Healthcare innovation barriers: Results of a survey of certified professional healthcare risk managers

Medical errors cause significant patient injuries, including deaths. Innovations designed to improve quality and reduce risk are numerous, as are the barriers that prevent innovation implementation. The purpose of this research was to analyze the relationships, if any, between the independent variables of hospital bed size and organizational structure, and the dependent variable barriers to three innovations: implementing a surgical safety checklist, preventing catheter-associated urinary tract infections, and adopting patient- and family-centered care. The findings strengthen and expand existing research and serve as the foundation for understanding barriers to implementation of three healthcare innovations. Future research should focus on organizational culture instead of innovation-specific barriers and should incorporate other independent variables, such as organizational profitability.     

Creating a culture for health care quality and safety

Approximately 67% of hospital quality indicators require some type of laboratory testing to monitor compliance. Unfortunately, in many hospitals, laboratory data information systems remain an untapped resource in eliminating medical errors and improving patient safety. Using case scenarios, this article demonstrates potential consequences for patient safety and quality of care when information sharing between medical technologists and nurses is not a part of a hospital's culture. The outcome for this patient could have been avoided if a more inclusive health care quality and safety culture existed. Creating a culture for health care quality and safety requires consensus building by clinical and administrative leaders. Consensus building occurs by managing relationships among and between a team of independent, autonomous physicians, nurses, allied health professionals, and health care administrators. These relationships are built on mutual respect and effective communication. Creating a quality culture is a challenging but necessary prerequisite for eliminating medical errors and ensuring patient safety. Physician leaders promoting and advancing cultural change in clinical care from one of exclusive decision making authority to a culture that is based on shared decision making are a necessary first step. Shared decision making requires mutual respect, trust, confidentiality, responsiveness, empathy, effective listening, and communication among all clinical team members. Physician and administrative leaders with a focus on patient safety and a willingness to change will ensure a culture of health care quality and safety.     

The ethical leadership challenge to do no harm: the cognitive imperative

In hospitals across the United States, there is a growing epidemic of unprecedented proportions. This epidemic is the rising number of deaths caused by medical errors. Deaths due to medical errors are a leading cause of deaths in the hospital setting. These errors are attributable to human error. Health care managers and leaders must gain knowledge of how cognition is related to human error. With this knowledge, health care managers and leaders will have a better understanding of how cognition is the primary cause of human error in the hospital setting. This article addresses and evaluates the different components of cognition and provides recommendations to reduce human error and thereby deaths in hospitals.     

Dueling priorities

The Institute of Medicine report on medical errors and the resulting attention from the public and health care purchasers pushed patients safety to the forefront of providers' quality initiatives. Now, some health care leaders say the preoccupation with safety is wrongheaded and could detract from broad efforts to improve care.     

Using the "customer service framework" to successfully implement patient- and family-centered care

Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.     

实施医疗服务质量记分管理 促进医疗质量和病人安全

目的提高医疗质量,保障病人安全。方法根据法律法规的要求结合医院实际,制定"医务人员医疗服务质量记分管理办法",规定记分的内容、分值,以记分为手段,规范医务人员临床诊疗行为,增强依法行医意识,提高医疗质量,消除医疗安全隐患,使医务人员能明确自身执业行为准则、要遵守的行为规范,从而由被动管理转变为主动管理。结果实施一年来收到了满意的效果,提高了病人对医疗工作的满意度和各项医疗指标;降低了院内感染发生率和差错发生率;提高了处方和病历的合格率。并为即将进行的全顺德区医院试点工作提供了依据。结论实施医务人员医疗服务质量记分管理办法,是提高医疗质量,保障病人安全的有效方法。     

Perceptions of preventable medical errors in Alberta, Canada.

OBJECTIVE: (i) To compare public perceptions of the frequency, responsibility, causes and solutions for preventable medical errors for persons who report and do not report having experienced a preventable medical error while receiving healthcare services in Alberta, Canada. (ii) To describe public opinion about confidentiality and disclosure of preventable medical error. (iii) To examine the relationship between reporting preventable medical error and perceived quality of the healthcare system. METHODS: Population-based telephone survey. Households selected by random digit dialing and individual in household selected by most recent birthday. Province of Alberta, Canada. Representative sample of adult Albertans (N = 1500). Public perceptions of the frequency, responsibility, causes and solutions for preventable medical error; opinions about confidentiality and disclosure; perceived quality of the healthcare system. RESULTS: Five hundred and fifty-nine (37.3%; 95% CI 34.8-39.8%) of 1500 respondents reported that they or a family member had ever experienced a preventable medical error while receiving health care in Alberta, Canada. Respondents who reported a preventable medical error were more likely to believe that preventable medical errors occur with greater frequency, were less likely to think that their doctor would tell them if a preventable medical error was made in their care, and tended to rate the quality of the healthcare system less favourably. CONCLUSION: This paper provides healthcare managers and policymakers with insight into the public's perceptions of preventable medical error and may facilitate the development of strategies to improve patient safety, public confidence and public satisfaction with the healthcare system.     

