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Magerøy MR, Macrae C, Braut GS, Wiig S. Managing patient safety and staff safety in nursing homes: exploring how leaders of nursing homes negotiate their dual responsibilities-a case study. Front Health Serv 2024; 4:1275743. [PMID: 38348403 PMCID: PMC10860424 DOI: 10.3389/frhs.2024.1275743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024]
Abstract
Objective Within healthcare, the role of leader is becoming more complex, and healthcare leaders carry an increasing responsibility for the performance of employees, the experience and safety of patients and the quality of care provision. This study aimed to explore how leaders of nursing homes manage the dual responsibility of both Health, Safety and Environment (HSE) and Quality and Patient Safety (QPS), focusing particularly on the approaches leaders take and the dilemmas they face. In addition, we wanted to examine how leaders experience and manage the challenges of HSE and QPS in a holistic way. Design/setting The study was designed as a case study. Data were collected through semi structured individual interviews with leaders of nursing homes in five Norwegian municipalities. Participants 13 leaders of nursing homes in urban and rural municipalities participated in this study. Results Data analysis resulted in four themes explaining how leaders of nursing homes manage the dual responsibility of HSE and QPS, and the approaches they take and the dilemmas they face: 1.Establishing good systems and building a culture for a work environment that promotes health and patient safety.2.Establish channels for internal and external collaboration and communication.3.Establish room for maneuver to exercise leadership.4.Recognizing and having the mandate to handle possible tensions in the dual responsibility of HSE and QPS. Conclusions The study showed that leaders of nursing homes who are responsible for ensuring quality and safety for both patients and staff, experience tensions in handling this dual responsibility. They acknowledged the importance of having time to be present as a leader, to have robust systems to maintain HSE and QPS, and that conflicting aspects of legislation are an everyday challenge.
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Affiliation(s)
- Malin Rosell Magerøy
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Carl Macrae
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Centre for Health, Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, United Kingdom
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Siri Wiig
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
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Ugelvik KS, Thomassen Ø, Braut GS, Geisner T, Sjøvold JE, Agri J, Montan C. Evaluation of prehospital preparedness for major incidents on a national level, with focus on mass casualty incidents. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02386-7. [PMID: 38117294 DOI: 10.1007/s00068-023-02386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/21/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. METHOD A national cross-sectional descriptive study of Norway's prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation. RESULTS Totally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation. CONCLUSION The study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level.
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Affiliation(s)
- Kristina Stølen Ugelvik
- University of Bergen, Bergen, Norway.
- Regional Trauma Centre, Haukeland University Hospital, Bergen, Norway.
| | - Øyvind Thomassen
- University of Bergen, Bergen, Norway
- HEMS, Haukeland University Hospital, Bergen, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Geir Sverre Braut
- Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Stavanger, Norway
| | - Thomas Geisner
- Gastrosurgical Department, Haukeland University Hospital, Bergen, Norway
| | | | - Joakim Agri
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Montan
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Magerøy MR, Braut GS, Macrae C, Wiig S. Healthcare leaders' and elected politicians' approach to support-systems and requirements for complying with quality and safety regulation in nursing homes - a case study. BMC Health Serv Res 2023; 23:880. [PMID: 37608326 PMCID: PMC10463382 DOI: 10.1186/s12913-023-09906-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Healthcare leaders play an important and complex role in managing and handling the dual responsibility of both Health, Safety and Environment (HSE) for workers and quality and patient safety (QPS). There is a need for better understanding of how healthcare leaders and decision makers organize and create support structures to handle these combined responsibilities in practice. The aim of this study was to explore how healthcare leaders and elected politicians organize, control, and follow up the work of HSE and QPS in a Norwegian nursing home context. Moreover, we explore how they interpret, negotiate, and manage the dual responsibility and possible tensions between employee health and safety, and patient safety and quality of service delivery. METHODS The study was conducted in 2022 as a case study exploring the experience of healthcare leaders and elected politicians in five municipalities responsible for providing nursing homes services in Norway. Elected politicians (18) and healthcare leaders (11) participated in focus group interviews (5) and individual interviews (11). Data were analyzed using inductive thematic analysis. RESULTS The analysis identified five main themes explaining how the healthcare leaders and elected politicians organize, control, and follow up the work of HSE and QPS: 1. Establish frameworks and room for maneuver in the work with HSE and QPS. 2. Create good routines and channels for communication and collaboration. 3. Build a culture for a health-promoting work environment and patient safety. 4. Create systems to handle the possible tensions in the dual responsibility between caring for employees and quality and safety in service delivery. 5. Define clear boundaries in responsibility between politics and administration. CONCLUSIONS The study showed that healthcare leaders and elected politicians who are responsible for ensuring sound systems for quality and safety for both patients and staff, do experience tensions in handling this dual responsibility. They acknowledge the need to create systems and awareness for the responsibility and argue that there is a need to better separate the roles and boundaries between elected politicians and the healthcare administration in the execution of HSE and QPS.
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Affiliation(s)
- Malin Rosell Magerøy
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway.
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Carl Macrae
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Centre for Health, Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Siri Wiig
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
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Braut GS. 50 år med aukande behov for helsepersonell. Tidsskr Nor Laegeforen 2023; 143:23-0089. [PMID: 36919305 DOI: 10.4045/tidsskr.23.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Braut GS. Omfattande og analytisk om helserett. Tidsskriftet 2023. [DOI: 10.4045/tidsskr.23.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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Braut GS. Complex challenges should be approached by a multitude of theories and models. Risk Anal 2023; 43:236-237. [PMID: 36351748 DOI: 10.1111/risa.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The ongoing pandemic may be regarded as a wicked problem. Therefore, it should be analyzed by a multitude of theories and models. Approaching the complex set of challenges posed to individuals and society by singular methods, can lead to suboptimal decisions. Good decisions must take into account the large set of uncertainties we are facing, by using well established procedures, as for example health technology assessment (HTA) and a nuanced ethical framework.
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Affiliation(s)
- Geir Sverre Braut
- Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
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Løland M, Braut GS, Lichtenberg SM, Egenberg S. Tools for establishing a sustainable safety culture within maternity services. A retrospective case study. SAGE Open Med 2023; 11:20503121231164264. [PMID: 37026106 PMCID: PMC10071155 DOI: 10.1177/20503121231164264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: This article reports the findings from a single case study on the long-term sustainability of a quality system in a large maternity unit. Method: The empirical basis is an analysis of documents related to the development, implementation, maintenance and outcome of the system over two decades. The main elements of the quality system are reported as findings, and the possible effects of the different elements are presented and discussed based on theories on safety management and leadership. Result: The findings suggest that the quality system served as the basis for a meaningful workplace community. The structure of meetings, research, training and budget input were all central factors for the development of the system. It resulted in systematic ongoing improvement, participation from all levels of the organization and trust within the organization. The effects of the system may still be seen after the end point of this study. Conclusions: It remains the responsibility of the management to ensure an adequate professional standard of services by a continuous internal quality assurance system for enhanced patient safety.
