Safer Health Care System Research Articles

Toward a Safer Health Care System: The Critical Need to Improve Measurement.

This Viewpoint discusses how policy makers might develop and implement standardized, validated metrics to track the progress of patient safety improvements.

Testing electronic health records in the "production" environment: an essential step in the journey to a safe and effective health care system.

Thorough and ongoing testing of electronic health records (EHRs) is key to ensuring their safety and effectiveness. Many health care organizations limit testing to test environments separate from, and often different than, the production environment used by clinicians. Because EHRs are complex hardware and software systems that often interact with other hardware and software systems, no test environment can exactly mimic how the production environment will behave. An effective testing process must integrate safely conducted testing in the production environment itself, using test patients. We propose recommendations for how to safely incorporate testing in production into current EHR testing practices, with suggestions regarding the incremental release of upgrades, test patients, tester accounts, downstream personnel, and reporting.

Critical Incident Reporting System in Teaching Hospitals in Turkey: A Survey Study.

Critical incident reporting systems (CIRS) and morbidity-mortality meetings (MMMs) offer the advantages of identifying potential risks in patients. They are key tools in improving patient safety in healthcare systems by modifying the attitudes of clinicians, nurses and staff (human error) and also the system (human and/or technical error) according to the analysis and the results of incidents. One anaesthetist assigned to an administrative and/or teaching position from all university hospitals (UHs) and training and research hospitals (TRHs) of Turkey (n=114) was contacted. In this survey study, we analysed the facilities of anaesthetists in Turkish UHs and TRHs with respect to CIRS and MMMs and also the anaesthetists' knowledge, experience and attitudes regarding CIs. Anaesthetists from 81 of 114 teaching hospitals replied to our survey. Although 96.3% of anaesthetists indicated CI reporting as a necessity, only 37% of departments/hospitals were reported to have CIRS. True definition of CI as "an unexpected /accidental event" was achieved by 23.3% of anaesthetists with CIRS. MMMs were reported in 60.5% of hospitals. Nevertheless, 96% of anaesthetists believe that CIRS and MMMs decrease the incidence of CI occurring. CI occurrence was attributed to human error as 4 [1-5]/10 and 3 [1-5]/10 in UHs and TRHs, respectively (p=0.005). In both hospital types, technical errors were evaluated as 3 [1-5]/10 (p=0.498). This first study regarding CIRS in the Turkish anaesthesia departments/hospitals highlights the lack of CI knowledge and CIRS awareness and use in anaesthesia departments/teaching hospitals in Turkey despite a safety reporting system set up by the Turkish Ministry of Health.

Confirmatory Factor Analysis of Patient Safety Culture in an Iranian Hospital: A Case Study of Fatemeh Zahra Hospital in Najafabad, Iran

Introduction: Transformation of patient safety culture towards developing an open culture can be the greatest challenge for achieving a safe healthcare system. This study aimed to carry out a structural analysis of the Persian translation version of a questionnaire assessing patient safety culture. Materials and Methods: The study was conducted to evaluate the Persian translation of patient safety culture questionnaire, developed by the National Patient Safety Agency. The questionnaire includes seven sections and 43 items investigating 12 dimensions of patient safety culture. The reliability of this questionnaire was confirmed with Cronbach's alpha (α>0.8). The questionnaire was distributed among employees of the Fatemeh Zahra Hospital in Najafabad, Iran, 2015. The collected data were analyzed using SPSS 18 and Amos 18. Results: Sufficiency of the sample size, as determined by Kaiser-Meyer-Olkin measure, was 0.809, which was significantly associated with zero; therefore, performing factor analysis was acceptable and justifiable. The value of Bartlett's test was 696, P-value was less than 0.001, and degree of freedom was equal to 91. In the final model, the relative Chi-square was equal to 1.75 and P-value was less than 0.001. Also, parsimony normed fit index, parsimony-adjusted comparative fit index, and root mean square error of approximation were equal to 0.571, 0.621, and 0.065, respectively. Conclusion: Based on the results of fitting indices for the model and the questionnaire used in the present study for assessing patient safety culture, it can be stated that the Persian translation of this instrument is valid and hospitals can use it to monitor patient safety culture improvement.

