Implementation Of Patient Safety Initiatives Research Articles

Patient safety improvement in the ear, nose and throat (ENT) speciality: a scoping review of improvement initiatives and involvement of frontline staff

Abstract Background The success of patient safety improvement initiatives depends on frontline staff engaging with improvement efforts. However, in the ENT speciality, there is less patient safety research compared to other healthcare specialities, and limited evidence on staff perspectives regarding safety improvement and the factors influencing their engagement. Objectives To map the literature on safety improvement efforts in the ENT speciality in UK settings, and to explore staff involvement and engagement with initiatives to improve patient safety in ENT. Methods A literature search was conducted using the PubMed, Ovid MEDLINE and SCOPUS databases to retrieve studies reporting the implementation of patient safety initiatives in ENT departments in the UK, and studies exploring frontline staff perspectives on improving safety in ENT. The selected studies were peer-reviewed, written in English and published between 2013 and 2023. Data were extracted and synthesised in accordance with the predefined research questions. Results 1,661 studies were screened, and 10 met the selection criteria. Findings demonstrated evidence of staff initiating, designing and implementing safety improvement initiatives. Frontline staff engagement and senior staff/managerial involvement were identified as key contributors to successful implementation. Only one study addressed frontline staff priorities for safety improvement, in the context of improving tracheostomy, with the author stating that results indicated that frontline staff are unwilling to implement low priority interventions. Conclusion Further research is needed to explore the factors influencing staff perspectives on how patient safety can be improved in ENT and the factors influencing their engagement. This could lead to recommendations for the development of successful, sustainable initiatives. The authors of this review recommend establishing the following as standard practice: (a) appointing staff as quality/safety champions, and (b) involving frontline staff and senior managers in co-developing improvement strategies.

The Patient Safety Adoption Framework: A Practical Framework to Bridge the Know-Do Gap.

Many patient safety initiatives fail to be adopted and implemented, even when proven effective. This creates the well-recognized know-do gap, referring to the discrepancy between what healthcare workers know should be done based on evidence and what takes place in practice. We aimed to develop a framework to improve the adoption and implementation of patient safety initiatives. We conducted a background literature review followed by qualitative interviews with patient safety leaders to identify barriers and facilitators to adoption and implementation. Inductive thematic analysis was used to generate themes that informed the development of the framework. We used a consensus-building approach to co-create the framework and guidance tool with an Ad Hoc Committee made up of subject-matter experts and patient family advisors. The framework was tested for utility, feasibility, and acceptability through qualitative interviews. The Patient Safety Adoption Framework contains 5 domains and 6 subdomains. The domains are leadership (subdomains: prioritization, accountability, governance), culture and context, process (subdomains: co-creation, high reliability, engagement), meaningful measurement, and person-centeredness. A guidance tool was developed to provide practical guidance for improvement teams using the framework. Testing affirmed the framework and guidance tool with a high degree of acceptability, feasibility, and utility among implementers and subject-matter experts. The Patient Safety Adoption Framework provides the essential components necessary to facilitate the adoption and implementation of patient safety initiatives. The framework offers a roadmap for healthcare organizations striving to close the know-do gap.

Perceptions of managerial staff on the patient safety culture at a tertiary hospital in South Africa

ABSTRACT Background Hospital managers are best suited and located to enhance patient safety culture within their institutions. Aim This study sought to provide insight on the perceptions of 10 managerial staff regarding the patient safety culture at a tertiary academic hospital in South Africa. Method In-depth interviews were conducted with strategic and operational managers within high-risk units in order to determinetheir perceptions regarding patient safety culture. Findings Participants described diverse aspects of the hospital’s patient safety culture including an overview of patient safety, implementation of patient safety initiatives, challenges to patient safety, current management of patient safety issues, as well as ways to improve the patient safety culture of the hospital. Conclusion The findings highlighted a number of areas to improve on to advance patient safety within the South African context. These include improving basic services, strengthening the infrastructure, improving staff attitudes and implementation of patient safety initiatives. Further research and development of quality improvement plans are essential to enhance patient safety.

