Patient safety in chiropractic teaching programs: a mixed methods study

Katherine A Pohlman,Stacie A Salsbury,Martha Funabashi,Silvano Mior,Michelle M Holmes

doi:10.1186/s12998-020-00339-0

Abstract

BackgroundPatient safety research has lagged within academic settings, including chiropractic teaching institutions. To develop a robust patient safety culture, the Institute of Medicine emphasized the need for employee’s attitudes to be understanding and positive. To initiate the assessment of the current culture and future needs, this study evaluated patient safety attitudes among chiropractic teaching clinic stakeholders (supervising clinicians, student interns, and administrative staff) and compared their standardized survey scores to established medical survey databases.MethodsWe conducted a cross-sectional, mixed methods survey design with quantitative analytic priority. Chiropractic interns, clinical faculty, and clinic staff of 5 international chiropractic educational programs completed a modified version of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture for Medical Offices Survey with open-ended comment fields between 2014 and 2016. Composite means of positive responses were calculated and compared to patient safety, quality of care, and overall self-ratings benchmarks from Canadian providers and academic settings in the AHRQ database. Qualitative responses were thematically categorized for a convergent analysis of quantitative results for the chiropractic sample.ResultsChiropractic survey response rate was 45.3% (n = 645). Quantitative survey results indicated moderate scores and ranges (57–85%) on all patient safety dimensions for the chiropractic samples. Academic medicine and chiropractic providers’ benchmarks scored higher positive responses than chiropractic teaching clinics on most quantitative dimensions, except for work pressure/pace. Teamwork, organizational learning, and patient tracking/follow-up were the most positively endorsed quantitative dimensions, with communication, staff training, office standardization, and leadership support considered areas for improvement in both settings. Qualitative responses for the chiropractic clinics identified a need for open communication; additional staff training and student involvement in creating safety cultures; standardization of office processes including information exchange, scheduling, and equipment maintenance; and leadership support that focused on decreasing work pressure/pace and setting safety priorities.ConclusionAs the first report of patient safety attitudes from stakeholders in chiropractic teaching clinics, specific areas of improvement were identified. Chiropractic teaching programs might consider incorporating these and related patient safety concepts into their formal curricula. Mixed methods approach offers teaching clinics opportunities to assess stakeholders’ insights and enhance safe delivery of chiropractic care.

Highlights

The Institute of Medicine (IOM) report, To Err Is Human, raised awareness about medical errors and challenged the healthcare community to develop a culture of patient safety [1]
All three comparison groups averaged above a mean of 70% for Information Exchange, Teamwork, and Organizational Learning - Clinical/Administrative, with Information Exchange being the only dimension in which all the chiropractic programs had scored at or above 70%
Patient Care Tracking/Follow-Up had a gap greater than 10% for both the community-based providers and teaching clinics compared with Agency for Healthcare Research and Quality (AHRQ)

Summary

Introduction

Hospital systems were targeted as key settings to prevent medical errors and increase the quality of patient care. Such initiatives have faltered in ambulatory care settings, perhaps assuming these environments are safer [2]. Similar to all healthcare specialties, professions offering SMT, most commonly chiropractic, physical therapy, osteopathy and naturopathy, often lack transparent patient safety cultures [9, 10]. Competing narratives within these professions fuel the ongoing debates about the risks and benefits of SMT [11], which may have stalled broader efforts to investigate and improve patient safety culture and performance in clinical practice and educational settings. To initiate the assessment of the current culture and future needs, this study evaluated patient safety attitudes among chiropractic teaching clinic stakeholders (supervising clinicians, student interns, and administrative staff) and compared their standardized survey scores to established medical survey databases

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Methods

Results

Discussion

Conclusion