Value creation through lean management: a case study of healthcare service operations

The purpose of this case study was to analyse a healthcare service facility, Thai Medical Centre (TMC), by applying lean thinking for system-wide process improvement and improved patient satisfaction. To address the research problem, a simulation-based case study was designed based on a private healthcare facility in Thailand. In this research, an attempt was made to understand and evaluate the factors associated with running an efficient healthcare system. Using the lean methodology process and the layout at the centre, the TMC system was analysed and then redesigned to optimise the lead time at its health promotion centre. The findings of this study demonstrate that through adopting lean process the system can become more efficient by providing a better, faster and safer healthcare system, which contributes to patient satisfaction. Also, these findings can be benchmarked elsewhere in order to improve healthcare system-wide efficiency.

Value creation through lean management: a case study of healthcare service operations

The purpose of this case study was to analyse a healthcare service facility, Thai Medical Centre (TMC), by applying lean thinking for system-wide process improvement and improved patient satisfaction. To address the research problem, a simulation-based case study was designed based on a private healthcare facility in Thailand. In this research, an attempt was made to understand and evaluate the factors associated with running an efficient healthcare system. Using the lean methodology process and the layout at the centre, the TMC system was analysed and then redesigned to optimise the lead time at its health promotion centre. The findings of this study demonstrate that through adopting lean process the system can become more efficient by providing a better, faster and safer healthcare system, which contributes to patient satisfaction. Also, these findings can be benchmarked elsewhere in order to improve healthcare system-wide efficiency.

Necessity of Clinical Engineers to Improve Present Health Technology Management in Developing Countries

<p>Developing countries such as Bangladesh, Nepal, Bhutan, Indonesia and so many could not introduce clinical engineering professional (CEP) in health technology management (HTM) science. As a result, they could not establish the safe health technology management. Conversely, CEP has been introduced by developed countries in HTM for about last 35 years long and thereby established a safe health care system. We noticed the continual problem in the health care management system. To overcome this continual problem, we think that clinical engineering professional is very much necessary to proper implementation of health technology management in developing countries in order to ensure the safe health care system. CEP will train to HTM personnel and a safe health care management will be established in developing countries. The modern medical technology will be involved by the proper practice of HTM and CEP. This pioneer professional will keep the whole HTM with good functional condition. Therefore, we conclude that introducing of CEP is badly necessary to improve the existing unhealthy HTM as well as health care system of the developing countries.HTM personnel will understand the necessity of CEP as well as health care planners. This paper will guide to the existing personnel of HTM and help them to understand the importance roles of CEP. Among these counties, the health care technology management system seems to very problematic. Continually, it is observing that the health care technology management performance is twisting with the increase of sophisticated medical devices. Authors firmly believe that an excellent benefit can be obtained by introducing skilled clinical engineers in the health services of developing countries as Bangladesh. </p>

How to combine lean and safety management in health care processes: A case from Spain

Resource reduction and need to assure high quality levels in healthcare have induced hospitals to develop projects that report multiple performances. In order to pursue patient safety and efficiency improvements simultaneously, “lean & safety” projects (L&S projects) could be implemented, combining Health Lean Management (HLM) and Clinical Risk Management (CRM). This research aims to understand how L&S projects can be implemented. The analyzed case is an exemplary one, as it has been triggered by who is in charge of patient safety and required firstly to reduce incidents and secondly to obtain efficiency improvements. Using an interview protocol grasped from literature, data have been collected conducting semi-structured interviews, analyzing relevant archival documentation and executing observations on the field. A new framework of analysis has been created answering the research purpose.This research represents one of the first studies that investigate characteristics of an HLM project adopted to solve CRM issues. The results suggest HLM and CRM should be considered in a new synergic methodology. First indications about how developing it are provided boosting future research.The outcomes of this research is valuable for hospital units and health organizations that need to achieve efficiency enhancement, improving patient safety at the same time. For managing clinical processes properly, hospital managers could consider the results of this research to solve their CRM problems. The emerged evidences contribute to the development of guidelines for the implementation of “L&S” projects, pursuing multiple objectives and contributing to the growth of more safe and sustainable health care systems.

Learning from Error, Learning from Each Other: A Peer Review Process in Texas

“To err is human” is more than a famous line by poet Alexander Pope; it is also the title of a 1999 Institute of Medicine (IOM) report addressing a safer health care system while recognizing the fallibility of clinicians. Morbidity and Mortality Conferences (M&MC) originated in the early 1900s and provide a time-honored method of learning from error. The Rural & Community Health Institute (RCHI) created a process to meet a need for M&MC in rural Texas. The RCHI reviews selected charts from 58 rural hospitals and facilitates discussions via teleconference at four to six meetings per week representing a variety of specialties and service units. Physicians, nurses, pharmacists, hospital administrators, and health care students participate in these calls. Learning from error allows us to learn from each other.