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Affiliation(s)
- Marianne Løland
- The Norwegian Healthcare Investigation
Board (Ukom), Oslo, Norway
- Marianne Løland, The Norwegian Healthcare
Investigation Board (Ukom), Post office box 225, Skøyen, Oslo 0213, Norway.
| | - Geir Sverre Braut
- Western Norway University of Applied
Sciences (hvl.no), Sogndal, Norway
- Retired from Stavanger University
Hospital, Stavanger, Rogaland, Norway
| | | | - Signe Egenberg
- Retired from Stavanger University
Hospital, Stavanger, Rogaland, Norway
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8
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Ellingsen CL, Alfsen GC, Ebbing M, Pedersen AG, Sulo G, Vollset SE, Braut GS. Garbage codes in the Norwegian Cause of Death Registry 1996-2019. BMC Public Health 2022; 22:1301. [PMID: 35794568 PMCID: PMC9261062 DOI: 10.1186/s12889-022-13693-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Reliable statistics on the underlying cause of death are essential for monitoring the health in a population. When there is insufficient information to identify the true underlying cause of death, the death will be classified using less informative codes, garbage codes. If many deaths are assigned a garbage code, the information value of the cause-of-death statistics is reduced. The aim of this study was to analyse the use of garbage codes in the Norwegian Cause of Death Registry (NCoDR). Methods Data from NCoDR on all deaths among Norwegian residents in the years 1996–2019 were used to describe the occurrence of garbage codes. We used logistic regression analyses to identify determinants for the use of garbage codes. Possible explanatory factors were year of death, sex, age of death, place of death and whether an autopsy was performed. Results A total of 29.0% (290,469/1,000,128) of the deaths were coded with a garbage code; 14.1% (140,804/1,000,128) with a major and 15.0% (149,665/1,000,128) with a minor garbage code. The five most common major garbage codes overall were ICD-10 codes I50 (heart failure), R96 (sudden death), R54 (senility), X59 (exposure to unspecified factor), and A41 (other sepsis). The most prevalent minor garbage codes were I64 (unspecified stroke), J18 (unspecified pneumonia), C80 (malignant neoplasm with unknown primary site), E14 (unspecified diabetes mellitus), and I69 (sequelae of cerebrovascular disease). The most important determinants for the use of garbage codes were the age of the deceased (OR 17.4 for age ≥ 90 vs age < 1) and death outside hospital (OR 2.08 for unknown place of death vs hospital). Conclusion Over a 24-year period, garbage codes were used in 29.0% of all deaths. The most important determinants of a death to be assigned a garbage code were advanced age and place of death outside hospital. Knowledge of the national epidemiological situation, as well as the rules and guidelines for mortality coding, is essential for understanding the prevalence and distribution of garbage codes, in order to rely on vital statistics. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13693-w.
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Affiliation(s)
- Christian Lycke Ellingsen
- Department of Pathology, Stavanger University Hospital, PO Box 8100, N-4068, Stavanger, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5020, Bergen, Norway.
| | - G Cecilie Alfsen
- Department of Pathology, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway.,Faculty of Medicine, University of Oslo, PO Box 1078, Blindern, N-0316, Oslo, Norway
| | - Marta Ebbing
- Department of Research and Development, Haukeland University Hospital, PO Box 1400, N-5021, Bergen, Norway
| | - Anne Gro Pedersen
- Department for Health Data and Collection, Norwegian Institute of Public Health, PO Box 973, Sentrum, N-5808, Bergen, Norway
| | - Gerhard Sulo
- Centre for Disease Burden, Norwegian Institute of Public Health, PO Box 973, Sentrum, N-5808, Bergen, Norway
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5020, Bergen, Norway.,Department of Health Metrics Sciences and Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, PO Box 8100, N-4068, Stavanger, Norway
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Alfsen GC, Braut GS, Ellingsen CL. En nasjonal strategi for obduksjoner mangler. Tidsskriftet 2022; 142:22-0061. [DOI: 10.4045/tidsskr.22.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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10
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Johansen LT, Braut GS, Øian P. Room for improvement in maternity care. Tidsskriftet 2022; 142:22-0208. [DOI: 10.4045/tidsskr.22.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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11
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Rozsa DJ, Dalbye R, Bernitz S, Blix E, Dalen I, Braut GS, Eggebø TM, Øian P, Sande RK. The effect of Zhang's guideline versus the WHO partograph on childbirth experience measured by the Childbirth Experience Questionnaire in the Labor Progression Study (LaPS): A cluster randomized trial. Acta Obstet Gynecol Scand 2021; 101:193-199. [PMID: 34859422 DOI: 10.1111/aogs.14298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Childbirth experience is an increasingly recognized and important measure of quality of obstetric care. Previous research has shown that it can be affected by intrapartum care and how labor is followed. A partograph is recommended to follow labor progression by recording cervical dilation over time. There are currently different guidelines in use worldwide to follow labor progression. The two main ones are the partograph recommended by the World Health Organization (WHO) based on the work of Friedman and Philpott and a guideline based on Zhang's research. In our study we assessed the effect of adhering to Zhang's guideline or the WHO partograph on childbirth experience. Zhang's guideline describes expected normal labor progression based on data from contemporary obstetric populations, resulting in an exponential progression curve, compared with the linear WHO partograph. The choice of labor curve affects the intrapartum follow-up of women and this could potentially affect childbirth experience. MATERIAL AND METHODS The Labor Progression Study (LaPS) study was a prospective, cluster randomized controlled trial conducted at 14 birth centers in Norway. Birth centers were randomized to either follow Zhang's guideline or the WHO partograph. Nulliparous women in active labor, with one fetus in cephalic presentation at term and spontaneous labor onset were included. At 4 weeks postpartum, included women received an online login to complete the Childbirth Experience Questionnaire (CEQ). Total score on the CEQ, the four domain scores on the CEQ, and scores on the individual items on the CEQ were compared between the two groups. RESULTS There were 1855 women in the Zhang group and 1749 women in the WHO partograph group. There was no difference in the total or domain CEQ scores between the two groups. We found statistically significant differences for two individual items; women in the Zhang group scored lower on positive memories and feeling of control. CONCLUSIONS Based on our findings on childbirth experience there is no reason to prefer Zhang's guideline over the WHO partograph.
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Affiliation(s)
- Daniella Judit Rozsa
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, Department of Caring and Ethics, University of Stavanger, Stavanger, Norway
| | - Rebecka Dalbye
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Stine Bernitz
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ellen Blix
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Torbjørn M Eggebø
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.,National Center for Fetal Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Ragnar Kvie Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Sundnes KO, Braut GS. COVID-19: systematic learning across boundaries requires a conceptual agreement. Scand J Public Health 2021; 49:809-814. [PMID: 34162297 PMCID: PMC8521361 DOI: 10.1177/14034948211027086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022]
Abstract
The COVID-19 epidemic has revealed a shortage of basic knowledge and understanding of pandemics, especially regarding their dynamics and how to contain them. The results are a host of governments' decrees and instructions, one replacing the other, often within the same week. It has further, in a truly short time, resulted in an overwhelming number of publications, many of them prioritising early publication over quality. This commentary addresses the concept of structured research related to disasters and how the use of endorsed guidelines will facilitate well-designed evaluation research with improved rigour and external validity, even if applied retrospectively. The outcome should be a solidified knowledge base. Further, the important role of public health efforts is to be highlighted, as their role has proved crucial during the COVID-19 pandemic.