Taking account of quality. Discussion

Another report from the Institute of Medicine in March 2001 has joined a large body of literature documenting serious quality and safety problems. Eight health care leaders discuss ways in which organizations can reduce medical errors and improve patient outcomes.     

Legacy Health's 'Big Aims' initiative to improve patient safety reduced rates of infection and mortality among patients

An uncomfortable truth about US health care is that medical harm and needless deaths continue to occur, even after a decade of concentrated efforts to eliminate them. However, some hospital systems are managing to improve patient safety. Legacy Health, a system with six hospitals in the Portland, Oregon, metropolitan area, engaged its entire workforce in an initiative to reduce rates of infection and mortality. Legacy staff used bundles of best practices to prevent four common health care-associated infections; reviewed deaths and revised procedures based on the findings; and included staff from different disciplines in daily medical rounds. The results were a 44.6 percent reduction in infections and a 13.5 percent reduction in mortality, as well as annual savings of more than $6.8 million for each of the first two years from the avoided costs of treating health care-associated infections. Fewer patients suffered, died, or incurred daunting copayments for hospital care. These results demonstrate that health care systems can greatly improve quality and safety and lower costs when leaders as well as front-line clinicians and staff are highly involved in improvement efforts.     

Hospital progress in reducing error: the impact of external interventions

Millions of Americans are harmed each year from medical errors. New patient safety standards, voluntary and mandatory error reporting, and increased public awareness have been interventions to improve patient safety. The author performed a survey of 145 hospital administrators from 48 states using the Baldrige 2006 Heath Care Criteria for Performance Excellence to investigate quality improvement efforts to reduce medical errors. Hospital administrators reported significant progress in implementing quality improvement processes that have reduced medical errors. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation was an effective intervention to drive efforts to reduce medical errors, whereas state medical error reporting and public awareness were not effective interventions.     

病人安全文化影响因素作用机制的路径分析

目的 筛选病人安全文化的影响因素并探索各因素对病人安全文化系统的影响机制,为更好地提高患者安全提供参考依据.方法 采用中文修订版医院病人安全文化调查表(C-HSOPSC),通过随机抽样的方法,对黑龙江省291名医院管理层人员进行现场调查,运用线性回归模型和Kendall相关系数筛选病人安全文化影响因素,利用路径分析方法探索其影响路径并建立路径模型.结果 路径分析结果表明,医院管理者的支持对病人安全文化直接影响最大,科室内团队合作也是重要的影响因素,但需要通过管理者支持才能对病人安全文化起到最大的间接作用.结论 病人安全涵盖多重维度视角,医院管理者应结合院领导的支持、科室内团队合作、非惩罚性文化、医务人员的沟通与交流等重要因素的影响路径采取相应干预措施.     

Collaborating with patients and their families

Patient‐ and family‐centered care is a healthcare approach that emphasizes collaboration among patients, families, and healthcare providers. The key concepts of patient‐ and family‐centered care can be applied in any healthcare setting to enhance patient safety, reduce the risk of medical errors, improve risk management processes, and create an organizational culture supportive of risk managers and open, honest communication.     

Continuing education meets the learning organization: the challenge of a systems approach to patient safety

Since the release of the report of the Institute of Medicine on medical errors and patient safety in November 1999, health policy makers and health care leaders in several nations have sought solutions that will improve the safety of health care. This attention to patient safety has high-lighted the importance of a learning approach and a systems approach to quality measurement and improvement. Balanced with the need for public disclosure of performance, confidential reporting with feedback is one of the prime ways that nations such as the United States, Canada, the United Kingdom, and Australia have approached this challenge. In the United States, the Quality Interagency Coordination Task Force has convened federal agencies that are involved in health care quality improvement for a coordinated initiative. Based on an investment in a strong research foundation in health care quality measurement and improvement, there are eight key lessons for continuing education if it is to parlay the interest in patient safety into enhanced continuing education and quality improvement in learning health care systems. The themes for these lessons are (1) informatics for information, (2) guidelines as learning tools, (3) learning from opinion leaders, (4) learning from the patient, (5) decision support systems, (6) the team learning together, (7) learning organizations, and (8) just-in-time and point-of-care delivery.     

