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Affiliation(s)
- Alan J Card
- From the Department of Pediatrics, University of California, San Diego, School of Medicine, La Jolla, CA
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Vacher A, El Mhamdi S, d'Hollander A, Izotte M, Auroy Y, Michel P, Quenon JL. Impact of an Original Methodological Tool on the Identification of Corrective and Preventive Actions After Root Cause Analysis of Adverse Events in Health Care Facilities: Results of a Randomized Controlled Trial. J Patient Saf 2021; 17:483-489. [PMID: 29116954 DOI: 10.1097/pts.0000000000000437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the study was to assess the effectiveness of a new methodological tool for the identification of corrective and preventive actions (CAPAs) after root cause analysis of health care-related adverse events. METHODS From January to June 2010, we conducted a randomized controlled trial involving risk managers from 111 health care facilities of the Aquitaine Regional Center for Quality and Safety in Health Care (France). Fifty-six risk managers, randomly assigned to two groups (intervention and control), identified CAPAs in response to two sequentially presented adverse event scenarios. For the baseline measure, both groups used their usual adverse event management tools to identify CAPAs in each scenario. For the experimental measure, the control group continued using their usual tools, whereas the intervention group used a new tool involving a systemic approach for CAPA identification. The main outcome measure was the number of CAPAs the participants identified that matched a criterion standard established by eight experts. RESULTS Baseline mean number of identified CAPAs did not differ between the two groups (P = 0.83). For the experimental measure, significantly more CAPAs (P = 0.001) were identified by the intervention group (mean [SD] = 4.6 [1.7]) than by the control group (mean [SD] = 2.8 [1.2]). CONCLUSIONS For the two scenarios tested, more relevant CAPAs were identified with the new tool than with usual tools. Further research is needed to assess the effectiveness of the new tool for other types of adverse events and its impact on patient safety.
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Affiliation(s)
- Anthony Vacher
- From the Institut de Recherche Biomédicale des Armées [French Armed Forces Biomedical Research Institute], Unité Sécurité des Systèmes à Risques, Brétigny sur Orge, France
| | | | - Alain d'Hollander
- Anesthesiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Marion Izotte
- Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine (CCECQA) [Aquitaine Regional Centre for Quality and Safety in Health Care], Hôpital Xavier Arnozan, Pessac, France
| | | | | | - Jean-Luc Quenon
- Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine (CCECQA) [Aquitaine Regional Centre for Quality and Safety in Health Care], Hôpital Xavier Arnozan, Pessac, France
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Ferdosi M, Rezayatmand R, Molavi Taleghani Y. Risk Management in Executive Levels of Healthcare Organizations: Insights from a Scoping Review (2018). Risk Manag Healthc Policy 2020; 13:215-243. [PMID: 32256134 PMCID: PMC7090183 DOI: 10.2147/rmhp.s231712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background This study attempted to present a framework and appropriate techniques for implementing risk management (RM) in executive levels of healthcare organizations (HCOs) and grasping new future research opportunities in this field. Methods A scoping review was conducted of all English language studies, from January 2000 to October 2018 in the main bibliographic databases. Review selection and characterization were performed by two independent reviewers using pretested forms. Results Following a keyword search and an assessment of fit for this review, 37 studies were analyzed. Based on the findings and considering the ISO31000 model, a comprehensive yet simple framework of risk management is developed for the executive levels of HCOs. It includes five main phases: establishing the context, risk assessment, risk treatment, monitoring and review, and communication and consultation. A set of tools and techniques were also suggested for use at each phase. Also, the status of risk management in the executive levels of HCOs was determined based on the proposed framework. Conclusion The framework can be used as a training tool to guide in effective risk assessment as well as a tool to assess non-clinical risks of healthcare organizations. Managers of healthcare organizations who seek to ensure high quality should use a range of risk management methods and tools in their organizations, based on their need, and not assume that each tool is comprehensive.
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Affiliation(s)
- Masoud Ferdosi
- Health Management and Economics Research Center, Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rezayatmand
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yasamin Molavi Taleghani
- Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Simsekler MCE, Kaya GK, Ward JR, Clarkson PJ. Evaluating inputs of failure modes and effects analysis in identifying patient safety risks. Int J Health Care Qual Assur 2019; 32:191-207. [PMID: 30859865 DOI: 10.1108/ijhcqa-12-2017-0233] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE There is a growing awareness on the use of systems approaches to improve patient safety and quality. While earlier studies evaluated the validity of such approaches to identify and mitigate patient safety risks, so far only little attention has been given to their inputs, such as structured brainstorming and use of system mapping approaches (SMAs), to understand their impact in the risk identification process. To address this gap, the purpose of this paper is to evaluate the inputs of a well-known systems approach, failure modes and effects analysis (FMEA), in identifying patient safety risks in a real healthcare setting. DESIGN/METHODOLOGY/APPROACH This study was conducted in a newly established adult attention deficit hyperactivity disorder service at Cambridge and Peterborough Foundation Trust in the UK. Three stakeholders of the chosen service together with the facilitators conducted an FMEA exercise along with a particular system diagram that was initially found as the most useful SMA by eight stakeholders of the service. FINDINGS In this study, it was found that the formal structure of FMEA adds value to the risk identification process through comprehensive system coverage with the help of the system diagram. However, results also indicates that the structured brainstorming refrains FMEA participants from identifying and imagining new risks since they follow the process predefined in the given system diagram. ORIGINALITY/VALUE While this study shows the potential contribution of FMEA inputs, it also suggests that healthcare organisations should not depend solely on FMEA results when identifying patient safety risks; and therefore prioritising their safety concerns.
