Strategies for Enhancing Perioperative Safety: Promoting Joy and Meaning in the Workforce

Workforce safety is a precondition of patient safety, and safety from both physical and psychological harm in the workplace is the foundation for an environment in which joy and meaning can exist. Achieving joy and meaning in the workplace allows health care workers to continuously improve the care they provide. This requires an environment in which disrespectful and harmful behaviors are not tolerated or ignored. Health care leaders have an obligation to create workplace cultures that are characterized by respect, transparency, accountability, learning, and quality care. Evidence suggests, however, that health care settings are rife with disrespectful behavior, poor teamwork, and unsafe working conditions. Solutions for addressing workplace safety problems include defining core values, tasking leaders to act as role models, and committing to becoming a high-reliability organization.     

A model for developing high-reliability teams

riley w., davis s.e., miller k.k. & mccullough m. (2010) Journal of Nursing Management 18, 556–563
A model for developing high-reliability teams Aim To develop a model for high reliability in health care quality and patient safety. Background A high-reliability health organization (HRO) has measurable near perfect performance in quality and safety. High reliability is necessary in health care where the consequences of error are high and the frequency is low. Key issues Despite a decade of intense focus on quality and safety since a series of reports from the Institute of Medicine (IOM), health care is not a completely safe industry and quality is not what it should be to ensure high reliability for patients. Conclusions A model for high reliability is presented that includes the individual skills necessary to assure high-reliability teams on a patient care unit. High-reliability teams (HRT) form an essential core of a HRO. These teams and their organizations value a culture of safety every day with every patient encounter. Implications for nursing management Nurse managers can lead in creating a HRO by first developing HRTs on their patient care unit.     

加拿大医疗风险监测预警机制的循证评价——整合全国卫生资源,建立病人安全体系

目的循证评价加拿大医疗风险监测预警机制的现状及其防范措施，为我国医疗风险监测预警机制的制定提供决策依据。 方法根据本课题组统一制定的检索策略，检索国内外相关数据库和官方网站等，全面收集有关加拿大医疗风险管理、医疗差错和病人安全等方面的文献，并将文献分类分级统计和进行描述性分析。 结果共纳入文献15篇，其中官方文献10篇（占2／3），有确切研究方法文献5篇（占1／3），主要涉及医疗风险管理和评估、医疗差错和病人安全等内容。加拿大于2001年成立国家病人安全指导委员会，提出要求整合全国卫生保健资源，建立病人安全系统，创建病人安全协会以改善病人安全的建议。依托医疗相关机构如医疗保健协会和卫生事业监督委员会等，通过建立和改善病人安全管理制度，收集和发布相关信息、制定具体措施、与医疗组织和机构进行沟通、交流，分享最佳病人安全医疗行为和模式，加强继续教育培训卫生专业人员，完善法律法规程序，增强公民医疗差错意识等途径在医疗风险防范、病人安全保障和医疗质量提高方面，取得了一定的成绩。 结论加拿大医疗风险防范体系较为完善，所采取的措施及其成功经验，对我国整合全国有限的卫生资源、建立科学高效的病人安全系统、增强全民病人安全意识、降低医疗差错都具有重要借鉴意义。     

An interprofessional training course in crises and human factors for perioperative teams

Improving patient safety and the culture of care are health service priorities that coexist with financial pressures on organisations. Research suggests team training and better team processes can improve team culture, safety, performance, and clinical outcomes, yet opportunities for interprofessional learning remain scarce. Perioperative practitioners work in a high pressure, high-risk environment without the benefits of stable team membership: this limits opportunities and momentum for team-initiated collaborative improvements. This article describes an interprofessional course focused on crises and human factors which comprised a 1-day event and a multifaceted sustainment programme for perioperative practitioners, grouped by surgical specialty. Participants reported increased understanding and confidence to enact processes and behaviours that support patient safety, including: team behaviours (communication, coordination, cooperation and back-up, leadership, situational awareness); recognising different perspectives and expectations within the team; briefing and debriefing; after action review; and using specialty-specific incident reports to generate specialty-specific interprofessional improvement plans. Participants valued working with specialty colleagues away from normal work pressures. In the high-pressure arena of front-line healthcare delivery, improving patient safety and theatre efficiency can often be erroneously considered conflicting agendas. Interprofessional collaboration amongst staff participating in this initiative enabled general and specialty-specific interprofessional learning that transcended this conflict.     

