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Olin K, Klinga C, Ekstedt M, Pukk-Härenstam K. Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study. BMC Health Serv Res 2023; 23:651. [PMID: 37331961 DOI: 10.1186/s12913-023-09674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/08/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Safety has been described as a dynamic non-event and as constantly present in professionals' work processes. Investigating management of complex everyday situations may create an opportunity to elucidate safety management. Anaesthesia has been at the frontline of enhancing patient safety - testing and implementing knowledge from other high-reliability industries, such as aviation, in the complex, adaptive system of an operating room. The aim of this study was to explore factors supporting anaesthesia nurses and anaesthesiologists in managing complex everyday situations during intraoperative anaesthesia care processes. METHODS Individual interviews with anaesthesia nurses (n = 9) and anaesthesiologists (n = 6) using cognitive task analysis (CTA) on case scenarios from previous prospective, structured observations. The interviews were analysed using the framework method. RESULTS During intraoperative anaesthesia care, management of everyday complex situations is sustained through preparedness, support for mindful practices, and monitoring and noticing complex situations and managing them. The prerequisites are created at the organization level. Managers should ensure adequate resources in the form of trained personnel, equipment and time, team and personnel sustainability and early planning of work. Management of complex situations benefits from high-quality teamwork and non-technical skills (NTS), such as communication, leadership and shared situational awareness. CONCLUSION Adequate resources, stability in team compositions and safe boundaries for practice with shared baselines for reoccurring tasks where all viewed as important prerequisites for managing complex everyday work. When and how NTS are used in a specific clinical context depends on having the right organizational prerequisites and a deep expertise of the relevant clinical processes. Methods like CTA can reveal the tacit competence of experienced staff, guide contextualized training in specific contexts and inform the design of safe perioperative work practices, ensuring adequate capacity for adaptation.
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Affiliation(s)
- Karolina Olin
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
- Supervisory Centre, Wellbeing Services County of Southwest Finland, Turku, Finland.
| | - Charlotte Klinga
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Stockholm Research and Development Unit for Elderly Persons (FOU Nu), Region Stockholm, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Karin Pukk-Härenstam
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden
- Department of Women and Children's Health, Karolinska University Hospital, Stockholm, Sweden
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Auschra C, Asaad E, Sydow J, Hinkelmann J. Interventions Into Reliability-Seeking Health Care Organizations: A Systematic Review of Their Goals and Measuring Methods. J Patient Saf 2022; 18:e1211-e1218. [PMID: 35948320 DOI: 10.1097/pts.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES Within the last 2 decades, numerous interventions making use of high-reliability theory have been implemented to increase reliability in healthcare organizations. This systematic literature review first explores the concrete goals on which such interventions focus. Second, the review captures how the achievement of these goals, or alternatively a change, generally an increase in organizational reliability, is measured across different contexts. METHODS Searches were conducted in PubMed, Academic Search Ultimate, Business SourcePremier, CINAHL, Communication Source, EconLit, ERIC, Medline, Political Science Complete, PsycArticles, APA PsycInfo, PSYNDEX, SocINDEX (via the resource hosterEbscoHost), and Web of Science (through November 22, 2021). Peer-reviewed, English language studies were included, reporting on the implementation of a concrete intervention to increase reliability in a medical context and referring to high-reliability theory. RESULTS The search first yielded 8896 references, from which 75 studies were included in the final sample. Important healthcare goals stated by the seminal report "Crossing the Quality Chasm" guided the analysis of the included studies. Most of the studies originated from the United States and report on interventions to increase reliability of either organizational units or whole organizations when aiming for safety (n = 65). Other goals reported on include effectiveness, and much less frequently timeliness, patient centeredness, and efficiency. Fifty-eight studies use quantitative measurement exclusively to account for the achievement of these goals; 7 studies use qualitative measurement exclusively, and 10 studies use a mixed-method approach. The operationalization of goals, including the operationalization of organizational reliability, and measurement methods do not follow a unified approach, despite claiming to be informed by a coherent theory. Instead, such operationalizations strongly depend on the overall objective of the study and the respective context. CONCLUSIONS Measuring the outcomes of high-reliability interventions into healthcare organizations is challenging for different reasons, including the difficult operationalization of partly overlapping goals, the complex, processual nature of achieving reliability, and the limited ability of organizations striving for more reliability if they are already performing on a high level. This review critically assesses the adoption of the goals stated in the seminal report "Crossing the Quality Chasm" and provides insights for organizations and funding providers that strive to evaluate more reliable service provision.