Patient safety and leadership style in the government general hospitals in Kuwait: a multi-method study

PurposeThis study aims to evaluate the relationships between leadership style and reported incidents, reporting practices and patient safety initiatives in Kuwaiti hospitals.Design/methodology/approachThis cross-sectional and retrospective quantitative multi-centre study was conducted in a secondary care setting. The multifactor leadership questionnaire and the patient safety questionnaire were distributed in six general hospitals to a sample of physicians, nurses and pharmacists. Incident reports were reviewed in each hospital to assess reporting practices.FindingsThe hospital with the most safety incident reports scored the highest on good reporting practices, whereas the hospital with the lowest score of poor reporting practices had reported fewer incidents. Reporting was better if an error reached the patient but caused no harm. Overall, reporting practices and implementation of patient safety initiatives in the hospitals were suboptimal. Nevertheless, a transformational leadership style had a positive effect on patient safety and reporting practices.Practical implicationsThis study represents a baseline for researchers to assess the relationship between leadership style and patient safety. Moreover, it highlights significant considerations to be addressed when planning patient safety improvement programmes. More investment is needed to understand how to raise transformational leaders who are more effective on patient safety. Further studies that include primary and tertiary health-care settings and the private sector are required.Originality/valueTo the best of the authors’ knowledge, this study is the first in Kuwait to report on the relationship between transformational leadership and safety practices.

Using systems thinking in patient safety: a case study on medicines management.

Systems thinking is used as a way of understanding behaviours and actions in complex healthcare organisations. An important premise of the concept is that every action in a system causes a reaction elsewhere in that system. These reactions can lead to unintended consequences, sometimes long after the original action, and so are not always attributed to them. This article applies systems thinking to a medicines management case study, to highlight how quality-improvement practitioners can use the approach to underpin planning and implementation of patient-safety initiatives. The case study is specific to transcribing in children's hospices, but the strategies can be applied to other areas. The article explains that, while root cause analysis tools are useful for identifying the cause of, and possible solutions to, problems, they need to be considered carefully in terms of unintended consequences, and how the system into which the solution is implemented can be affected by the change. Analysis of problems using a systems-thinking approach can help practitioners to develop robust and well informed business cases to present to decision makers.

Patient safety initiatives in Central and Eastern Europe: A mixed methods approach by the LINNEAUS collaboration on patient safety in primary care

ABSTRACTBackground: Despite patient safety being recognized as an important healthcare issue in the European Union, there has been variable implementation of patient safety initiatives in Central and Eastern Europe (CEE).Objective: To assess the status of patient safety initiatives in countries in CEE; to describe a process of engagement in Poland, which can serve as a template for the implementation of patient safety initiatives in primary care.Methods: A mixed methods design was used. We conducted a review of literature focusing on publications from CEE, an inventory of patient safety initiatives in CEE countries, interviews with key informants, international survey, review of national reporting systems, and pilot demonstrator project in Poland with implementation of patient safety toolkits assessment.Results: There was no published patient safety research from Albania, Belarus, Greece, Latvia, Lithuania, Romania, or Russia. Nine papers were found from Bulgaria, Croatia, the Czech Republic, Poland, Serbia, and Slovenia. In most of the CEE countries, patient safety had been addressed at the policy level although the focus was mainly in hospital care. There was a dearth of activity in primary care. The use of patient improvement strategies was low.Conclusion: International cooperation as exemplified in the demonstrator project can help in the development and implementation of patient safety initiatives in primary care in changing the emphasis away from a blame culture to one where greater emphasis is placed on improvement and learning.

Implementing Patient Safety Initiatives in Rural Hospitals

Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in 8 small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of 3 patient safety interventions: the Agency for Healthcare Research and Quality (AHRQ) patient safety culture survey, use of personal digital assistants (PDAs), and sharing of emergency room protocols. The experience suggested that a collaborative model between rural hospitals, a payer, a hospital association, a quality improvement organization, and academic institutions can effectively support patient safety activities in rural hospitals. Successful implementation of the 3 patient safety interventions depended on leadership provided by nursing and patient safety/quality managers and open, trusting communications within the hospitals.

An Ounce of Prevention: Medical–Legal Aspects of Burn Injury

Since the 1999 Institute of Medicine's landmark report, “To Err is Human,” and the implementation of patient safety initiatives, medical errors and claims for injury as a result of these errors continue to be an area of concern for hospitals, physicians, nurses, and industry. The end of the decade saw the cost of medical malpractice insurance steadily increasing as a result of increasing awards against hospitals and physicians. This article reviews the medical–legal aspects of burn injury.