Structural empowerment and patient safety culture among registered nurses working in adult critical care units

armellino d. , Quinn Griffin m.t. & Fitzpatrick j.j. (2010) Journal of Nursing Management 18, 796–803
Structural empowerment and patient safety culture among registered nurses working in adult critical care units Aim The aim of the present study was to examine the relationship between structural empowerment and patient safety culture among staff level Registered Nurses (RNs) within adult critical care units (ACCU). Background There is literature to support the value of RNs’ structurally empowered work environments and emerging literature towards patient safety culture; the link between empowerment and patient safety culture is being discovered. Methods A sample of 257 RNs, working within adult critical care of a tertiary hospital in the United States, was surveyed. Instruments included a background data sheet, the Conditions of Workplace Effectiveness and the Hospital Survey on Patient Safety Culture. Results Structural empowerment and patient safety culture were significantly correlated. As structural empowerment increased so did the RNs’ perception of patient safety culture. Conclusion To foster patient safety culture, nurse leaders should consider providing structurally empowering work environments for RNs. Implications for nursing management This study contributes to the body of knowledge linking structural empowerment and patient safety culture. Results link structurally empowered RNs and increased patient safety culture, essential elements in delivering efficient, competent, quality care. They inform nursing management of key factors in the nurses’ environment that promote safe patient care environments.     

Patients' and health care professionals' attitudes towards the PINK patient safety video

Rationale, aims and objectives Patients can play an important role in reducing health care harm. Finding strategies to encourage patients to take on an active role in issues related to the quality and safety of their care is therefore essential. The aim of this study was to examine patients' and health care professionals' attitudes towards a video aimed at promoting patient involvement in safety‐related behaviours. Method A within‐subjects design was used where participants were required to complete a questionnaire pre and post screening of a patient safety video. Participants are 201 patients aged 19–103 years (mean 52) and 95 health care professionals aged 23–48 years (mean 32). Main outcome measures include (i) patients' willingness to participate and perceived importance in participating in safety‐related behaviours; and (ii) health care professionals' willingness to support patient involvement. Results After watching the video patients elicited more positive attitudes towards asking doctors and nurses if they had washed their hands and notifying them about issues to do with personal hygiene. No significant effects were observed in relation to patients notifying staff if they have not received their medication or if they were in pain or feeling unwell. In relation to health care professionals, doctors and nurses were more willing to support patient involvement in asking about hand hygiene after they had watched the video. Conclusion Video may be effective at changing patients' and health care professionals' attitudes towards patient involvement in some, but not all safety‐related behaviours. Our findings suggest video may be most effective at encouraging involvement in behaviours patients are less inclined to participate in and health care professionals are less willing to support.     

Nurse Leaders: Transforming Interprofessional Relationships to Bridge Healthcare Quality and Safety

Health care remains an exceedingly complex, high-risk industry with the potential for errors resulting in patient injury or mortality. Many health care systems have progressed toward high reliability principles to improve quality and safety. Nurse leaders are integral to high reliability as they establish a vision and operational objectives that permeate an organizational commitment to safety. Interprofessional relationships and team dynamics among clinicians can enhance or impede their ability to collaborate and provide care. In this paper, we discuss the influence of clinician relationships on health care performance and provide insights into nurse leader interventions to improve interprofessional collaboration and drive high reliability.     

护理安全管理新思路

病人安全与医疗护理差错日益受到人们关注。从护理角度出发,保障和促进病人安全,需要加强护理安全管理,随着对病人安全的深入研究和探讨,护理管理者对护理安全理念的认识也应更新,重点从接受人皆会犯错的事实、明确差错多来自系统问题、借助安全管理成果和信息技术、创建“安全文化”以及建立自愿报告系统5个方面阐述了护理安全管理的一些新思路。     