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Affiliation(s)
- Carolin Auschra
- From the Department of Management, Freie Universität Berlin, Berlin, Germany
| | | | - Jörg Sydow
- From the Department of Management, Freie Universität Berlin, Berlin, Germany
| | - Jürgen Hinkelmann
- Department for Anesthesiology, Intensive Care and Emergency Medicine, St Josefs Hospital, Dortmund, Germany
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Camacho-Rodríguez DE, Carrasquilla-Baza DA, Dominguez-Cancino KA, Palmieri PA. Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14380. [PMID: 36361273 PMCID: PMC9658502 DOI: 10.3390/ijerph192114380] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America. PURPOSE Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC). METHODS This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated. RESULTS In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66). CONCLUSIONS Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.
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Affiliation(s)
- Doriam E. Camacho-Rodríguez
- Facultad de Enfermería, Universidad Cooperativa de Colombia, Santa Marta 470002, Colombia
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
| | - Deibys A. Carrasquilla-Baza
- Facultad de Enfermería, Universidad Cooperativa de Colombia, Santa Marta 470002, Colombia
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
| | - Karen A. Dominguez-Cancino
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
- Addiction Study Program, Université de Sherbrooke, 150, Place Charles-Le Moyne, Bureau 200, Longueuil, QC J4K 0A8, Canada
- Escuela de Salud Pública, Universidad de Chile, Av. Independencia 939, Independencia, Santiago de Chile 8380453, Chile
| | - Patrick A. Palmieri
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
- South American Center for Qualitative Research, Universidad Norbert Wiener, Av. Arequipa 444, Lima 15046, Peru
- College of Graduate Health Studies, A.T. Still University, 800 West Jefferson Street, Kirksville, MO 63501, USA
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030, USA
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Moslehpour M, Chau KY, Tu YT, Nguyen KL, Barry M, Reddy KD. Impact of corporate sustainable practices, government initiative, technology usage, and organizational culture on automobile industry sustainable performance. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:83907-83920. [PMID: 35776298 DOI: 10.1007/s11356-022-21591-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
The increasing worldwide automobile production and usage adversely impact the environmental, economic, and social well-being. Although the automobile companies are trying to solve this problem by adopting corporate sustainability, there is a gap in the extant literature on sustainable corporate practices that are the most important to empower better sustainability performance. This study highlights the impact of core corporate sustainable practices attributes, government initiative, technology usage, and organizational culture on the sustainable performance of the automobile industry in India. The study proposed six aspects and fifty-three criteria from the literature review. The current article has used survey questionnaires to collect the primary data. The present article also applied the smart-PLS to test the association among the variables. The results indicated that the corporate sustainable practices attributes, technology usage, and organizational culture have a positive and significant linkage with the sustainable performance of the automobile industry. The current article guides the regulators in developing the regulations to improve sustainable organizational performance using sustainable corporate practices.
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Affiliation(s)
- Massoud Moslehpour
- Department of Business Administration, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
- Department of Management, California State University, 5500 University Parkway, San BernardinoSan Bernardino, CA, 92407, USA
| | - Ka Yin Chau
- City University of Macau Faculty of Business, Taipa, Macau.
| | - Yu-Te Tu
- Department of Business Administration, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan.
| | - Khanh-Linh Nguyen
- School of Business and Management, RMIT International University, 702 Nguyen Van Linh, District 7, Ho Chi Minh City, Vietnam
| | - Momodou Barry
- Department of Business Administration, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
| | - Kamasani Dhanasekhar Reddy
- Department of Business Administration, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
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Veazie S, Peterson K, Bourne D, Anderson J, Damschroder L, Gunnar W. Implementing High-Reliability Organization Principles Into Practice: A Rapid Evidence Review. J Patient Saf 2022; 18:e320-e328. [PMID: 32910041 DOI: 10.1097/pts.0000000000000768] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To promote a safety culture and reduce harm, health care systems are adopting high-reliability organization (HRO) principles. This rapid review synthesizes HRO frameworks, metrics, and implementation effects to help inform health systems' efforts toward becoming HROs. METHODS Bibliographic databases were searched from 2010 to 2019. One reviewer used prespecified criteria to assess articles for inclusion, evaluate study quality, extract data, and grade strength of evidence with second reviewer checking. RESULTS Twenty-three articles were identified: 8 described frameworks, 9 examined metrics, and 9 evaluated implementation outcomes. Five common strategies for HRO implementation emerged (developing leadership, supporting a culture of safety, providing training and learning, building data systems, and implementing quality improvement interventions). The Joint Commission's and Institute for Healthcare Improvement's frameworks emerged as the most comprehensive and widely applicable. The Joint Commission's Oro 2.0 metric for evaluating HRO progress similarly stood out as it was developed through broad stakeholder input and was validated by external researchers. Multicomponent HRO interventions delivered for at least 2 years were associated with improved process and patient safety outcomes. Because each HRO intervention was only supported by a single poor or fair-quality study-none of which contained a concurrent control group-a causal relationship between any HRO initiative and outcomes could not be established. CONCLUSIONS Health care system adoption of HRO principles is associated with improved safety outcomes, yet the level of evidence is low. Priorities for future HRO studies include use of concurrent control groups and examination of specific outcomes measurements.
