas according to attitudes and perceptions. ORIGINALITY/VALUE To the knowledge, this is the first study to use SAQ to examine nurses' safety culture attitudes in Saudi Arabian ICUs. The present findings provide a baseline and further details about Saudi Arabian ICU safety. Study participants represented nine nationalities, indicating the nursing workforce's diversity, which is expected to continue in the future. Such a nursing cultural heterogeneity calls for further studies to examine and evaluate attitudes and values to improve ICU safety culture.
Collapse
|
33
|
Taylor JA, Pandian R. A dissonant scale: stress recognition in the SAQ. BMC Res Notes 2013; 6:302. [PMID: 23902850 PMCID: PMC3733616 DOI: 10.1186/1756-0500-6-302] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 07/29/2013] [Indexed: 11/18/2022] Open
Abstract
Background Our previous analyses using the Stress Recognition subscale of the Safety Attitudes Questionnaire (SAQ) resulted in significant effect estimates with equally opposing explanations. We suspected construct validity issues and investigated such using our own data and correlation matrices of previous published studies. Methods The correlation matrices for each of the SAQ subscales from two previous studies by Speroff and Taylor were replicated and compared. The SAS Proc Factor procedure and the PRIORS = SMC option were used to perform Common Factor Analysis. Results The correlation matrices of both studies were very similar. Teamwork, Safety Climate, Job Satisfaction, Perceptions of Management and Working Conditions were well-correlated. The correlations ranged from 0.53 to 0.76. For Stress Recognition correlations ranged from -0.15 to 0.03. Common Factor Analysis confirmed the isolation of Stress Recognition. CFA returned a strong one-factor model that explained virtually all of the communal variance. Stress Recognition loaded poorly on this factor in both instances, and the CFA indicated that 96.4-100.0% of the variance associated with Stress Recognition was unique to that subscale, and not shared with the other 5 subscales. Conclusions We conclude that the Stress Recognition subscale does not fit into the overall safety climate construct the SAQ intended to reflect. We recommend that this domain be omitted from overall safety climate scale score calculations, and clearly identified as an important yet distinct organizational construct. We suggest that this subscale be investigated for its true meaning, characterized as such, and findings conveyed to SAQ end users. We make no argument against Stress Recognition as an important organizational metric, rather we suggest that as a stand-alone construct its current packaging within the SAQ may be misleading for those intent on intervention development and evaluation in healthcare settings if they interpret Stress Recognition results as emblematic of safety climate.
Collapse
Affiliation(s)
- Jennifer A Taylor
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA.
| | | |
Collapse
|
34
|
Rabøl LI, McPhail MA, Østergaard D, Andersen, HB, Mogensen T. Promoters and barriers in hospital team communication. A focus group study. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1753807612y.0000000009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
35
|
Does health care role and experience influence perception of safety culture related to preventing infections? Am J Infect Control 2013; 41:638-41. [PMID: 23809690 DOI: 10.1016/j.ajic.2012.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 09/04/2012] [Accepted: 09/04/2012] [Indexed: 11/20/2022]
Abstract
Growing evidence reveals the importance of improving safety culture in efforts to eliminate health care-associated infections. This multisite, cross-sectional survey examined the association between professional role and health care experience on infection prevention safety culture at 5 hospitals. The findings suggest that frontline health care technicians are less directly engaged in improvement efforts and safety education than other staff and that infection prevention safety culture varies more by hospital than by staff position and experience.