Reducing medication errors in nursing practice.

Medication errors remain one of the most common causes of unintended harm to patients. They contribute to adverse events that compromise patient safety and result in a large financial burden to the health service. The prevention of medication errors, which can happen at every stage of the medication preparation and distribution process, is essential to maintain a safe healthcare system. One third of the errors that harm patients occur during the nurse administration phase: administering medication to patients is therefore a high-risk activity. This article highlights factors that contribute to medication errors, including the safety culture of institutions. It also discusses factors that relate specifically to nurses, such as patient acuity and nursing workload, the distractions and interruptions that can occur during medication administration, the complexity of some medication calculations and administration methods, and the failure of nurses to adhere to policies or guidelines.

Quality improvement in general practice

Quality improvement describes the process of improving patients’ safety, experiences and health outcomes by systematically addressing individual and organisational processes. This is aimed at creating a ‘self-improving NHS’, in which individual clinicians are empowered to make changes toward a more efficient, safe and cost-effective healthcare system that is readily able to respond to patients’ needs. Improvement science is increasingly recognised as a central component to healthcare, and with general practice taking on added responsibility for the healthcare budget, it is essential that our training addresses aspects of healthcare organisation and improvements. This article offers a summary for AITs and GPs to further their understanding of improvement science. It provides some useful methods to facilitate the delivery of change in the GP surgery.

An Audit of Emergency Department Accreditation Based on Joint Commission International Standards (JCI).

Despite thousands of years from creation of medical knowledge, it not much passes from founding the health care systems. Accreditation is an effective mechanism for performance evaluation, quality enhancement, and the safety of health care systems. This study was conducted to assess the results of emergency department (ED) accreditation in Shohadaye Tajrish Hospital, Tehran, Iran, 2013 in terms of domesticated standards of joint commission international (JCI) standards. This cohort study with a four-month follow up was conducted in the ED of Shohadaye Tajrish Hospital in 2013. The standard evaluation checklist of Iran hospitals (based on JCI standards) included 24 heading and 337 subheading was used for this purpose. The effective possible causes of weak spots were found and their solutions considered. After correction, assessment of accreditation were repeated again. Finally, the achieved results of two periods were analyzed using SPSS version 20. Quality improvement, admission in department and patient assessment, competency and capability test for staffs, collection and analysis of data, training of patients, and facilities had the score of below 50%. The mean of total score for accreditation in ED in the first period was 60.4±30.15 percent and in the second period 68.9±22.9 (p=0.005). Strategic plans, head of department, head nurse, resident physician, responsible nurse for the shift, and personnel file achieved the score of 100%. Of total headings below 50% in the first period just in two cases, collection and analysis of data with growth of 40% as well as competency and capability test for staffs with growth of 17%, were reached to more than 50%. Based on findings of the present study, the ED of Shohadaye Tajrish hospital reached the score of below 50% in six heading of quality improvement, admission in department and patient assessment, competency and capability test for staffs, collection and analysis of data, training of patients, and facilities. While, the given score in strategic plans, head of department, head nurse, resident physician, responsible nurse for the shifts, and personnel file was 100%.

Patient Safety Culture: Nurses’ Attitude in Marvdasht Shahid Motahary Hospital, 1392

Objectives:Improving the safety culture has been implemented as a key strategy to improve patient safety in health care systems. Several surveys have shown that assessment of patient safety attitude and examining to what extent these attitudes exist could be used as an effective tool for promoting patient safety and such data meet the managers’ information needs over time. Thus, considering the importance of patient safety as a basic principle in improving the quality of clinical services and patient satisfaction, this study was aimed to examine nurse’s attitudes towards the safety culture. Materials and Methods: In this cross-sectional study the study population included nurses who were working in Marvdasht Shahid Motahary hospital, 2013. The sample size was selected by using a stratified randomization method as 114. The data were collected through HSOPSC questionnaire that has been introduced by the Health Care Research and Quality agency in 2004. The questionnaire is composed of eight parts. One part is about demographic and career information and other parts are about different dimensions of the patient safety culture. The collected data were then analyzed using the SPSS software and descriptive statistical tests. Results: The obtained results showed that the manager and supervisor expectations and actions in order to promote patient safety and the overall understanding of patient safety dimensions received the highest rating. On the other hand, staffing and non-punitive response to errors dimensions received the lowest score among the 12 dimensions of patient safety culture. Nonetheless, 44% of the studied population considered the patient safety status in their units as acceptable. However, 39% of the population had not reported any errors in the past 12 months. Conclusion: Based on the results of the present study, the need to improve the safety culture at different dimensions seems necessary. Also, the culture of error reporting without any fear of censure or punishment should be institutionalized in future.