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Affiliation(s)
- Knut Ole Sundnes
- The Intervention Centre, Oslo University Hospital, Norway
- University of Stavanger, Centre for Risk Management and Societal Safety, Norway
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Sleveland A, Lende TH, Søiland H, Lode K, Braut GS. The balance between professional autonomy and organizational obligations in resilient management of specialized health care: A Norwegian document study. Int J Risk Saf Med 2021; 33:335-355. [PMID: 34569979 DOI: 10.3233/jrs-210003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adverse events in hospitals may jeopardize the safety of patients. Failure in professional autonomy, organizational learning or in the contact between these two factors may explain the occurrence of injurious incidents in hospitals. OBJECTIVE To study reasons for failure in contact between professional autonomy and organizational learning in resilient management of specialized health care through document analysis. METHODS A total of 20 reports from the Norwegian Board of Health Supervision were evaluated by a retrospective in-depth document analysis. In the analysis of adverse events, we applied the Braut model to identify function or failure of 1. Professional autonomy, 2. Organizational learning and 3. Contact between professional autonomy and organizational learning. RESULTS Multivariable regression analysis showed that 'Failure in organizational learning' was the only explanatory variable for 'Failure in contact between doctors and nurses' autonomy and organizational learning'. 'Failure in organizational learning' had the strongest effect on 'Failure in contact between doctors and nurse's autonomy and organizational learning' (B = 1.69; 95% CI = 0.45 to 2.92). 'Failure in professional autonomy' showed no significant effect on this contact. CONCLUSIONS 'Failure in organizational learning' is associated with 'Failure in contact between professional autonomy and organizational learning'. 'Failure in professional autonomy' did not influence this contact.
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Affiliation(s)
- Anette Sleveland
- Department of Media and Social Sciences, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Tone Hoel Lende
- Breast Cancer Research Group, Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Håvard Søiland
- Breast Cancer Research Group, Department of Surgery, Stavanger University Hospital, Stavanger, Norway.,The Nursing and Health Care Research Group, Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kirsten Lode
- The Nursing and Health Care Research Group, Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Geir Sverre Braut
- The Nursing and Health Care Research Group, Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
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Johansen LT, Braut GS, Acharya G, Andresen JF, Øian P. Adverse events reporting by obstetric units in Norway as part of their quality assurance and patient safety work: an analysis of practice. BMC Health Serv Res 2021; 21:931. [PMID: 34493278 PMCID: PMC8424984 DOI: 10.1186/s12913-021-06956-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Norwegian Board of Health Supervision aims to contribute to the improvement of quality and patient safety in the healthcare services. Planned audits were performed to investigate how 12 selected Norwegian obstetric units reported and analyzed adverse events as the part of their quality assurance and patient safety work. METHODS Serious adverse events coded as birth asphyxia, shoulder dystocia and severe postpartum hemorrhage that occurred during 2014 (the most recent year for which the quality assured data were available) were obtained from the Medical Birth Registry of Norway. The obstetric units were asked to submit medical records, internal adverse events reports, and their internal guidelines outlining which events should be reported to the quality assurance system. We identified the adverse events at each obstetric unit that were reported internally and/or to the central authorities. Two obstetricians carried out an evaluation of each event reported. RESULTS Five hundred fifty-three serious adverse events were registered among 17,323 births that took place at the selected units. Twenty-one events were excluded because of incorrect coding or missing information. Eight events were registered in more than one category, and these were distributed to the category directly related to injury or adverse outcome. Nine of twelve (75 %) obstetric units had written guidelines describing which events should be reported. The obstetric units reported 49 of 524 (9.3 %) serious adverse events in their internal quality assurance system and 39 (7.4 %) to central authorities. Of the very serious adverse events, 29 of 149 (19.4 %) were reported. Twenty-three of 49 (47 %) reports did not contain relevant assessments or proposals for improving quality and patient safety. CONCLUSIONS This study showed that adverse event reporting and analyses by Norwegian obstetric units, as a part of quality assurance and patient safety work, are suboptimal. The reporting culture and compliance with guidelines need to be improved substantially for better safety in patient care, risk mitigation and clinical quality assurance.
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Affiliation(s)
- Lars T Johansen
- Department for Specialized Health Services, Norwegian Board of Health Supervision, PO Box 231 Skøyen, 0213, Oslo, Norway.
| | - Geir Sverre Braut
- Department for Specialized Health Services, Norwegian Board of Health Supervision, PO Box 231 Skøyen, 0213, Oslo, Norway.,Stavanger University Hospital, Stavanger, Norway.,Western Norway University of Applied Sciences, Sogndal, Norway
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.,Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Fredrik Andresen
- Department for Specialized Health Services, Norwegian Board of Health Supervision, PO Box 231 Skøyen, 0213, Oslo, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
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Davies JI, Gelb AW, Gore-Booth J, Martin J, Mellin-Olsen J, Åkerman C, Ameh EA, Biccard BM, Braut GS, Chu KM, Derbew M, Ersdal HL, Guzman JM, Hagander L, Haylock-Loor C, Holmer H, Johnson W, Juran S, Kassebaum NJ, Laerdal T, Leather AJM, Lipnick MS, Ljungman D, Makasa EM, Meara JG, Newton MW, Østergaard D, Reynolds T, Romanzi LJ, Santhirapala V, Shrime MG, Søreide K, Steinholt M, Suzuki E, Varallo JE, Visser GHA, Watters D, Weiser TG. Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report. PLoS Med 2021; 18:e1003749. [PMID: 34415914 PMCID: PMC8415575 DOI: 10.1371/journal.pmed.1003749] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. METHODS AND FINDINGS The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees. CONCLUSIONS To track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.
