Healthcare Quality Improvement Research Articles

Digital Skills in the 21st Century: Understanding the Impact of Digital Literacy on Nurses

The aim of this research is to draw attention to the importance of digital literacy in nursing services. Technological advances have driven global development in an unprecedented manner over the last two decades, leading to significant growth in access and connectivity for billions of people worldwide. Approximately 2.5 billion people own smartphones, and four billion people use social media. Digital literacy now requires not only the ability to use technology on a social level, but also the capacity to analyze and integrate digital information. The increasing demand from the labor market for individuals to be digitally literate has spurred targeted interventions and innovations aimed at equipping the future workforce with necessary digital skills. However, despite these efforts, the digital skills gap remains a global challenge. A digitally enabled profession ensures citizens receive the highest quality healthcare. Health-related infrastructures are rapidly digitalizing, leading to significant improvements in healthcare quality. Digital literacy is crucial for accessing and interpreting data, analyzing medical images, and using technology to enhance patient care. Assessing digital literacy levels within healthcare is an issue that should not be overlooked, as technology plays an increasingly important role in both clinical work and research. It is noted that the digital literacy levels of nursing students vary globally, and there is limited research on the factors that influence these levels. Therefore, academics should prioritize this concept and invest in further research and educational initiatives to improve digital literacy.

Sustainability of Interprofessional Education: Protocol for a Scoping Review.

Interprofessional education (IPE) is an approach that can improve health care quality, contribute to the qualification of health care professionals, and train undergraduate students. Although this strategy has made significant progress in the last decade, integration, sustainability, and institutional growth are still priorities worldwide. Thus, maintaining strategies is essential for their full development and evolution. This study aimed to identify discussions about the sustainability of IPE and map its actions or strategies (or both). The scoping review will follow the Joanna Briggs Institute methodology. This scoping review protocol follows the JBI Reviewers' Manual, with 6 stages: identifying the research question; identifying relevant studies; study selection; data extraction and coding; analysis and interpretation of results; and consultation with stakeholders. Two independent and blind reviewers will evaluate and select studies available in English, Portuguese, and Spanish based on the eligibility criteria. Searches will be conducted on LILACS, Embase, Scopus, PubMed/MEDLINE, ERIC, Web of Science, CINAHL, Google Scholar databases; ProQuest Dissertations & Theses Global, and Brazilian Digital Library of Theses and Dissertations. The main research question is as follows: What have been the sustainability strategies for IPE actions? This scoping review will incorporate studies (empirical or theoretical-reflective) that address strategies or actions (or both) for IPE sustainability. They must present a quantitative, qualitative, or mixed methods approach and be available in full text. Data on strategies or actions for IPE sustainability will be extracted and inserted into a spreadsheet for analysis. Quantitative data will be analyzed using descriptive statistics, while qualitative analysis will identify meanings and patterns through thematic analysis. Thus, the aim is to present the compiled findings in tables and charts. The database search was conducted on March 22, 2024. In April and May 2024, duplicate studies were excluded. From July to November 2024, study selection will be carried out. In December 2024, data extraction and tabulation will take place, as well as consultation with stakeholders. The aim is to publish the results in scientific journals in January 2025. This protocol will guide this scoping review to identify discussions on the sustainability of IPE and map its actions or strategies (or both); summarize the definitions and institutions that develop or promote IPE; and present the main recommendations for the area under study. Additionally, possible research gaps can be identified to guide future studies. This review will shed light on existing knowledge gaps and the current state of research, which could provide support for future research, programs, and policy responses to foster collaboration and interprofessional practice and, consequently, improve the quality of user care. This information will be useful in supporting decision-making by government officials, managers, teachers, facilitators, and students in the implementation, maintenance, and development of IPE. Open Science Framework 5VNJS; https://osf.io/5vnjs/. DERR1-10.2196/60763.