Second victim phenomenon: Is ‘just culture’ a reality? An integrative review

BackgroundDespite rigorous and multiple attempts to establish a culture of patient safety and a goal to decrease incidence of patient deaths in the health care, estimations of preventable mortality due to medical errors varied widely from 44,000 to 250,000 in hospital settings. This magnitude of medical errors establishes patient safety as being at the forefront of public concerns, healthcare practice and research. In addition to the potential negative impact on patients and the healthcare system, medical errors evoke intense psychological responses in health care providers' responses that threaten their personal and professional selves, and their ability to deliver high quality patient care. Studies show half of all hospital providers will suffer from second victim phenomena at least once in their careers. Health care institutions have begun a paradigm shift from blame to fairness, referred to as ‘just culture’. ‘Just culture’ better ensures that a balanced, responsible approach for both providers who err and healthcare organizations in which they practice, and shifts the focus to designing improved systems in the workplace.ObjectivesThe aim of this review was to identify: how medical errors affect health care professionals, as second victims; and how health care organizations can make ‘just culture’ a reality.DesignAn integrative review was performed using a methodical three-step search on the concept of second victims' perceptions and responses, as well as ‘just culture’ of health care institutions.ResultsA total of 42 research studies were identified involving health care professionals: 10 qualitative studies; eight mixed-method studies; and 24 quantitative studies. Second victims' perceptions of the current ‘just culture’ included: 1) fear of repercussions of reporting medical errors as a barrier; 2) supportive safety leadership is central to reducing fear of error reporting; 3) improved education on adverse event reporting, developing positive feedback when adverse events are reported, and the development of non-punitive error guidelines for health care professionals are needed; and 4) the need for development of standard operating procedures for health care facility peer-support teams.ConclusionsSecond victims' perceptions of organizational and peer support are a part of ‘just culture’. Enhanced support for second victims may improve the quality of health care, strengthen the emotional support of the health care professionals, and build relationships between health care institutions and staff. Although some programs are in place in health care institutions to support ‘just culture’ and second victims, more comprehensive programs are needed.     

What we know and what they do: nursing students' experiences of improvement knowledge in clinical practice

Nations around the world face mounting problems in health care, including rising costs, challenges to accessing services, and wide variations in safety and quality. Several reports and surveys have clearly demonstrated that adverse events and errors pose serious threats to patient safety. It has become obvious that future health professionals will need to address such problems in the quality of patient care. This article discuss a research study examining improvement knowledge in clinical practice as experienced by nursing students with respect to a patient-centred perspective, knowledge of health-care processes, the handling of adverse events, cross-professional collaboration, and the development of new knowledge. Six focus groups were conducted, comprising a total of 27 second-year students. The resulting discourses were recorded, coded and analysed. The findings indicate a deficiency in improvement knowledge in clinical practice, and a gap between what students learn about patient care and what they observe. In addition the findings suggest that there is a need to change the culture in health care and health professional education, and to develop learning models that encourage reflection, openness, and scrutiny of underlying individual and organizational values and assumptions in health care.     

Do inquiries into health system failures lead to change in clinical governance systems?

Aim

This paper reports the first part of a case study investigation to examine the changes at King Edward Memorial Hospital (KEMH) following an inquiry established to review the quality of obstetric and gynaecological services.

Background

Common findings from a range of health inquiries in recent times include that there have been inadequate adverse event reporting systems, the absence of transparent systems for staff and patients to report concerns about quality of patient care, and an ineffective medical credentialing and performance review system. The similarity of findings from many health inquiries raises the question of whether an inquiry does lead to changes to improve patient care and safety. There has been very little reported in the literature about this.

Method

Using a case study strategy the areas of medical credentialing, performance review and involvement of consumers in care were chosen as the KEMH clinical governance processes to be examined for changes post inquiry. Documents, archives and interviews were used as data sources for this case study. Documents were examined using a normative analytic approach and the Miles and Huberman framework was used for data analysis of the interviews.

Findings

There were significant changes in the area of credentialing and performance review evident in analysis of all sources of data. There were some improvements in the processes of involving consumers in care, but deficits were identified in regard to the provision of training and upskilling for clinicians to improve their communication skills and interactions with patients and families.     

Effect of patient safety education interventions on patient safety culture of health care professionals: Systematic review and meta-analysis