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Affiliation(s)
- Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Public Health, Wits University, Johannesburg, South Africa
- * E-mail:
| | - Adrian W. Gelb
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia & Perioperative Care, University of California San Francisco, California, United States of America
| | - Julian Gore-Booth
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
| | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
| | - Jannicke Mellin-Olsen
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway
| | - Christina Åkerman
- Dell Medical School, University of Texas at Austin, Austin, Texas, United States of America
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, Massachusetts, United States of America
| | - Emmanuel A. Ameh
- Division of Paediatric Surgery, The National Hospital, Abuja, Nigeria
- National Surgical, Obstetric and Anaesthesia Planning Committee, Federal Ministry of Health, Abuja, Nigeria
| | - Bruce M. Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Western Cape, South Africa
| | - Geir Sverre Braut
- Research Department of Community Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Miliard Derbew
- School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway
| | | | - Lars Hagander
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carolina Haylock-Loor
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia, Intensive Care Medicine, Interventional Pain Unit, Hospital Del Valle, San Pedro Sula, Honduras
| | - Hampus Holmer
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Walter Johnson
- Department of Neurosurgery, Loma Linda University, Loma Linda, California, United States of America
| | - Sabrina Juran
- Population and Development, United Nations Population Fund, New York, New York, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nicolas J. Kassebaum
- Anesthesiology and Pain Medicine, Health Metrics Sciences, Global Health, and Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Andrew J. M. Leather
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Michael S. Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, United States of America
| | - David Ljungman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmanuel M. Makasa
- SADC-Wits Regional Collaboration Centre for Surgical Healthcare (WitSSurg), Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Mark W. Newton
- Department of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Tennessee, United States of America
- AIC Kijabe Hospital, Kenya
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, The University of Copenhagen, Copenhagen, Denmark
| | - Teri Reynolds
- Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Lauri J. Romanzi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vatshalan Santhirapala
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anaesthesia and Perioperative Care, Guy’s and St. Thomas’ Hospital, London, United Kingdom
| | - Mark G. Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Margit Steinholt
- Helgeland Hospital Trust, Sandnessjøen, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Emi Suzuki
- The World Bank, Washington, DC, United States of America
| | - John E. Varallo
- Department of Safe Surgery, Jhpiego, Baltimore, Maryland, United States of America
| | - Gerard H. A. Visser
- Department of Obstetrics, University Medical Center, Utrecht, the Netherlands
| | - David Watters
- University Hospital Geelong, Victoria, Australia
- Faculty of Health, School of Medicine, Deakin University, Victoria, Australia
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Thomas G. Weiser
- Stanford University School of Medicine, Department of Surgery Division of General Surgery, Section of Trauma & Critical Care Stanford University, Stanford, United States of America
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland
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Kolnes NH, Eikeland SN, Ersdal TA, Braut GS. Estimating the consequences of a COVID-19 super spreader: A stochastic model of a night on the town. Scand J Public Health 2021; 50:111-116. [PMID: 34304620 PMCID: PMC8807544 DOI: 10.1177/14034948211031400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A stochastic model estimated the consequences of a COVID-19 super spreader event occurring in the local municipality of Stavanger, Norway as a result of a night on the town. The model imposed different infection control regulations and compared these different scenarios. For Stavanger’s 161 locations of service, secondary transmissions from a super spreader event was estimated to infect a median of 37, requiring the quarantining of 200 guests given no infection control regulations, 23 and 167 when imposing social distancing regulations and other hygienic infection control measures, 7 infected and 63 quarantined guests with restrictions placed on the guest capacity, and 4 infected and 57 quarantined guests with both forms of restriction in use.
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Øvstebø AMM, Braut GS, Bjørshol CA. Confidential information to a third person – the Health Research Act prevents us. Tidsskr Nor Laegeforen 2021; 141:20-0998. [PMID: 33754682 DOI: 10.4045/tidsskr.20.0998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lycke Ellingsen C, Alfsen GC, Braut GS. Forensic autopsies in Norway 1996-2017: A retrospective study of factors associated with deaths undergoing forensic autopsy. Scand J Public Health 2021; 50:424-431. [PMID: 33685312 PMCID: PMC9152604 DOI: 10.1177/1403494821997208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Forensic autopsies are important for the investigation of deaths with a legal
or public-health interest, as well as being a source for cause-of-death
statistics. The aim of this study was to investigate the use of forensic
autopsies in Norway, with a special emphasis on geographical variation. Methods: Data from the Norwegian Cause of Death Registry for the years 1996–2017
included 920,232 deaths and 37,398 forensic autopsies. We used logistic
regression to identify factors that were associated with the proportion of
forensic autopsies, grouped according to the registered cause of death.
Explanatory variables were age and sex, place of death, police district,
population size and urbanity level of the municipality and distance to the
autopsy facility. Results: The proportion of deaths undergoing forensic autopsy was 4.1%, with the
highest being homicides (96.6%) and the lowest being deaths from natural
causes (1.7%). Variation between police districts was 0.9–7.8%, and the span
persisted during the study period. The most important explanatory variables
across the strata were place of death (there were few autopsies of deaths in
health-care facilities), police district and age of the deceased. Distance
to the autopsy facility, sex, population size and the level of urbanity had
only a minor influence. The variation between police districts was not fully
accounted for by the other investigated factors. Conclusions: Unjustified differences in the frequency of autopsies may lead to
insufficient investigation of possible unnatural deaths. In worst-case
scenarios, homicides or other criminal cases might remain undetected. It
may also introduce spurious shifts in the cause-of-death
statistics.
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Affiliation(s)
- Christian Lycke Ellingsen
- Department of Pathology, Stavanger University Hospital, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - G Cecilie Alfsen
- Department of Pathology, Akershus University Hospital, Norway.,Faculty of Medicine, University of Oslo, Norway
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Abstract
OBJECTIVES The aim of this study was to explore if, and in what ways, there has been changes in the supervisory approach toward Norwegian hospitals due to the implementation of a new management and quality improvement regulation (Regulation on Management and Quality Improvement in the Healthcare Services, hereinafter referred to as "Quality Improvement Regulation"). Moreover, we aimed to understand how inspectors' work promotes or hampers resilience potentials of adaptive capacity and learning in hospitals. METHODS The study design is a case study of implementation and impact of the Quality Improvement Regulation. We performed a document analysis, and conducted and analyzed 3 focus groups and 2 individual interviews with regulatory inspectors, recruited from 3 county governor offices who are responsible for implementation and supervision of the Quality Improvement Regulation in Norwegian regions. RESULTS Data analysis resulted in 5 themes. Informants described no substantial change in their approach owing to the Quality Improvement Regulation. Regardless, data pointed to a development in their practices and expectations. Although the Norwegian Board of Health Supervision, at the national level, occasionally provides guidance, supervision is adapted to specific contexts and inspectors balance trade-offs. Informants expressed concern about the impact of supervision on hospital performance. Benefits and disadvantage with positive feedback from inspectors were debated. Inspectors could nurture learning by improving their follow-up and add more hospital self-assessment. CONCLUSIONS A nondetailed regulatory framework such as the Quality Improvement Regulation provides hospitals with room to maneuver, and self-assessment might reduce resource demands. The impact of supervision is scarce with an unfulfilled potential to learn from supervision. The Government could contribute to a shift in focus by instructing the county governors to actively reflect on and communicate positive experiences from, and smart adaptations in, hospital practice.
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Affiliation(s)
- Sina Furnes Øyri
- From the Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
| | - Geir Sverre Braut
- From the Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
- Stavanger University Hospital, Stavanger, Norway
| | - Carl Macrae
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, United Kingdom
| | - Siri Wiig
- From the Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
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Øyri SF, Braut GS, Macrae C, Wiig S. Hospital managers' perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study. BMJ Open 2020; 10:e042847. [PMID: 33273051 PMCID: PMC7716670 DOI: 10.1136/bmjopen-2020-042847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022] Open
Abstract
A new regulatory framework to support local quality and safety efforts in hospitals was introduced to the Norwegian healthcare system in 2017. This study aimed to investigate hospital managers' perspectives on implementation efforts and the resulting work practices, to understand if, and how, the new Quality Improvement Regulation influenced quality and safety improvement activities. DESIGN This article reports one study level (the perspectives of hospital managers), as part of a multilevel case study. Data were collected by interviews and analysed according to qualitative content analysis. SETTING Three hospitals retrieved from two regional health trusts in Norway. PARTICIPANTS 20 hospital managers or quality advisers selected from different levels of hospital organisations. RESULTS Four themes were identified in response to the study aim: (1) adaptive capacity in hospital management and practice, (2) implementation efforts and challenges with quality improvement, (3) systemic changes and (4) the potential to learn. Recent structural and cultural changes to, and development of, quality improvement systems in hospitals were discovered (3). Participants however, revealed no change in their practice solely due to the new Quality Improvement Regulation (2). Findings indicated that hospital managers are legally responsible for quality improvement implementation and participants described several benefits with the new Quality Improvement Regulation (2). This related to adaptation and flexibility to local context, and clinical autonomy as an inevitable element in hospital practice (1). Trust and a safe work environment were described as key factors to achieve adverse event reporting and support learning processes (4). CONCLUSIONS This study suggests that a lack of time, competence and/or motivation, impacted hospitals' implementation of quality improvement efforts. Hospital managers' autonomy and adaptive capacity to tailor quality improvement efforts were key for the new Quality Improvement Regulation to have any relevant impact on hospital practice and for it to influence quality and safety improvement activities.