Advancements in Artificial Intelligence-Enhanced Imaging Diagnostics for the Management of Liver Disease—Applications and Challenges in Personalized Care

Liver disease can significantly impact life expectancy, making early diagnosis and therapeutic intervention critical challenges in medical care. Imaging diagnostics play a crucial role in diagnosing and managing liver diseases. Recently, the application of artificial intelligence (AI) in medical imaging analysis has become indispensable in healthcare. AI, trained on vast datasets of medical images, has sometimes demonstrated diagnostic accuracy that surpasses that of human experts. AI-assisted imaging diagnostics are expected to contribute significantly to the standardization of diagnostic quality. Furthermore, AI has the potential to identify image features that are imperceptible to humans, thereby playing an essential role in clinical decision-making. This capability enables physicians to make more accurate diagnoses and develop effective treatment strategies, ultimately improving patient outcomes. Additionally, AI is anticipated to become a powerful tool in personalized medicine. By integrating individual patient imaging data with clinical information, AI can propose optimal plans for treatment, making it an essential component in the provision of the most appropriate care for each patient. Current reports highlight the advantages of AI in managing liver diseases. As AI technology continues to evolve, it is expected to advance personalized diagnostics and treatments and contribute to overall improvements in healthcare quality.

Kindness: Poor cousin or equal kin to Compassion and Empathy in the Healthcare Literature? A Scoping Review

ObjectiveThis scoping review seeks to understand how kindness, compassion and empathy are defined and conceptualised within existing healthcare services literature.IntroductionLittle consensus exists on how healthcare literature defines and conceptualises kindness....

Modelling the cost-effectiveness and budget impact of pay-for-performance programs in health care

IntroductionWith an upward trend in adoption by industrialized nations, pay-for-performance (P4P) mechanisms are increasingly recognized for fostering quality improvement in healthcare. P4P programs conventionally reward providers with supplemental payments upon achieving predefined performance targets. This study aims to utilize decision modelling to determine the cost-effectiveness and maximum incentive levels of P4P programs.MethodsA decision model, grounded in previously published models exploring the cost-effectiveness of implementation programs, was developed. The model evaluates the cost-effectiveness of P4P programs for an exogenous reward size under varied reward mechanisms and also in scenarios with and without a budget or time constraint.ResultsIn instances where P4P programs do not substitute other healthcare programs, their incremental cost-effectiveness ratio (ICER) is deterministically set and ranges from treatment ICER to infinity, irrespective of the reward mechanism. With a budget or time constraint in play, the P4P program is incentivized up to the point where its population cost or ICER aligns with that of the program being replaced.ConclusionThe proposed decision model effectively calculates the cost-effectiveness and budget impact of P4P programs, accommodating various reward mechanisms and scenarios, both with and without budget or time constraints.

Flexible scan statistic with a restricted likelihood ratio for optimized COVID-19 surveillance.

Disease surveillance remains important for early detection of new COVID-19 variants. For this purpose, the World Health Organization (WHO) recommends integrating of COVID-19 surveillance with other respiratory diseases. This requires knowledge of areas with elevated risk, which in developing countries is lacking from the routine analyses. Focusing on Ghana, this study employed scan-statistic cluster analysis to uncover the spatial patterns of incidence and Case Fatality Rates (CFR) of COVID-19 based on reports covering the four pandemic waves in Ghana between 12 March 2020 and 28 February 2022. Applying flexible spatial scan statistic with restricted likelihood ratio, we examined the incidence and CFR clusters before and after adjustment for covariates. We used distance to the epicentre, proportion of the population aged ≥ 65, male proportion of the population and urban proportion of the population as the covariates. We identified 56 significant spatial clusters for incidence and 26 for CFR for all four waves of the pandemic. The Most Likely Clusters (MLCs) of incidence occurred in the districts in south-eastern Ghana, while the CFR ones occurred in districts in the central and the northeastern parts of the country. These districts could serve as sites for sentinel or genomic surveillance. Spatial relationships were identified between COVID-19 incidence covariates and the CFR. We observed closeness to the epicentre and high proportions of urban populations increased COVID-19 incidence, whiles high proportions of those aged ≥ 65 years increased the CFR. Accounting for the covariates resulted in changes in the distribution of the clusters. Both incidence and CFR due to COVID-19 were spatially clustered, and these clusters were affected by high proportions of the urban population, high proportions of the male population, high proportions of the population aged ≥ 65 years and closeness to the epicentre. Surveillance should target districts with elevated risk. Long-term control measures for COVID-19 and other contagious diseases should consider improving quality healthcare access and measures to reduce growth rates of urban populations.