Dignity-driven decision making: a compelling strategy for improving care for people with advanced illness

The concept of dignity-driven decision making builds on previous efforts to define and develop patient- and family-centered care for people with advanced illness. More a framework than a rigid structure, the dignity-driven decision making model emphasizes the centrality of a collaborative process in which patients, most of whom are elderly; their families; and clinicians work together continuously to define the goals of care and how best to implement them. The early experiences of some organizations already practicing dignity-driven decision making in their care suggest that the model can improve patient care. Whether the system of care can produce enough savings to pay for its increased costs in the form of additional clinicians and managers is not yet known. Policy-driven actions, such as payment reform and closer alignment of quality incentives with the model's objectives, will be integral to further development and dissemination of the model.     

A modified Delphi methodology to conduct a failure modes effects analysis: a patient-centric effort in a clinical medical laboratory

In this article, we describe the use of an information-gathering tool, the Delphi technique, to overcome issues encountered when conducting a failure modes effects analysis as part of a define, measure, analyze, implement, control study to improve the processes of a clinical medical laboratory. The study was conducted with the goals of reducing medical errors in the total testing process (TTP) in order to improve patient safety, patient satisfaction, and improve the overall quality of the health care services provided by the subject hospital while meeting its Joint Commission (JC) accreditation requirements. The study found that the Delphi technique was very useful in overcoming 4 barriers encountered in conducting a failure modes effects analysis in a hospital's clinical medical laboratory and in achieving those goals.     

员工对患者安全文化认知的现状调研

目的 了解某医院患者安全文化现状,为持续改善医疗质量提供依据。方法 对全院员工发放中文版医院患者安全文化调查表（HSOPSC）,计算量表各维度及各条目的积极反应率。结果 共1 208名员工参与调查,组织的学习与持续改进、科室内团队合作、对医院安全的总体评价、管理者在促进患者安全方面的意愿和行动、管理者对患者安全的支持、交接班和转科等维度积极反应率均大于75%,为优势区域;人员配置、对错误的非惩罚性反应、沟通开放程度、不良事件报告频率等维度积极反应率均小于50%,为待改进区域。不同职称、学历、下班延误时间、年龄、岗位、与患者直接接触等因素对医院患者安全文化总分有显著影响。结论 该院员工对患者安全文化认知现状较好,但在人员配置等方面需继续改进。     

Patient safety attitudes and behaviors of graduating medical students

As North American medical schools reformulate curricula in response to public calls for better patient safety, surprisingly little research is available to explain and improve the translation of medical students' knowledge and attitudes into desirable patient safety behaviors in the clinical setting. A total of 139 fourth-year medical students at Virginia Commonwealth University, School of Medicine, 96% of the 2010 graduating class, completed the Attitudes toward Patient Safety Questionnaire and a self-report of safety behaviors. The students were exposed to informal discussions of patient safety concepts but received no formal patient safety curriculum. Most students recognized errors and responded with attitudes supportive of patient safety but desired behaviors were less common. In particular, errors went unreported, owing, in part, to the relationships of power and social influence undergirding the traditional authority gradient in the culture of medicine. A deeper understanding of patient safety attitudes, behavior, and medical culture is required to better inform instructional design decisions that influence desired patient safety behaviors and improve patient care.     

公立医院人才可持续发展满意度对管理人员公共服务动机的作用机制研究

目的 明确人才可持续发展满意度对公立医院管理人员公共服务动机的影响机制。方法 选取北京市18家三级公立医院617名管理人员进行调查，使用fsQCA 3.0软件进行模糊集定性比较分析。结果 影响公立医院管理人员公共服务动机的条件组态可分为晋升主导型、改革主导型和综合型三种。结论 公立医院中层与院领导的公共服务动机模式不同。建议优化中层选聘晋升流程，完善绩效考核体系；给予公立医院改革自主权，推进医疗卫生体系剩余索取权和控制权两权统一。     

医院开展患者就医体验管理的思考与展望

医院开展患者就医体验管理,有利于提升患者满意度,为此建议采取优化就医流程,改善医患沟通方式,加强医疗机构基础设施管理,优化电子信息平台等措施。针对公立医院面临的困惑和难题,提出提高医疗水平,保证医疗质量,重视网络评价,重视医疗人文关怀,提升医院文化水平等建议,以期改善服务质量,增强患者舒适度体验。