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Affiliation(s)
- Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science Technology , Abu Dhabi, United Arab Emirates.,School of Management, University College London , London, UK
| | | | - James R Ward
- Department of Engineering, University of Cambridge , Cambridge, UK
| | - P John Clarkson
- Department of Engineering, University of Cambridge , Cambridge, UK
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Holden J, Card AJ. Patient safety professionals as the third victims of adverse events. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519850914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Alan J Card
- Department of Pediatrics, UC San Diego School of Medicine, La Jolla, CA, USA
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Simsekler MCE. The link between healthcare risk identification and patient safety culture. Int J Health Care Qual Assur 2019; 32:574-587. [DOI: 10.1108/ijhcqa-04-2018-0098] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeRisk identification plays a key role identifying patient safety risks. As previous research on risk identification practices, as applied to patient safety, and its association with safety culture is limited, the purpose of this paper is to evaluate current practice to address gaps and potential room for improvement.Design/methodology/approachThe authors carry out interview-based questionnaires in one UK hospital to investigate real-world risk identification practices with eight healthcare staff, including managers, nurses and a medical consultant. Considering various aspects from both risk identification and safety culture practices, the authors investigate how these two are interrelated.FindingsThe interview-based questionnaires were helpful for evaluating current risk identification practices. While gaining significant insights into risk identification practices, such as experiences using current tools and methods, mainly retrospective ones, results also explicitly showed its link with the safety culture and highlighted the limitation in measuring the relationship.Originality/valueThe interviews addressed valuable challenges affecting success in the risk identification process, including limitations in safety culture practice, training, balancing financial and safety concerns, and integrating risk information from different tools and methods.
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Simsekler MCE, Ward JR, Clarkson PJ. Evaluation of system mapping approaches in identifying patient safety risks. Int J Qual Health Care 2018; 30:227-233. [PMID: 29346654 DOI: 10.1093/intqhc/mzx176] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective While many system mapping approaches (SMAs) have been broadly used in safety-critical industries, few have so far been employed in the healthcare field to assist in the identification of patient safety risks. In this study, we evaluated a set of system modelling approaches to assess their potential contribution to the identification of risks affecting patient safety. The aim was to gain a greater understanding of the practical application of system modelling approaches with the help of the risk categorization framework developed in this study. Setting We conducted this study in a newly established Adult Attention Deficit Hyperactivity Disorder (ADHD) service at Cambridge and Peterborough Foundation Trust. Study participants Eight key stakeholders of the chosen service, including clinicians, managers and administrative staff, were individually asked to evaluate a set of pre-defined six SMAs according to their usefulness in identifying patient safety risks through interview-based questionnaires. Results It was found that each SMA could be useful in the chosen healthcare service in different ways. Further, specific types of diagrams were selected by stakeholders as more useful than others in identifying different sources of risks within the given system. Conclusions The results of the evaluation showed that the system diagram is the most useful SMA in risk identification within the given system, while limited time, resources and experience of stakeholders with SMAs may present possible obstacles for their potential use in the healthcare field in future.
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Affiliation(s)
- Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi Campus, Abu Dhabi 127788, United Arab Emirates.,School of Management, University College London, 1 Canada Square, London E14 5AA, UK
| | - James R Ward
- Engineering Department, Engineering Design Centre, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
| | - P John Clarkson
- Engineering Department, Engineering Design Centre, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
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Simsekler MCE, Ward JR, Clarkson PJ. Design for patient safety: a systems-based risk identification framework. ERGONOMICS 2018; 61:1046-1064. [PMID: 29394872 PMCID: PMC6116892 DOI: 10.1080/00140139.2018.1437224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Current risk identification practices applied to patient safety in healthcare are insufficient. The situation can be improved, however, by studying systems approaches broadly and successfully utilised in other safety-critical industries, such as aviation and chemical industries. To illustrate this, this paper first investigates current risk identification practices in the healthcare field, and then examines the potential of systems approaches. A systems-based approach, called the Risk Identification Framework (RID Framework), is then developed to enhance improvement in risk identification. Demonstrating the strengths of using multiple inputs and methods, the RID Framework helps to facilitate the proactive identification of new risks. In this study, the potential value of the RID Framework is discussed by examining its application and evaluation, as conducted in a real-world healthcare setting. Both the application and evaluation of the RID Framework indicate positive results, as well as the need for further research. Practitioner Summary: The findings in this study provide insights into how to make a better amalgamation of risk identification inputs to the safer design and more proactive risk management of healthcare delivery systems, which have been an increasing research interest amongst human factor professionals and ergonomists.