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Affiliation(s)
- Sina Furnes Øyri
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Safety, Economics and Planning, University of Stavanger, Stavanger, Norway
| | - Carl Macrae
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, Nottinghamshire, UK
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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21
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Palm M, Moen L, Braut GS. Risk analyses in the intersection between patient and workplace safety: A case study of hazids in para-clinical supporting systems in specialized health care. SAGE Open Med 2020; 8:2050312120977136. [PMID: 33294187 PMCID: PMC7705811 DOI: 10.1177/2050312120977136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/06/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The aim is to investigate the appropriateness of hazid for performing risk analyses in supporting systems in hospitals. METHODS We used a case study approach for evaluating introduction of hazid for the first time in two different university hospital settings. The hazid was performed in a customized way according to the specific needs at the two sites. FINDINGS In both settings studied, the hazid approach revealed several phenomena that were followed up in the ordinary quality improvement work. The results were widely acknowledged as valid as seen from the managerial level. The participants reported that they felt comfortable in the hazid process and were able to freely present their current concerns and perspectives on risks related to their daily work. CONCLUSION Hazid is basically a meeting between competent workers who elaborate on their own risk picture. It is giving other types of information not gained through other often-used approaches. Specific risk factors can be described in real time as seen by people directly involved, thus circumventing the hierarchy in the organization. The process in itself can trigger improvement actions. APPLICATION TO PRACTICE Hazid can be used for presenting a valid risk picture as seen from below in the organization.
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Affiliation(s)
| | - Leif Moen
- Stavanger University Hospital, Stavanger,
Norway
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Braut GS, Åbotsvik BF, Dalbakk M, Spansvoll L, Berntsen G. «Sløyfa» – en metode for analyse av risiko i klinisk arbeid i grenseflaten mellom spesialisthelsetjenesten og kommunehelsetjenesten. TFO 2020. [DOI: 10.18261/issn.2387-5984-2020-02-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Husabø G, Nilsen RM, Solligård E, Flaatten HK, Walshe K, Frich JC, Bondevik GT, Braut GS, Helgeland J, Harthug S, Hovlid E. Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation. BMJ Open 2020; 10:e037715. [PMID: 33082187 PMCID: PMC7577024 DOI: 10.1136/bmjopen-2020-037715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the effects of external inspections on (1) hospital emergency departments' clinical processes for detecting and treating sepsis and (2) length of hospital stay and 30-day mortality. DESIGN Incomplete cluster-randomised stepped-wedge design using data from patient records and patient registries. We compared care processes and patient outcomes before and after the intervention using regression analysis. SETTING Nationwide inspections of sepsis care in emergency departments in Norwegian hospitals. PARTICIPANTS 7407 patients presenting to hospital emergency departments with sepsis. INTERVENTION External inspections of sepsis detection and treatment led by a public supervisory institution. MAIN OUTCOME MEASURES Process measures for sepsis diagnostics and treatment, length of hospital stay and 30-day all-cause mortality. RESULTS After the inspections, there were significant improvements in the proportions of patients examined by a physician within the time frame set in triage (OR 1.28, 95% CI 1.07 to 1.53), undergoing a complete set of vital measurements within 1 hour (OR 1.78, 95% CI 1.10 to 2.87), having lactate measured within 1 hour (OR 2.75, 95% CI 1.83 to 4.15), having an adequate observation regimen (OR 2.20, 95% CI 1.51 to 3.20) and receiving antibiotics within 1 hour (OR 2.16, 95% CI 1.83 to 2.55). There was also significant reduction in mortality and length of stay, but these findings were no longer significant when controlling for time. CONCLUSIONS External inspections were associated with improvement of sepsis detection and treatment. These findings suggest that policy-makers and regulatory agencies should prioritise assessing the effects of their inspections and pay attention to the mechanisms by which the inspections might contribute to improve care for patients. TRIAL REGISTRATION NCT02747121.
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Affiliation(s)
- Gunnar Husabø
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Roy Miodini Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Erik Solligård
- Clinic of Anesthesia and Intensive Care, St. Olavs Hospital University Hospital in Trondheim, Trondheim, Norway
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Kieran Walshe
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Jan C Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Department 5, Norwegian Board of Health Supervision, Oslo, Norway
| | | | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department 5, Norwegian Board of Health Supervision, Oslo, Norway
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Hovlid E, Braut GS, Hannisdal E, Walshe K, Bukve O, Flottorp S, Stensland P, Frich JC. Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis. BMJ Open 2020; 10:e038850. [PMID: 32868366 PMCID: PMC7462249 DOI: 10.1136/bmjopen-2020-038850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections. METHODS We performed a literature search (1980-January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change. RESULTS We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation's current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance. CONCLUSIONS External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.
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Affiliation(s)
- Einar Hovlid
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Haugesund, Norway
| | - Einar Hannisdal
- Department of health, County Governor in Oslo and Akershus, Oslo, Norway
| | - Kieran Walshe
- The University of Manchester Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Oddbjørn Bukve
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | | | - Per Stensland
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Jan C Frich
- Institute of Health and Society, Universitetet i Oslo, Oslo, Norway
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Øyri SF, Braut GS, Macrae C, Wiig S. Exploring links between resilience and the macro-level development of healthcare regulation- a Norwegian case study. BMC Health Serv Res 2020; 20:762. [PMID: 32811492 PMCID: PMC7433050 DOI: 10.1186/s12913-020-05513-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/06/2020] [Indexed: 11/28/2022] Open
Abstract
Background The relationship between quality and safety regulation and resilience in healthcare has received little systematic scrutiny. Accordingly, this study examines the introduction of a new regulatory framework (the Quality Improvement Regulation) in Norway that aimed to focus on developing the capacity of hospitals to continually improve quality and safety. The overall aim of the study was to explore the governmental rationale and expectations in relation to the Quality Improvement Regulation, and how it could potentially influence the management of resilience in hospitals. The study applies resilience in healthcare and risk regulation as theoretical perspectives. Methods The design is a single embedded case study, investigating the Norwegian regulatory healthcare regime. Data was collected by approaching three regulatory bodies through formal letters, asking them to provide internal and public documents, and by searching through open Internet-sources. Based on this, we conducted a document analysis, supplemented by interviews with seven strategic informants in the regulatory bodies. Results The rationale for introducing the Quality Improvement Regulation focused on challenges associated with implementation, lack of management competencies; need to promote quality improvement as a managerial responsibility. Some informants worried that the generic regulatory design made it less helpful for managers and clinicians, others claimed a non-detailed regulation was key to make it fit all hospital-contexts. The Government expected hospital managers to obtain an overview of risks and to adapt risk management and quality improvement measures to their specific context and activities. Conclusions Based on the rationale of making the Quality Improvement Regulation flexible to hospital context, encouraging the ability to anticipate local risks, along with expectations about the generic design as challenging for managers and clinicians, we found that the regulators did consider work as done as important when designing the Quality Improvement Regulation. These perspectives are in line with ideas of resilience. However, the Quality Improvement Regulation might be open for adaptation by the regulatees, but this may not necessarily mean that it promotes or encourages adaptive behavior in actual practice. Limited involvement of clinicians in the regulatory development process and a lack of reflexive spaces might hamper quality improvement efforts.