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Affiliation(s)
- Stephanie Veazie
- From the VA Evidence Synthesis Program Coordinating Center, Portland, OR
| | - Kim Peterson
- From the VA Evidence Synthesis Program Coordinating Center, Portland, OR
| | - Donald Bourne
- From the VA Evidence Synthesis Program Coordinating Center, Portland, OR
| | - Johanna Anderson
- From the VA Evidence Synthesis Program Coordinating Center, Portland, OR
| | | | - William Gunnar
- VHA National Center for Patient Safety, University of Michigan, Ann Arbor, MI
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Jaimes Valencia ML, Alvarado Alvarado AL, Mejía Arciniegas CN, López Galán AV, Mancilla Jiménez VA, Padilla García CI. Correlación del grado de percepción y cultura de seguridad del paciente en una Institución de tercer nivel 2015-2019. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: La seguridad del paciente es considerado como un patrón integrado de comportamiento individual y organizacional, basado en creencias y valores compartidos que continuamente busca minimizar el daño al paciente, que resulta de la atención. Objetivo: Analizar la correlación de percepción de cultura de seguridad del paciente, y grado de seguridad percibido en funcionarios de una Institución de Salud de tercer nivel de atención (2015-2017-2019). Materiales y Métodos: Estudio cuantitativo correlacional, con una muestra intencional derivada del registro de una base de datos de cultura de seguridad del paciente, con un total de 402 registros. La medición se realizó mediante el cuestionario Hospital Survey on Patient Safety Culture. Resultados: En los resultados globales el mayor porcentaje de encuestados correspondió al personal asistencial (73,4%). El principal servicio asistencial es unidad de cuidado intensivo (18,2%) y la mayor participación correspondió al rol de enfermeras y auxiliares de enfermería (45,7%). Según las respuestas positivas para los datos globales se determina 2 de 12 dimensiones clasificadas como fortaleza en el componente de Aprendizaje organizacional (81,5%) y Trabajo en equipo (85,5%) y el grado de seguridad percibido con correlaciones (p: 0,000) que se identifican en seis dimensiones entre ellas notificación de eventos, y aprendizaje organizacional. Discusión: La correlación del grado de seguridad percibido con las dimensiones del cuestionario guarda similitud en especial la notificación de eventos. Conclusión: La seguridad del paciente y el grado de seguridad percibido guardan correspondencia en la medida que en las instituciones realizan intervenciones en diferentes componentes entre ellos la notificación de eventos y trabajo en equipo.
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Hedsköld M, Sachs MA, Rosander T, von Knorring M, Pukk Härenstam K. Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work. BMC Health Serv Res 2021; 21:48. [PMID: 33419431 PMCID: PMC7796601 DOI: 10.1186/s12913-020-06042-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Safety culture can be described and understood through its manifestations in the organization as artefacts, espoused values and basic underlying assumptions and is strongly related to leadership-yet it remains elusive as a concept. Even if the literature points to leadership as an important factor for creating and sustaining a mature safety culture, little is known about how the safety work of first line managers' is done and how they balance the different and often conflicting organizational goals in everyday practice. The purpose of this study was to explore how health care first line managers perceive their role and how they promote patient safety and patient safety culture in their units. METHODS Interview study with first line managers in intensive care units in eight different hospitals located in the middle of Sweden. An inductive qualitative content analysis approach was used, this was then followed by a deductive analysis of the strategies informed by constructs from High reliability organizations. RESULTS We present how first line managers view their role in patient safety and exemplify concrete strategies by which managers promote patient safety in everyday work. CONCLUSIONS Our study shows the central role of front-line managers in organizing for safe care and creating a culture for patient safety. Although promoted widely in Swedish healthcare at the time for the interviews, the HSOPSC was not mentioned by the managers as a central source of information on the unit's safety culture.
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Affiliation(s)
- Mats Hedsköld
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Magna Andreen Sachs
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Torleif Rosander
- Department of Anaesthesiology and intensive care, Södersjukhuset, Stockholm Region, Sweden
| | - Mia von Knorring
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Karin Pukk Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Paediatric Emergency Care, Astrid Lindgren's Children's' Hospital, Karolinska University Hospital, Stockholm, Stockholm Region, Sweden.
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