Risk Reduction for Adverse Drug Events Through Sequential Implementation of Patient Safety Initiatives in a Children's Hospital

Medication management is a complex, multifaceted system. Prescribing errors occur upstream in the process, and as such, their effects can be perpetuated, and sometimes even exacerbated, in subsequent steps. These errors place patients at risk of adverse drug events. Children, especially young infants, are at particular risk because of their size, unique physiology, and immature ability to metabolize drugs. The purpose of this study was to reduce the risk of harm to children resulting from prescribing errors. We sequentially implemented patient safety initiatives over a 1-year time frame at a pediatric tertiary care academic facility. The initiatives included an educational Web site with competency examination, distribution of a personal digital assistant-based standardized dosing reference, a zero-tolerance policy for incomplete or incorrect medication orders, prescriber performance feedback, and presentation of outcome data at citywide grand rounds. A total of 8718 orders were collected and analyzed to assess the impact of these initiatives. The absolute risk reduction from prescribing errors was 38 per 100 orders, with a relative risk reduction of 49%. Web-based education with point-of-care drug references and a zero-tolerance policy for incomplete or incorrect orders were most effective in decreasing potential adverse drug events. Documentation of appropriate weight-based dosing and indication for therapy increased by 24% and 42%, respectively. Process-improvement initiatives focusing on prescriber education and behavior modification can reduce the risk of harm to pediatric patients from prescribing errors.

Struggling to Invent High‐Reliability Organizations in Health Care Settings: Insights from the Field

The Mission of the Agency for Healthcare Research and Quality (AHRQ) has been to support and conduct health services research and to disseminate those research findings. Recently the Agency has changed its mission to: "Improving the quality, safety, efficiency and effectiveness of health care for all Americans." For agency personnel working with the topic of patient safety, that change has created a need to develop greater awareness of the current patient safety initiatives underway at leading health care systems in order to determine where AHRQ might best play a role in helping these systems more rapidly adopt new practices to improve patient safety. In order to make that determination, AHRQ conducted a customer needs assessment of leaders in selected health care systems, asking them questions about their current implementation initiatives and their perceived needs for continued implementation of patient safety initiatives. Although not designed or conducted as a research study, the hour-long interviews produced rich insights into the implementation efforts of patient safety initiatives. The senior leaders interviewed in each of the health care systems, described implementing patient safety initiatives on multiple fronts-in some systems as many as 15 initiatives were underway. As the number of initiatives attests, there was no lack of knowledge about what patient safety practices should be implemented (CPOE, rapid response teams, reduction in surgical site infections) rather the major struggle these health care systems faced was the "how to" of implementation. Most initiatives were only newly begun, so these leaders were not yet confident about what they had learned from these efforts or whether they could be sustained over time. These health care systems drew many of the ideas for initiatives from outside of health care, for example, the nuclear power industry or aviation. The executives expressed concern about a number of issues including: how patient safety initiatives should be sequenced, the lack of benchmarking data to measure their systems against and the pressing need for IT standardization. The insights from this customer needs assessment revealed a wealth of implementation knowledge in the field and has led AHRQ to create an opportunity for leading edge health care systems to learn from each other via learning networks.

Implementation of patient safety initiatives in US hospitals

PurposeThe purpose of this study is to explore the use of patient safety initiatives (PSIs) at the US hospitals. These PSIs include such approaches as open discussion of errors, education and training, and system redesign. In particular, the paper seeks to examine factors that influence the implementation of PSIs as well as the benefits realized from their implementation.Design/methodology/approachThe paper draws on the TQM and medical safety literatures to develop a conceptual framework for improving patient safety. Extensive survey data were gathered from 252 hospitals throughout the US to test McFadden et al.'s model of the factors influencing successful implementation of PSIs.FindingsCertain barriers (lack of top management support, lack of resources, lack of incentives and lack of knowledge) significantly impeded implementation while other factors (perceived importance of PSIs) facilitated implementation. It was also found that implementation of PSIs was associated with benefits to the hospital in areas such as medical error reduction, cost reduction, and patient satisfaction.Research limitations/implicationsThe use of a single respondent represents a possible limitation. Future research will explore organizational culture and its relationship to patient safety.Practical implicationsThe findings provide direction for implementing more effective PSIs at hospitals.Originality/valueThe paper contributes to the literature on patient safety and medical errors by testing specific mechanisms that are associated with successful implementation of PSIs.