Collapse
|
36
|
Palmer JA, Meterko M, Zhao S, Berlowitz D, Mobley E, Hartmann CW. Nursing Home Employee Perceptions of Culture Change. Res Gerontol Nurs 2013; 6:152-60. [DOI: 10.3928/19404921-20130610-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/13/2013] [Indexed: 11/20/2022]
|
37
|
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
|
38
|
Meurling L, Hedman L, Sandahl C, Felländer-Tsai L, Wallin CJ. Systematic simulation-based team training in a Swedish intensive care unit: a diverse response among critical care professions. BMJ Qual Saf 2013; 22:485-94. [PMID: 23412932 PMCID: PMC3711495 DOI: 10.1136/bmjqs-2012-000994] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Teamwork—that is, collaboration and communication—is an important factor for safe healthcare, but professions perceive the quality of teamwork differently. Objective To examine the relationship between simulation-based team training (SBTT) and different professions’ self-efficacy, experienced quality of collaboration and communication, perceptions of teamwork and safety, together with staff turnover. Methods All staff (n=151; physicians, nurses and nurse assistants) in an intensive care unit (ICU) at a university hospital were systematically trained over 2 years. Data on individual self-efficacy were measured using the self-efficacy questionnaire; the experienced quality of collaboration and communication, teamwork climate, safety climate and perception of working conditions were sampled using the ICU version of the safety attitudes questionnaire (SAQ). Staff turnover and sick leave was measured using the hospital's staff administration system for the intervention ICU and a control ICU in the same hospital. Results The perception of safety differed between professions before training. Nurses’ and physicians’ mean self-efficacy scores improved, and nurse assistants’ perceived quality of collaboration and communication with physician specialists improved after training. Nurse assistants’ perception of the SAQ factors teamwork climate, safety climate and working conditions were more positive after the project as well as nurses’ perception of safety climate. The number of nurses quitting their job and nurse assistants’ time on sick leave was reduced in comparison to the control ICU during the study period. Limitations Results for SAQ factors must be interpreted with caution given that Cronbach's α and inter-correlations for the SAQ factors showed lower values than benchmarking data. Conclusions All team members benefited from the SBTT in an authentic composed team, but this was expressed differently for the respective professions.
Collapse
Affiliation(s)
- Lisbet Meurling
- Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
39
|
Desme A, Mendes N, Perruche F, Veillard E, Elie C, Moulinet F, Sanson F, Georget JM, Tissier A, Pourriat JL, Claessens YE. Nurses' understanding influences comprehension of patients admitted in the observation unit. JOURNAL OF HEALTH COMMUNICATION 2013; 18:583-593. [PMID: 23402319 DOI: 10.1080/10810730.2012.743626] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Comprehension is poor in patients admitted in the emergency observation unit. Teamwork communication gaps could contribute to patients' misunderstanding of their health condition. To determine in patients admitted in the emergency observation unit whether comprehension of diagnosis, prognosis, and management depended on nurses' comprehension, the authors conducted a prospective observational study in a busy adult emergency department of a tertiary teaching hospital in Paris over 2 months. Consecutive patients admitted in the emergency observation unit were included. Patients' and nurses' comprehension of diagnosis, prognosis, and management was compared with the statements of the emergency department attending physicians for these items. The authors observed whether patients' misunderstanding was associated with nurses' misunderstanding. A total of 544 patients were evaluated. For each patient, nurses' and patients' comprehension was available. Patients understood severity in 40%, organ involved in 69%, medical wording in 57%, reason for admission in 48%, and discharge instruction in 67%. In comparison with patients, nurses better understood each item except for discharge instruction. The authors observed that patients' comprehension was better when nurses understood diagnosis (p <.0001), reasons for admission (p =.032) and discharge instructions (p =.002). Nurses' understanding of severity did not modify patients' comprehension. These results support the conclusions that communication gaps in teamwork alter patients' comprehension and that nurses' and patients' misunderstandings are associated. Therefore, improving communication by nurses and physicians to patients may improve patients' understanding.
Collapse
Affiliation(s)
- Aline Desme
- Department of Emergency Medicine, Hôpital Cochin, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Fassier T, Favre H, Piriou V. [How to assess the impact of morbimortality conferences on healthcare quality and safety in ICU ?]. ACTA ACUST UNITED AC 2012; 31:609-16. [PMID: 22766465 DOI: 10.1016/j.annfar.2012.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate the morbidity and mortality conferences (MMC) impact in intensive care unit (ICU) setting on quality of care and patients' safety. DATA SOURCES A review of English and French articles in Medline database (1990-2011) related to MMC in the ICU. Keywords used: "morbidity (and) mortality conference(s)", "intensive care unit", "intensive/critical care medicine". Additional studies identified by hand search in French national guidelines about MMCs and in the Annales Françaises d'Anesthésie Réanimation and Réanimation journals index. Identification and preliminary analysis performed using title and abstract, for every study related to MMC in the ICU. STUDY SELECTION Only original studies about MMC in the ICU setting that reported an assessment were included. Papers reporting guidelines and methods for MMC implementation were excluded. DATA EXTRACTION Extraction used predefined data fields, including study design, MMC characteristics, assessment methods and results. DATA SYNTHESIS Studies about MMC in the ICU are recent and scarce. Results comparison and synthesis are impaired by discrepancies in study designs. Although the effectiveness of MMC is not evidence-based, data are consistent for their positive impact on quality of care and patient safety in the ICU. CONCLUSION Further studies are required to assess the impact of MMC in the ICU. Based on this literature review, a 4-level evaluation scheme can be suggested: 1) evaluation of MMC implementation in care units and facilities; 2) evaluation of MMC organization; 3) evaluation of MMC on quality of care; 4) evaluation of MMC impact on patients' mortality and morbidity.