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Affiliation(s)
- Sina Furnes Øyri
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.
| | - Geir Sverre Braut
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.,Stavanger University Hospital, Stavanger, Norway
| | - Carl Macrae
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Stavanger, Norway
| | - Siri Wiig
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
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Johansen LT, Braut GS, Acharya G, Andresen JF, Øian P. How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units. Acta Obstet Gynecol Scand 2020; 100:139-146. [PMID: 32668008 PMCID: PMC7754562 DOI: 10.1111/aogs.13959] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Introduction The Norwegian Board of Health Supervision inspects healthcare institutions to ensure safety and quality of health and welfare services. A planned inspection of 12 maternity units aimed to investigate the practice of obstetric care in the case of birth asphyxia, shoulder dystocia and severe postpartum hemorrhage. Material and methods The inspection was carried out at two large, four medium and six small maternity units in Norway in 2016 to investigate adverse events that occurred between 1 January and 31 December 2014. Six of them were selected as control units. The Norwegian Board of Health Supervision searched the Medical Birth Registry of Norway to identify adverse events in each of the categories and then requested access to the medical records for all patients identified. Information about guidelines, formal teaching and simulation training at each unit was obtained by sending a questionnaire to the obstetrician in charge of each maternity unit. Results The obstetric units inspected had 553 serious adverse events of birth asphyxia, shoulder dystocia or severe postpartum hemorrhage among 17 323 deliveries. Twenty‐nine events were excluded from further analysis due to erroneous coding or missing data in the patients’ medical records. We included 524 cases (3.0% of all deliveries) of adverse events in the final analysis. Medical errors caused by substandard care were present in 295 (56.2%) cases. There was no difference in the prevalence of substandard care among the maternity units according to their size. Surprisingly, we found significantly fewer cases with substandard care in the units which the supervisory authorities considered particularly risky before the inspection, compared with the control units. Seven of the 12 units had regular formal teaching and training arrangements for obstetric healthcare personnel as outlined in the national guidelines. Conclusions Prevalence of adverse events was 3% and similar in all maternity units irrespective of their size. A breach in the standard of care was observed in 56.2% of cases and almost half of the maternity units did not follow national recommendations regarding teaching and practical training of obstetric personnel, suggesting that they should focus on implementing guidelines and training their staff.
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Affiliation(s)
- Lars T Johansen
- Department for Specialized Health Services, Norwegian Board of Health Supervision, Oslo, Norway
| | - Geir Sverre Braut
- Department for Specialized Health Services, Norwegian Board of Health Supervision, Oslo, Norway.,Stavanger University Hospital and Western Norway University of Applied Sciences, Stavanger, Norway
| | - Ganesh Acharya
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.,Women´s Health and Perinatology Research Group, Department of Clinical Medicine UiT, The Arctic University of Norway, Tromsø, Norway.,Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Center for Fetal Medicine, Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Fredrik Andresen
- Department for Specialized Health Services, Norwegian Board of Health Supervision, Oslo, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
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Bjørnsen G, Njå O, Braut GS. A Tool to Assess Learning Processes Based on the Cooperation Principle. Engineering Assets and Public Infrastructures in the Age of Digitalization 2020. [DOI: 10.1007/978-3-030-48021-9_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Lunde A, Braut GS. The Concept of Overcommitment in Rescue Operations: Some Theoretical Aspects Based on Empirical Data. Air Med J 2019; 38:343-349. [PMID: 31578972 DOI: 10.1016/j.amj.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Studies on Norwegian avalanche rescue operations have indicated high-stake searching of avalanches during elevated risk conditions. We perceive these characteristics as a sign of overcommitment. The purpose of this study is to explore the concept of overcommitment in Norwegian medical evacuation and rescue operations. How can overcommitment be described and understood as a uniform concept in rescue operations based on empirical data? METHODS In a qualitative, exploratory study, 9 focus group interviews were conducted with a total of 30 crewmembers from the Norwegian air ambulance service. RESULTS In this first in a series of 2 articles, crewmembers' reflections on the concept of overcommitment, important factors to consider when balancing risk and benefit in every mission, and a number of causal factors are presented. A definition of overcommitment in the context of rescue activities is presented. CONCLUSION Air ambulance personnel recognize overcommitment in a variety of situations. They broaden the concept to include both regular, everyday actions and hazardous rescue attempts in extraordinary incidents. The causal factors form recognizable constellations that may offer useful starting points for systems-based counteracting measures. The definition of overcommitment could provide a background for evaluation and learning in the rescue service.
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Affiliation(s)
| | - Geir Sverre Braut
- The University of Stavanger, Stavanger, Norway; Stavanger University Hospital, Stavanger, Norway
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Affiliation(s)
- Geir Sverre Braut
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway;
- SEROS – Centre for Risk Management and Societal Safety, University of Stavanger, Stavanger, Norway;
| | - Svein R. Kjosavik
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway;
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Lunde A, Braut GS. Overcommitment: Management in Helicopter Emergency Medical Services in Norway. Air Med J 2019; 38:168-173. [PMID: 31122581 DOI: 10.1016/j.amj.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Overcommitment in demanding rescue situations may put both rescuers and patients in danger. This study aimed at identifying individual approaches and organizational strategies that counteract instances in which rescuers commit more than is feasible, desirable, expected, recommended, or compellingly necessary. How is overcommitment managed by professional frontline rescuers during hazardous medical evacuation and rescue situations? METHODS In a qualitative, exploratory study, 9 focus group interviews were conducted with a total of 30 crewmembers from the Norwegian Helicopter Emergency Medical Service. RESULTS In this second article in a series of 2 articles on overcommitment, 12 commitment-moderating factors are presented. Air ambulance personnel pointed at sociological, cognitive, and organizational elements that may influence their degree of commitment in challenging and hazardous rescue situations. CONCLUSION Air ambulance personnel describe a team-based approach to adjust their level of commitment in medical evacuation and rescue missions. They rely on known, however important, nontechnical skills and organizational measures to combat overcommitment in demanding rescue situations. Some of their approaches to safe performance should be adoptable by other rescue units and less experienced voluntary, not-for-profit, rescue organizations.