Beyond the Queue: Exploring Waiting Practices in the Stories of Patients With Breast Cancer.

Waiting is an important topic in healthcare debates, mostly discussed in the form of waiting lists and waiting times. In this discourse, the experiential element of waiting stays hidden. Understanding the waiting experiences of patients can help to better understand healthcare waiting practices, which have a large impact on patients. We performed a thematic analysis on 12 patients' books of women with breast cancer. We focused on the theme of waiting within these stories, through an abductive analysis. We identified three themes within the waiting practices of patients with breast cancer: (1) Thickening of time, (2) contaminated time and (3) navigating time. The theme thickening of time highlights waiting moments where time is experienced as moving at a very slow pace with intense emotional impact. The theme of contaminated time highlights the waiting processes as an ongoing component of experiencing illness. The theme of navigating time highlights patients' temporal agency, showing their waiting work in the form of strategies for dealing with practical and emotional aspects of waiting. The waiting experiences of patients provide insights into the burden of waiting, which is partly connected to the way healthcare services are organised and the experience of illness. Understanding these multifaceted experiences of patients helps pinpoint areas for healthcare quality improvement. The choice for the theme and approach of this research, waiting, was developed with a citizen science initiative of collecting patient stories.

Synergistic use of Unplanned Reoperation and Hospital Readmission rates for quality monitoring in pediatric surgical care.

Unplanned reoperation (URO) and unplanned hospital readmission (UHR) are key quality indicators used to assess healthcare quality improvement. The aim of this study was to describe, quantify, analyze and compare both indicators in a Pediatric Surgery Department. An observational study was conducted reviewing the medical records of pediatric patients who underwent unplanned reoperation and unplanned hospital readmission over a six-year period in a pediatric surgical unit. The incidence, indications, and causes of reoperations and readmissions were analyzed. A total of 6,376 surgeries were performed over a six-year period. During this time, there were 37 (0.58%) URO and 20 (0.31%) UHR. There were 23/2,437(0.94%) URO and 14/2,437(0.57%) UHR among emergency surgeries. In contrast, there were 14/3,939(0.35%) URO and 6/3,939(0.15%) UHR among elective surgeries (p < 0.05). Outpatient surgeries had 3/1,639 (0.18%) URO and 1/1,639 (0.06%) UHR compared to inpatient surgeries that had 11/2,300(0.47%) URO and 5/2,300 (0.21%) UHR respectively (p = ns). A total of 1,570 appendectomies were performed during the study period, with 8/1,570(0.5%) patients requiring either a URO or a UHR. The most frequent indication for both URO and UHR were intra-abdominal infections. The main cause of URO was a technical error during surgery (70%), while the main cause of UHR was an error in the medical treatment (35%). In our practice, URO are more frequent than UHR. Emergency surgeries have a higher risk of undergoing an URO or a UHR. Acute appendicitis is the most common diagnosis associated with the need for an URO or a UHR. The majority of unplanned reoperation cases are due to technical errors during surgery.