Collapse
Affiliation(s)
- T Fassier
- EAM, « Santé, Individus, Société », faculté de médecine Laënnec, université de Lyon, France
| | | | | |
Collapse
|
41
|
Gallego B, Westbrook MT, Dunn AG, Braithwaite J. Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics. Int J Qual Health Care 2012; 24:311-20. [DOI: 10.1093/intqhc/mzs028] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
42
|
Ovseiko PV, Buchan AM. Organizational culture in an academic health center: an exploratory study using a competing values framework. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:709-718. [PMID: 22534590 DOI: 10.1097/acm.0b013e3182537983] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Implementing cultural change and aligning organizational cultures could enhance innovation, quality, safety, and job satisfaction. The authors conducted this mixed-methods study to assess academic physician-scientists' perceptions of the current and preferred future organizational culture at a university medical school and its partner health system. METHOD In October 2010, the authors surveyed academic physicians and scientists jointly employed by the University of Oxford and its local, major partner health system. The survey included the U.S. Veterans Affairs Administration's 14-item Competing Values Framework instrument and two extra items prompting respondents to identify their substantive employer and to provide any additional open-ended comments. RESULTS Of 436 academic physicians and scientists, 170 (39%) responded. Of these, 69 (41%) provided open-ended comments. Dominant hierarchical culture, moderate rational and team cultures, and underdeveloped entrepreneurial culture characterized the health system culture profile. The university profile was more balanced, with strong rational and entrepreneurial cultures, and moderate-to-strong hierarchical and team cultures. The preferred future culture (within five years) would emphasize team and entrepreneurial cultures and-to a lesser degree-rational culture, and would deemphasize hierarchical culture. CONCLUSIONS Whereas the university and the health system currently have distinct organizational cultures, academic physicians and scientists would prefer the same type of culture across the two organizations so that both could more successfully pursue the shared mission of academic medicine. Further research should explore strengthening the validity and reliability of the organizational culture instrument for academic medicine and building an evidence base of effective culture change strategies and interventions.
Collapse
Affiliation(s)
- Pavel V Ovseiko
- Nuffield Department of Clinical Medicine, Medical Sciences Division, University of Oxford, Oxford, England
| | | |
Collapse
|
43
|
Factors influencing teamwork and collaboration within a tertiary medical center. World J Methodol 2012; 2:18-23. [PMID: 25237612 PMCID: PMC4145561 DOI: 10.5662/wjm.v2.i2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/01/2012] [Accepted: 03/21/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To understand how work climate and related factors influence teamwork and collaboration in a large medical center.
METHODS: A survey of 3462 employees was conducted to generate responses to Sexton’s Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs.
RESULTS: Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R2 = 0.59) and in collaboration (R2 = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled.
CONCLUSION: Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are operating in a setting conducive to intra-organizational collaboration.
Collapse
|
44
|
Lyndon A, Zlatnik MG, Wachter RM. Effective physician-nurse communication: a patient safety essential for labor and delivery. Am J Obstet Gynecol 2011; 205:91-6. [PMID: 21640970 DOI: 10.1016/j.ajog.2011.04.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 04/07/2011] [Accepted: 04/11/2011] [Indexed: 11/25/2022]
Abstract
Effective communication is a hallmark of safe patient care. Challenges to effective interprofessional communication in maternity care include differing professional perspectives on clinical management, steep hierarchies, and lack of administrative support for change. We review principles of high reliability as they apply to communication in clinical care and discuss principles of effective communication and conflict management in maternity care. Effective clinical communication is respectful, clear, direct, and explicit. We use a clinical scenario to illustrate an historic style of nurse-physician communication and demonstrate how communication can be improved to promote trust and patient safety. Consistent execution of successful communication requires excellent listening skills, superb administrative support, and collective commitment to move past traditional hierarchy and professional stereotyping.
Collapse
|