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Affiliation(s)
| | - Geir Sverre Braut
- The University of Stavanger, Stavanger, Norway; Stavanger University Hospital, Stavanger, Norway
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Bleskestad IH, Braut GS. Information is called for on the legal basis for processing. Tidsskr Nor Laegeforen 2019; 139:19-0274. [PMID: 31062565 DOI: 10.4045/tidsskr.19.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Johansen LT, Braut GS, Andresen JF, Øian P. An evaluation by the Norwegian Health Care Supervision Authorities of events involving death or injuries in maternity care. Acta Obstet Gynecol Scand 2018; 97:1206-1211. [PMID: 29806955 PMCID: PMC6175322 DOI: 10.1111/aogs.13391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/13/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We aimed to determine how serious adverse events in obstetrics were assessed by supervision authorities. MATERIAL AND METHODS We selected cases investigated by supervision authorities during 2009-2013. We analyzed information about who reported the event, the outcomes of the mother and infant, and whether events resulted from errors at the individual or system level. We also assessed whether the injuries could have been avoided. RESULTS During the study period, there were 303 034 births in Norway, and supervision authorities investigated 338 adverse events in obstetric care. Of these, we studied 207 cases that involved a serious outcome for mother or infant. Five mothers (2.4%) and 88 infants (42.5%) died. Of the 207 events reported to the supervision authorities, patients or relatives reported 65.2%, hospitals reported 39.1%, and others reported 4.3%. In 8.7% of cases, events were reported by more than 1 source. The supervision authority assessments showed that 48.3% of the reported cases involved serious errors in the provision of health care, and a system error was the most common cause. We found that supervision authorities investigated significantly more events in small and medium-sized maternity units than in large units. Eighteen health personnel received reactions; 15 were given a warning, and 3 had their authority limited. We determined that 45.9% of the events were avoidable. CONCLUSIONS The supervision authorities investigated 1 in 1000 births, mainly in response to complaints issued from patients or relatives. System errors were the most common cause of deficiencies in maternity care.
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Affiliation(s)
| | - Geir Sverre Braut
- Stavanger University Hospital and Western Norway University of Applied SciencesStavangerNorway
| | | | - Pål Øian
- Department of Obstetrics and GynecologyFaculty of Health SciencesInstitute of Clinical MedicineThe University Hospital of North NorwayThe Arctic University of NorwayTromsøNorway
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Hovlid E, Frich JC, Walshe K, Nilsen RM, Flaatten HK, Braut GS, Helgeland J, Teig IL, Harthug S. Effects of external inspection on sepsis detection and treatment: a study protocol for a quasiexperimental study with a stepped-wedge design. BMJ Open 2017; 7:e016213. [PMID: 28877944 PMCID: PMC5589010 DOI: 10.1136/bmjopen-2017-016213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Inspections are widely used in health care as a means to improve the health services delivered to patients. Despite their widespread use, there is little evidence of their effect. The mechanisms for how inspections can promote change are poorly understood. In this study, we use a national inspection campaign of sepsis detection and initial treatment in hospitals as case to: (1) Explore how inspections affect the involved organizations. (2) Evaluate what effect external inspections have on the process of delivering care to patients, measured by change in indicators reflecting how sepsis detection and treatment is carried out. (3) Evaluate whether external inspections affect patient outcomes, measured as change in the 30-day mortality rate and length of hospital stay. METHODS AND ANALYSIS The intervention that we study is inspections of sepsis detection and treatment in hospitals. The intervention will be rolled out sequentially during 12 months to 24 hospitals. Our effect measures are change on indicators related to the detection and treatment of sepsis, the 30-day mortality rate and length of hospital stay. We collect data from patient records at baseline, before the inspections, and at 8 and 14 months after the inspections. We use logistic regression models and linear regression models to compare the various effect measurements between the intervention and control periods. All the models will include time as a covariate to adjust for potential secular changes in the effect measurements during the study period. We collect qualitative data before and after the inspections, and we will conduct a thematic content analysis to explore how inspections affect the involved organisations. ETHICS AND DISSEMINATION The study has obtained ethical approval by the Regional Ethics Committee of Norway Nord and the Norwegian Data Protection Authority. It is registered at www.clinicaltrials.gov (Identifier: NCT02747121). Results will be reported in international peer-reviewed journals. TRIAL REGISTRATION NCT02747121; Pre-results.
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Affiliation(s)
- Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal and Norwegian Board of Health Supervision, Oslo, Norway
| | - Jan C Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kieran Walshe
- Health Management Group, Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Roy M Nilsen
- Department of Health and Social Sciences, Department of Research and Development, Western Norway University of Applied Sciences, Haukeland University Hospital, Bergen, Norway
| | - Hans Kristian Flaatten
- Department of Anaesthesia and Intensive Care, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Department of research, Stavanger University Hospital, Stavanger; Norwegian Board of Health Supervision, Oslo, Norway
| | - Jon Helgeland
- Quality Measurement Unit, Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Lise Teig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stig Harthug
- Department of Research and Development, Department of Clinical Science, Faculty of Medicine and Dentistry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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Bleskestad IH, Braut GS. Unntak fra taushetsplikten? Tidsskriftet 2017; 137:17-0970. [DOI: 10.4045/tidsskr.17.0970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Braut GS. Ein klassikar i ny utgåve. Tidsskriftet 2017. [DOI: 10.4045/tidsskr.17.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
OBJECTIVE Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims. METHODS, PARTICIPANTS This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims. We used a semistructured interview guide focusing on their experiences after providing CPR. SETTING The study was conducted in the Stavanger region of Norway, an area with very high bystander CPR rates. RESULTS Three themes emerged from the interview analysis: concern, uncertainty and coping strategies. Providing CPR had been emotionally challenging for all lay rescuers and, for some, had consequences in terms of family and work life. Several lay rescuers experienced persistent mental recurrences of the OHCA incident and had concerns about the outcome for the cardiac arrest victim. Unknown or fatal outcomes often caused feelings of guilt and were particularly difficult to handle. Several reported the need to be acknowledged for their CPR attempts. Health-educated lay rescuers seemed to be less affected than others. A common coping strategy was confiding in close relations, preferably the health educated. However, some required professional help to cope with the OHCA incident. CONCLUSIONS Lay rescuers experience emotional and social challenges, and some struggle to cope in life after providing CPR in OHCA incidents. Experiencing a positive patient outcome and being a health-educated lay rescuer seem to mitigate concerns. Common coping strategies are attempts to reduce uncertainty towards patient outcome and own CPR quality. Further studies are needed to determine whether an organised professional follow-up can mitigate the concerns and uncertainty of lay rescuers.