Global Research Trends on Factors Affecting Patient Satisfaction Levels in Hospital Inpatient Wards: A Bibliometric Analysis

ABSTRACT Research on patient satisfaction in hospital inpatient rooms is one of the main focuses in efforts to improve the quality of health services. Understanding the factors that influence patient satisfaction is crucial for policy makers and healthcare practitioners. Although various studies have been conducted, the global map of this research trend is still not clearly depicted. This study aims to fill this gap by conducting a bibliometric analysis of the literature related to patient satisfaction in hospitals, using a visualization approach to provide deeper insights into the dynamics of research in this area. The method used involved data collection of scholarly articles from 2014 to 2024 using Google Scholar's Publish or Perish application. A total of 50 articles were selected based on relevance to keywords such as Patient Satisfaction, Inpatient Room, Satisfaction Factors, Hospital, and Health Services. This data was then analyzed using VOSviewer to visualize the relationship between various elements in the literature through network visualization, overlay visualization, and density visualization. This approach mapped research trends, identified key clusters, and showed collaboration patterns and dominant topics. The results show that service quality and patient satisfaction are the main focus in the literature. Research clusters showed significant attention to basic aspects of healthcare such as hospital care and facilities, while demographic aspects and specific determinants were less explored. Citation analysis showed that articles providing comprehensive reviews or practical models received more attention. In addition, the density visualization revealed the dominance of quality of care aspects, but also showed the potential for further research on topics such as technological innovation and the impact of health policy. The conclusions of this study show that although much research has been conducted, there are still significant research gaps that can be further explored. This study maps global trends in patient satisfaction studies, and provides guidance for researchers to focus on less explored areas, thereby contributing to the improvement of healthcare quality in hospitals. Keywords: Patient Satisfaction, Service Quality, Hospital, Bibliometric Analysis.

The use of outcome data from quality registries to learn and improve; a Dutch nationwide quantitative analysis in five disease areas

BackgroundClinical quality registries (CQR) aid in measuring, collecting and monitoring outcome data but it is still unknown how these data are used by hospitals to improve the quality of care. This study assessed the current state of outcome-based quality improvement in the Netherlands in 2022 based on data from multiple disease areas and CQRs; cardiothoracic surgery (Netherlands Heart Registration [NHR]), cardiology (NHR), nephrology, (Nefrovision), intensive care (National Intensive Care Evaluation [NICE]), and orthopaedic surgery (Dutch Arthroplasty Register [LROI]).Methods & resultsThe Health Outcomes Management Evaluation (HOME) model was used to assess the current state of outcome-based quality improvement. A questionnaire with 36 questions was sent to healthcare departments of the six disease areas in participating hospitals within five quality registrations in the Netherlands. In total, 124 responses were received; 20 within cardiology, 12 within cardiothoracic surgery, 30 within nephrology, 35 within intensive care and 27 within orthopaedic surgery. Results showed outcome measures were actively used to improve the quality of care, several improvement initiatives were implemented, but outcomes were not always monitored regularly. Results differed between hospitals, but differences were limited between disease areas.ConclusionThe current state of outcome-based quality improvement in all five disease areas is that outcome measures were consequently employed and used on a frequent basis aiming to achieve quality improvement in healthcare. Results can be improved by structurally embedding the entire improvement cycle into the organisation.

Behavioral incentives on pay-for-performance schemes in primary health care: a scoping review