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Affiliation(s)
- M. C. Emre Simsekler
- Khalifa University of Science and Technology, Department of Industrial and Systems Engineering, Abu Dhabi, 127788, UAE
- University College London, School of Management, London, E14 5AA, UK
- Corresponding Author: M. C. Emre Simsekler, Khalifa University of Science and Technology, Department of Industrial and Systems Engineering, P.O. Box 127788, Abu Dhabi, United Arab Emirates, , T: +971 (0)2 501 8410, F: +971 (0)2 447 2442
| | - James R. Ward
- University of Cambridge, Engineering Department, Engineering Design Centre, Cambridge, CB2 1PZ, UK
| | - P. John Clarkson
- University of Cambridge, Engineering Department, Engineering Design Centre, Cambridge, CB2 1PZ, UK
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Card AJ. Physician Burnout: Resilience Training is Only Part of the Solution. Ann Fam Med 2018; 16:267-270. [PMID: 29760034 PMCID: PMC5951259 DOI: 10.1370/afm.2223] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/11/2017] [Accepted: 01/04/2018] [Indexed: 11/09/2022] Open
Abstract
Physicians and physician trainees are among the highest-risk groups for burnout and suicide, and those in primary care are among the hardest hit. Many health systems have turned to resilience training as a solution, but there is an ongoing debate about whether that is the right approach. This article distinguishes between unavoidable occupational suffering (inherent in the physician's role) and avoidable occupational suffering (systems failures that can be prevented). Resilience training may be helpful in addressing unavoidable suffering, but it is the wrong treatment for the organizational pathologies that lead to avoidable suffering- and may even compound the harm doctors experience. To address avoidable suffering, health systems would be better served by engaging doctors in the co-design of work systems that promote better mental health outcomes.
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Affiliation(s)
- Alan J Card
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
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Simsekler MCE, Card AJ, Ward JR, Clarkson PJ. Trust-level risk identification guidance in the NHS East of England. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2016; 27:67-76. [PMID: 26410009 DOI: 10.3233/jrs-150651] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In healthcare, a range of methods are used to improve patient safety through risk identification within the scope of risk management. However, there is no evidence determining what trust-level guidance exists to support risk identification in healthcare organisations. This study therefore aimed to determine such methods through the content analysis of trust-level risk management documents. METHOD Through Freedom of Information Act, risk management documents were requested from each acute, mental health and ambulance trust in the East of England region of NHS for content analysis. Received documents were also compared with guidance from other safety-critical industries to capture differences between the documents from those industries, and learning points to the healthcare field. RESULTS A total of forty-eight documents were received from twenty-one trusts. Incident reporting was found as the main method for risk identification. The documents provided insufficient support for the use of prospective risk identification methods, such as Prospective Hazard Analysis (PHA) methods, while the guidance from other industries extensively promoted such methods. CONCLUSION The documents provided significant insight into prescribed risk identification practice in the chosen region. Based on the content analysis and guidance from other safety-critical industries, a number of recommendations were made; such as introducing the use of PHA methods in the creation and revision of risk management documents, and providing individual guidance on risk identification to promote patient safety further.
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Affiliation(s)
- M C Emre Simsekler
- University College London, Department of Management Science and Innovation, London, UK
| | - Alan J Card
- Evidence-Based Health Solutions, LLC, Notre Dame, IN, USA
| | - James R Ward
- University of Cambridge, Department of Engineering, Engineering Design Centre, Cambridge, UK
| | - P John Clarkson
- University of Cambridge, Department of Engineering, Engineering Design Centre, Cambridge, UK
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Peerally MF, Carr S, Waring J, Dixon-Woods M. The problem with root cause analysis. BMJ Qual Saf 2016; 26:417-422. [PMID: 27340202 PMCID: PMC5530340 DOI: 10.1136/bmjqs-2016-005511] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | - Susan Carr
- John Walls Renal Unit, University Hospitals of Leicester, Leicester, UK
| | - Justin Waring
- CHILL, Nottingham University Business School, University of Nottingham, Nottingham, UK
| | - Mary Dixon-Woods
- SAPPHIRE, Department of Health Sciences, University of Leicester, Leicester, UK
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Affiliation(s)
- Julie E Reed
- NIHR CLAHRC NWL, Imperial College London, London, UK
| | - Alan J Card
- Department of Management, University of Notre Dame, Notre Dame, Indiana, USA Evidence-Based Health Solutions, LLC, Notre Dame, Indiana, USA
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Card AJ, Ward JR, Clarkson PJ. Rebalancing risk management--Part 2: The Active Risk Control (ARC) Toolkit. J Healthc Risk Manag 2015; 34:4-17. [PMID: 25630281 DOI: 10.1002/jhrm.21160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The adoption of systems-focused risk assessment techniques has not led to measurable improvement in the rate of patient harm. Why? In part, because these tools focus solely on understanding problems and provide no direct support for designing and managing solutions (ie, risk control). This second installment of a 2-part series on rebalancing risk management describes a structured approach to bridging this gap: The Active Risk Control (ARC) Toolkit. A pilot study is presented to show how the ARC Toolkit can improve the quality of risk management practice.
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