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Affiliation(s)
- Wenche Torunn Mathiesen
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Conrad Arnfinn Bjørshol
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Stord/Haugesund University College, Haugesund, Norway
| | - Eldar Søreide
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
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Hovlid E, Høifødt H, Smedbråten B, Braut GS. A retrospective review of how nonconformities are expressed and finalized in external inspections of health-care facilities. BMC Health Serv Res 2015; 15:405. [PMID: 26399426 PMCID: PMC4580086 DOI: 10.1186/s12913-015-1068-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 09/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background External inspections are widely used in health care as a means of improving the quality of care. However, the way external inspections affect the involved organization is poorly understood. A better understanding of these processes is important to improve our understanding of the varying effects of external inspections in different organizations. In turn, this can contribute to the development of more effective ways of conducting inspections. The way the inspecting organization states their grounds for noncompliant behavior and subsequently follows up to enforce the necessary changes can have implications for the inspected organization’s change process. We explore how inspecting organizations express and state their grounds for noncompliant behavior and how they follow up to enforce improvements. Methods We conducted a retrospective review, in which we performed a content analysis of the documents from 36 external inspections in Norway. Our analysis was guided by Donabedian’s structure, process, and outcome model. Results Deficiencies in the management system in combination with clinical work processes was considered as nonconformity by the inspecting organizations. Two characteristic patterns were identified in the way observations led to a statement of nonconformity: one in which it was clearly demonstrated how deficiencies in the management system could affect clinical processes, and one in which this connection was not demonstrated. Two characteristic patterns were also identified in the way the inspecting organization followed up and finalized their inspection: one in which the inspection was finalized solely based on the documented changes in structural deficiencies addressed in the nonconformity statement, and one based on the documented changes in structural and process deficiencies addressed in the nonconformity statement. Conclusion External inspections are performed to improve the quality of care. To accomplish this aim, we suggest that nonconformities should be grounded by observations that clearly demonstrate how deficiencies in the management system might affect the clinical processes, and that the inspection should be finalized based on documented changes in both structural and process deficiencies addressed in the nonconformity statement.
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Affiliation(s)
- Einar Hovlid
- Institute of Social Science, Sogn og Fjordane University College, PO Box 133, 6851, Sogndal, Norway. .,The Norwegian Board of Health Supervision, PO Box 8128 Dep, 0032, Oslo, Norway.
| | - Helge Høifødt
- The Norwegian Board of Health Supervision, PO Box 8128 Dep, 0032, Oslo, Norway.
| | - Bente Smedbråten
- The Norwegian Board of Health Supervision, PO Box 8128 Dep, 0032, Oslo, Norway.
| | - Geir Sverre Braut
- The Norwegian Board of Health Supervision, PO Box 8128 Dep, 0032, Oslo, Norway. .,Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway.
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Åsprang AF, Frich JC, Braut GS. Organizational impact of governmental audit of blood transfusion services in Norway: A qualitative study. Transfus Apher Sci 2015; 53:228-32. [PMID: 25935295 DOI: 10.1016/j.transci.2015.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
Little is known about the organizational impact of supervisory activities in blood banks. We did a study with the aim to explore health professional's experiences with the external audit of blood transfusion services in Norway. The audit and supervision brought attention to deficiencies in systems and practices, and had been a catalyst for quality improvement. We identify facilitators and barriers to change. While audits can bring attention to known deficiencies, and trigger improvement processes which previously have not been prioritized, involvement of senior management is important to secure change across departments.
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Affiliation(s)
| | - Jan C Frich
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Geir Sverre Braut
- Norwegian Board of Health Supervision, Oslo, Norway; Stavanger University Hospital, Stavanger, Norway.
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Rimstad R, Njå O, Rake EL, Braut GS. Incident Command and Information Flows in a Large-Scale Emergency Operation. J Contingencies & Crisis Man 2014. [DOI: 10.1111/1468-5973.12033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rune Rimstad
- Norwegian Air Ambulance Foundation; Drøbak Norway
- Department of Industrial Economics, Risk Management and Planning; University of Stavanger; Stavanger Norway
- Oslo University Hospital; Oslo Norway
| | - Ove Njå
- Department of Industrial Economics, Risk Management and Planning; University of Stavanger; Stavanger Norway
| | | | - Geir Sverre Braut
- Norwegian Board of Health; Oslo Norway
- Stord/Haugesund University College; Stord/Haugesund Norway
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Hannisdal E, Arianson H, Braut GS, Schlichting E, Vinnem JE. A risk analysis of cancer care in Norway: the top 16 patient safety hazards. Jt Comm J Qual Patient Saf 2014; 39:511-6. [PMID: 24294679 DOI: 10.1016/s1553-7250(13)39067-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cancer care processes represents a number of potential threats to patient safety. A national risk analysis of Norwegian cancer care, entailing diagnosis, treatment, follow-up, palliative care, and terminal care, was conducted. METHODS Literature review and a retrospective analysis of hazards in different national databases were combined with interviews with key health personnel in an attempt to identify 50 possible hazards. A project team from the Norwegian Board of Health Supervision (NBHS) and 23 other persons participated in the workshop in 2009. RESULTS In a stepwise, consensus-driven process, the 23 participants discussed the 50 possible hazards and then selected the 16 that they considered most important-clustered into three groups: diagnosis and primary treatment, interactions, and complications. The NBHS distributed the risk analysis report to a variety of stakeholders and asked Norway's hospital trusts to address the hazards. The report generally met a positive reception, albeit with local and interdisciplinary differences in the extent of the perceived applicability of the respective hazards. Two follow-up studies in 2012 and 2013 showed that the hospital trusts lacked the implementation capacity to identify operational solutions to reduce the hazards. At the largest hospital trust in Norway-Oslo University Hospital-the Department of Oncology retested the national risk analysis in in 2011. Four groups, representing different parts of the patient care process. selected 9 of the 16 national hazards and identified 4 new ones. The department has established goals and appropriate activities for 3 of the hazards. CONCLUSIONS The Ministry of Health and Care determined that hospital trusts must increase their implementation capacity regarding operational solutions to reduce the hazards.
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Affiliation(s)
- Einar Hannisdal
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
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Braut GS. Helsekonsekvensanalysar for samfunnsmedisinarar. Tidsskriftet 2013. [DOI: 10.4045/tidsskr.13.0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Braut GS. Solid murstein på alle måtar. Tidsskriftet 2013. [DOI: 10.4045/tidsskr.13.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Braut GS. Assistentarbeid i helsetenesta – noko å tenkje meir på. Tidsskriftet 2013. [DOI: 10.4045/tidsskr.12.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Braut GS. [Professionally defensible work is about good processes]. Tidsskr Nor Laegeforen 2008; 128:2223. [PMID: 18846151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Braut GS. [Practice-based medical education is best for all]. Tidsskr Nor Laegeforen 2003; 123:2239. [PMID: 14508541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
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Braut GS. [Obligations of health services in work with substance abuse]. Tidsskr Nor Laegeforen 2003; 123:49-51. [PMID: 12600152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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Braut GS. [Time--a resource shorter than money!]. Tidsskr Nor Laegeforen 2001; 121:1449. [PMID: 11449763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
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Braut GS, Ebbe A. [Abortion committees in Rogaland better than the recently reported]. Tidsskr Nor Laegeforen 2001; 121:506. [PMID: 11255875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Braut GS. [The value basis of future medicine]. Tidsskr Nor Laegeforen 2000; 120:3743-5. [PMID: 11215952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
The aim of this article is to propose a way of structuring the values that should constitute the basis of future medical practice, starting with the values that are common in contemporary medical practice. First, medicine must acknowledge that human worth is inviolable. This leads to activities aimed at strengthening autonomy as well as protecting the weak and vulnerable aspects of human life. Second, medicine must be based on sound professional practice. Medical knowledge should be developed by scientific means, but not only by biomedical methods. The fundamentally stochastic nature of medicine must be acknowledged. The third set of values relates to equity in the access to medical care. Services for the weakest among us should have high priority. Finally, medical practice has to be predictable and transparent.
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