Abstract Background Incentivizing healthcare professionals through pay-for-performance (P4P) schemes has become an essential strategy to enhance healthcare quality and efficiency. In Portugal, a P4P framework was put in place in Primary Health Care (PHC). Understanding how these incentives influence healthcare delivery is crucial for optimizing P4P effectiveness. Objectives This scoping review aims to compare the impacts of intrinsic and extrinsic incentives of P4P schemes within PHC teams. Methods We are conducting a comprehensive scoping review following the PRISMA-ScR guidelines. The databases PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO are being searched to identify experimental and quasi-experimental studies. Eligible studies focused on PHC providers organized in teams, examining the role of intrinsic and extrinsic incentives under both public and private healthcare settings. Results Preliminary findings include a Dutch study demonstrating significant improvements in adherence to prescribing guidelines through electronic health records based P4P indicator. In Ethiopia, performance-based non-financial incentives led to enhanced data quality and evidence utilization among health workers. Conversely, a study from Burkina Faso highlighted mixed results in antenatal care quality improvement despite incentive implementation. In Scotland, studies on the removal of financial incentives indicated potential declines in certain quality care metrics, suggesting the complexities involved in the direct and indirect effects of incentive withdrawal. Conclusions The preliminary evidence indicates that both intrinsic and extrinsic incentives can significantly impact the effectiveness of P4P schemes, though the nature and magnitude of these impacts vary considerably. The findings underscore the necessity of a nuanced approach to designing and implementing incentive mechanisms in PHC to foster sustainable improvements in healthcare quality. Key messages • Intrinsic and extrinsic incentives significantly influence P4P scheme effectiveness in PHC. • Designing P4P incentives requires nuanced consideration of varying impacts on healthcare quality.

The Utilization of Blockchain for Data Security for the Chronic Pain Physician.

The COVID-19 pandemic accelerated the surge in medical data utilization, notably impacting chronic pain management given its enormous economist cost. While the collection and use of data enhances research and care quality, data exchange risks compromising integrity and privacy, exemplified by the Change Healthcare cyberattack. Here, we review the potential of blockchain for the utilization for cybersecurity in the healthcare system with an emphasis on the field of chronic pain. Blockchain technology emerges as a potential solution, offering decentralized, secure, and immutable data management. Blockchain ensures transparency, integrity, and data privacy, which is crucial in healthcare. Smart contracts may offer automated, secure management of implantable neuromodulation devices such as spinal cord stimulators and intrathecal pumps. Blockchain's potential in pharmaceutical supply chain integrity is exemplified in preliminary efforts ensuring that the medication retrieved by the patient is indeed the intended medication. Despite limitations such as speed of transactions, blockchain presents innovative avenues for healthcare security and quality improvement, necessitating further development for widespread implementation. Blockchain's applicability is not only applicable to chronic pain management, but can be used in medicine as a whole.

07 Partnering with patients with living and lived experience of eating disorders to improve inpatient care on an acute paediatric medicine unit

Abstract Background Since the COVID-19 pandemic, hospitals nationally are seeing a growing number of adolescent patients with eating disorders requiring acute medical stabilization, which is often a time of crisis in the trajectory of this ego-syntonic disorder. The complexity of these admissions often lead to safety events for patients and moral distress for clinicians. Medical admissions can also be an opportunity to engage youth and families. Patient partners are a pillar in healthcare quality improvement, but historically we have not engaged adolescent patient partners in improving acute eating disorder treatment. We gathered the experience of patients and families with living and lived experience of eating disorder treatment to improve their quality of care in an acute paediatric medicine unit. Objectives We aimed to describe the experience of patients and families with living and lived experience of eating disorder treatment, specifically acute medical stabilization, through a quality improvement patient engagement project. Design/Methods We used a mixed-methods design of semi-structured interviews and a focus group with adolescents with eating disorders and their caregivers in an acute medical unit at a tertiary paediatric hospital in British Columbia. We employed opportunity sampling by distributing recruitment flyers through patient experience councils, outpatient clinics, other non-acute units, and to all patients admitted with a medically unstable eating disorder at our hospital during the study period. The interviews consisted of open-ended questions, yes/no questions, and Likert scales related to four categories: admission process, inpatient experience, team communication, and discharge process. Two reviewers analyzed the qualitative data using thematic analysis, and the quantitative data was analyzed descriptively. Quality improvement projects are exempt from Research Ethics Board approval. However, we utilized the "A Project Ethics Community Consensus Initiative" (ARECCI) Ethics Guideline and Screening Tool and presented our proposal at the hospital's quality improvement and research oversight committees. Results We completed 8 interviews with patients with current living experience admitted to our acute medical unit. We also completed 1 interview with a patient with past lived experience and 1 focus group with patients and caregivers. Primary themes identified included uncertainty about their overall treatment journey and stress due to the sudden new expectations on the inpatient unit, such as activity restriction, meal plans by the hospital, and bathroom access after meal times. Patients identified the importance of relational care, inclusion in treatment planning, acknowledgement of the demanding nature of eating disorders, and individualized care. Due to variability in training, resource allocation, and gaps in communication, these patient-identified priorities are not always met. While 100% of participants stated they understood the reasons and goals for admission, participants averaged 3.7 on a 1 (lowest) to 5 (highest) Likert scale when asked to rate their satisfaction with the information they received. Five out of eight adolescents felt that there was consistency in communication within the team. Conclusion We demonstrate the complex needs of patients with eating disorders who require acute medical stabilization. Targeted knowledge mobilization initiatives through admission orientation documents and family-centered rounds could better meet those needs. We are currently developing an admission pamphlet and journal for patients admitted with a new eating disorder to our medical unit. Patient partners exhibited a high willingness to participate in our study and readily acknowledged the importance their contributions could hold for other patients.