EDITORIAL

EDITORIAL

The 2013 National Nursing Workforce Survey of Registered Nurses

The 2013 National Nursing Workforce Survey of Registered Nurses

Impact of a nursing information system in clinical practice: a longitudinal study project.

The implementation of adequate clinical information systems helps to deal with the immense flow of health data to ensure the continuity of care and access to a safe and high-quality healthcare system. Currently there is an increasing awareness of the importance of evaluating and measuring the impact of such systems in clinical practice. Implementations often fail, due to inadequate interaction between technology and human elements. This article describes a research project aimed at evaluating the impact of a clinical nursing information system (CNIS), called Professional Assessment Instrument (PAI), in clinical practice. The study will evaluate PAI Quality, Nurses Satisfaction, PAI Use, Nurses and Environment Characteristics, Net Benefits and Nurses' Experiences related to the PAI use. A theoretical model developed for this research will guide the study. A quali-quantitative longitudinal design will be performed involving two hospitals over a 9-month period. To measure different dimensions that affect the success/failure of CNIS we will use different tools/ methods of data collection (questionnaires, psychometric tools, surveys and focus groups). This study will evaluate the impact of a CNIS in hospitals providing an overview of the factors which can help and hinder the implementation of an information system. The results of the study will support interventions to improve and implement clinical information systems designed to computerize nursing data, with positive effects on public health and research in general, providing further evidence for health policy.

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background The health-care system's success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results The data analysis resulted in three main themes: 'providing environmental prerequisites for safe nursing practice', 'uniting and integrating health-care providers', and 'creating an atmosphere of safe care'. Conclusion The results indicate that to facilitate providing safe care, nurse leaders should improve nurses' working conditions, develop the nurses' practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers' professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.

Perceptions of Canadian labour and delivery nurses about incident reporting: A qualitative descriptive focus group study

BackgroundEstimates of incidents (adverse events) occurring during inpatient hospital stays suggest patient safety demands attention. Improving the safety of health care systems requires understanding incidents and their causes. Labour and delivery nurses can contribute to understanding incidents and incident reporting because they actively identify and report incidents in practice. ObjectivesTo explore Canadian labour and delivery nurses’ perceptions about reporting incidents in practice and identify factors facilitating or constraining incident reporting. DesignA descriptive qualitative study design using focus groups to collect data. SettingsThree labour and delivery units within one health authority in the province of British Columbia. ParticipantsSixteen registered nurses participated in one of four focus groups between 2009 and 2010. MethodsWe audio-taped interviews, transcribed the data, and analysed interview data using inductive content analysis and constant comparison. ResultsWe identified four main themes. The themes included determining an incident, the labour and delivery context, and barriers and facilitating factors for incident reporting. The nurses viewed incidents they identified as unique to their practice. Rather than being a single error, a series of events, which nurses often regarded as out of their control, could lead to incidents. The practice context for labour and delivery, specifically fear of litigation and complexity of decision-making about incidents, affected nurses’ perceptions of incidents and incident reporting. Positive team dynamics complicated the process of incident identification and reporting. Nurses viewed lack of time and fatigue, inadequate reporting tools, and unit culture as barriers to incident reporting. Facilitating factors were learning opportunities, practice improvement, and professional responsibility. ConclusionsTeam work in Canadian labour and delivery practice settings influences determinations of what constitutes incidents and how they are managed. The complexity of incidents that occur in perinatal practice contexts suggests new approaches would be valuable for incident reporting.

An Interprofessional Team-Based Learning Module in Quality Improvement Concepts

Abstract Nurses and physicians share responsibility for improving quality and safety in health care systems, which argues for shared learning about these concepts. This 2.5-hour module, one of two ...

An Advanced Interprofessional Team-Based Learning Module in Quality Improvement Concepts

Abstract Nurses and physicians share responsibility for improving quality and safety in health care systems, which argues for shared learning about these concepts. This 2.5-hour module, one of two ...