Integrating Quantitative Data and Qualitative Insights to Understand 30-Day Readmission Rates: A Mixed-Methods Study.

The rate of patients readmitted to hospitals within 30 days of discharge is a critical indicator of healthcare quality. This study explored the factors contributing to 30-day hospital readmission rates nationally and at Arrowhead Regional Medical Center (ARMC) through a mixed-methods research design. Quantitative analysis utilized data from the Centers for Medicare & Medicaid Services (CMS) database, focusing on patient demographics, principal diagnoses, length of stay, and hospital characteristics. Multivariate regression and descriptive statistics were employed to identify predictors of 30-day readmission. The qualitative analysis sought to understand the specific medical conditions and patient profiles linked to higher readmission rates. The findings revealed that older age, specific principal diagnoses (e.g., heart failure, pneumonia, chronic obstructive pulmonary disease (COPD)), and longer initial hospital stays were associated with an increased likelihood of 30-day readmission. Gender disparities and hospital size/type also influenced readmission rates. These results provide valuable insights into the complex interplay of individual patient characteristics and hospital attributes in driving readmissions. The study's mixed-methods approach yielded a comprehensive understanding of the quantitative patterns and qualitative factors contributing to 30-day hospital readmission rates, offering important implications for healthcare quality improvement initiatives.

Nurses' Role in Healthcare Quality Improvement

Nurses' Role in Healthcare Quality Improvement

Healing Havens: How Evidence-Based Design is Transforming Medical Spaces Into Therapeutic Environments.

To explore how evidence-based design is transforming healthcare environments into transforming spaces that improve patient outcomes and staff experiences. Traditional hospital designs often prioritize functionality over patient and staff well-being. This editorial examines the shift toward evidence-based design in healthcare facilities. We review recent studies and case examples demonstrating the impact of thoughtful healthcare design on infection rates, patient recovery, and staff performance. Evidence shows that elements such as private rooms, access to nature, and improved lighting can significantly reduce infections, accelerate healing, and enhance staff satisfaction. Implementing evidence-based design principles in healthcare environments can lead to measurable improvements in patient outcomes, staff performance, and overall healthcare quality.

Knowledge toward quality improvement among Jordanian nursing students: A cross-sectional study.

Nurses have a critical role in quality improvement (QI) and patient safety. This necessitates gaining knowledge and mastering QI abilities to lead and participate in QI programs in clinical practice. To assess undergraduate nursing students' knowledge about QI, and experience of patient safety situation; and examine the relationship between obtaining information on healthcare quality and knowledge about QI in Jordan. A descriptive cross-sectional correlational design was used. The study engaged undergraduate nursing students from two Jordanian universities (Public and private universities). A convenient sample of 147 nursing undergraduate students from universities. Data were collected using paper-based self-reported questionnaires. The Quality Improvement Knowledge, Skills, and Attitudes (QulSKA) survey and the Healthcare Professional Patient Safety Assessment Curriculum Survey (HPPSACS) were used to assess knowledge about QI and patient safety. Out of 152 students, 147 completed the study. Overall, QI knowledge was moderate (mean score 57.7). Students from the private university scored significantly higher than public university students. Regarding patient safety, 74.8% of students observed medical errors in clinical areas. However, only 57.1% of the students disclosed a medical error to a faculty member. Also, the results showed a significant positive correlation between knowledge level about QI and obtaining information about QI, quality in healthcare, and patient safety from sources other than the undergraduate nursing program at universities (p≤.001). This study suggests a potential gap in QI education. Integrating QI concepts into nursing curricula may be necessary to prepare future nurses for healthcare quality improvement.

The Impact of Healthcare Service Quality on Patient Satisfaction at University Health Center

Patient satisfaction is a critical aspect of healthcare service quality that needs to be periodically evaluated and improved. Understanding various factors, including empathy, assurance, reliability, tangibility, and responsiveness, is necessary to enhance healthcare quality and improve patient satisfaction. This research aims to investigate the level of patient satisfaction and the relationship between patient satisfaction and service quality, using the five SERVQUAL model as a framework. A positivist approach was used to explore the relationship between variables. Data collection was carried out for two weeks using online questionnaires. For this research, 120 UiTM respondents were chosen using convenience sampling. Data was analyzed using SPSS version 29. The findings revealed a significant positive relationship between tangibility, responsiveness, and empathy with patient satisfaction. This study highlights the importance of regularly assessing patient satisfaction and identifying areas for improvement in healthcare service quality. University health centers can enhance patient satisfaction and provide better student healthcare services by focusing on tangibility, responsiveness, and empathy.

Understanding the Concept of Patient Safety Culture

Background: Patient safety culture is crucial for improving health care quality, however, there is no consensus on its definition. Purpose: This study aimed to clarify and update the concept of patient safety culture. Methods: We employed Norris’ 6-step concept clarification method. The content was organized through a scoping review of 4 databases. Twelve health professionals participated in focus groups and 10 experts participated in content validation. The content validity coefficient (CVC) was calculated for agreement between experts. Results: Three patient safety culture domains were identified: organizational, professional, and patient and family participation. The experts rated the definitions favorably, with high CVC scores (&gt;0.87), indicating good agreement. The operational definitions were reduced from 76 to 54 items after expert evaluation. Conclusion: An updated definition of patient safety culture is provided, which can inform development of assessment instruments by managers and health care professionals.

The Leaders in Informatics, Quality, and Systems (LInQS) Fellowship.

Leaders in Informatics, Quality, and Systems (LInQS) is a non-ACGME (Accreditation Council for Graduate Medical Education)-accredited 2-year training program developed to enhance training in the fields of health care delivery, quality improvement (QI), clinical informatics, and leadership. This single-institution 2-year longitudinal training program grounded in QI and informed by leadership and clinical informatics includes didactics, coaching, and mentorship, all centered around individualized QI projects. The program has been available to sub-specialty fellows, advanced practice providers, and physicians. From 2019 to 2023, 32 fellows have been accepted into the program with 13 graduates and 16 currently enrolled. Fellows have been predominately female, physicians, and from multiple specialties but predominantly hospital medicine. Fellows' evaluations of the fellowship are highly positive, rating the didactics and mentorship aspects of the curriculum most favorably. Most fellows' projects utilized informatics solutions including clinical decision support tools to increase quality of care, improve patient outcomes, and reduce costs of care resulting in manuscript publications, national presentations, and a national specialty society award. Since matriculation, 50% of fellows received certification as Epic Physician Builders and 34% received leadership positions in clinical informatics, quality, and education. Our experience supports the need to provide health care providers more expansive training in the areas of QI, clinical informatics, and leadership for improving health care delivery. Additional in-depth knowledge and experience in these fields may produce and benefit leaders in these fields.