AimTo synthesize and evaluate the cumulative effect of patient safety education intervention for health care professional staff in the hospital setting on their patient safety culture.BackgroundPatient security Culture is an important factor in ensuring patient safety and it is recommended as one of the pillars of preventive strategies in the healthcare system.DesignSystematic review and meta-analysis were prospectively registered with PROSPERO.MethodsThis review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, EMBASE, Ovid, CINAHL, Cochran Library, Web of Science and randomized control trial registration databases from January 1999 to February 2021. Studies on patient safety culture intervention were included. We assessed research quality using the jadad scale for RCTs and the Methodological Index for Non-Randomized StudiesResultsSixteen studies with a total of 3438 participants in the intervention group and 3121 in the control group were included in the final analysis. The random-effect meta-analysis shows significant heterogeneity among studies that assessed patient safety culture as a mean percentage of positive responses or as a mean score of 1–5 scale. (I² = 91% and 77%, respectively). Also, there was a significant difference between experimental and control group in the overall pooled effect of patient safety culture in the studies that used the mean percentage of positive response [Mean Difference = 5.24, 95% confidence interval (1.32, 9.16, Z = 2.62; P = 0.009] or the mean score [Mean Difference = 0.08, 95% confidence interval (0.01, 0.15), Z = 2.26; P = 0.02]. The difference was no longer significant in the mean score studies after excluding the studies with low-quality scores. Subgroup analysis showed no change in the pooled effect of the studies with quasi-experimental [Mean Difference = 7.84, 95% confidence interval (2.35, 13.33); Z = 2.80; p = 0.005) or before-after design [MD= 0.11, 95% confidence interval (0.07, 0.14); Z = 5.74; p = 0.000]. However, the patient safety education intervention remained effective after one year of follow-up.ConclusionsOur review Provides empirical evidence on current efforts in patient safety education to improve a healthcare professional-patient safety culture. The Patient safety education program could improve the patient safety culture of health care professionals.     

Prioritising quality

The deluge of new initiatives, proposals and recommendations for solving the problems required to improve patient safety and quality of health care continues unabated. Implementing the proposed solutions for improving patient safety and quality of care requires setting priorities for action throughout the different levels of the health-care system. Currently, we face the dilemma of having to set priorities from the plentiful themes that are intuitively sensible and well accepted. There is an increasing number of examples of using systematic processes which contain explicit and transparent criteria for priority setting in patient safety and quality initiatives. These should be more widely adopted and become a key requirement for all future proposals for improving patient safety and quality of health care.     

Achieving a high-reliability organization through implementation of the ARCC model for systemwide sustainability of evidence-based practice

High-reliability health care organizations are those that provide care that is safe and one that minimizes errors while achieving exceptional performance in quality and safety. This article presents major concepts and characteristics of a patient safety culture and a high-reliability health care organization and explains how building a culture of evidence-based practice can assist organizations in achieving high reliability. The ARCC (Advancing Research and Clinical practice through close Collaboration) model for systemwide implementation and sustainability of evidence-based practice is highlighted as a key strategy in achieving high reliability in health care organizations.     

河北省综合医院护理工作环境现状及与护理质量安全的相关性研究

目的调查河北省综合医院护理工作环境的现状,并分析其与护理质量安全的相关性。方法采用护士工作环境量表和护理质量安全问卷对河北省20所二级、三级综合医院的1023名护士进行问卷调查。结果护理工作环境得分为（3．45±0．55）分,得分最高的维度为医护合作,最低的维度为充足的人力和物力。良好的医护合作可使护士对病区护理质量和出院后患者自我护理有正性影响;鼓励护士参与医院事务、重视高质量护理服务的基础工作,对护士的患者安全评价有正性影响。结论河北省综合医院护理工作环境总体较好,良好的护理工作环境有利于护理质量和患者安全的保障,医疗主管部门和护理管理者应当继续优化护理工作环境的各要素,以进一步提升护理质量和患者安全。     

Nurses create a culture of patient safety: it takes more than projects

Healthcare organizations are embracing the sciences of safety, improvement, human factors, and complexity to transform their culture into a culture of safety and high reliability. Nurses are the front lines of healthcare delivery, and as such, the front lines of safety and quality processes and outcomes. Nurses are required to both understand and develop the skills needed to improve care processes and to own the work of improvement as a professional responsibility. These changes demand that nurses understand both the complex demands of providing harm-free care and the system dynamics needed to create the conditions for improved outcomes, organizational, and system performance, and intraprofessional development and teamwork. The author presents the challenge of maintaining a safe patient care environment and describes a model that can detect and mitigate the migration of safe nursing care into at-risk and unsafe nursing care. She emphasizes the importance of healthcare organizations performing as high reliability organizations and outlines 'planned practices' steps to introduce new technology and innovation, and concludes by considering the interaction between individual practice and system performance.     

A new perspective on blame culture: an experimental study

Objectives Recently, a range of different institutions worldwide has identified the ‘culture of blame’ and the fear of being punished as the principal reasons for the lack of medical error reporting and, consequently, of their reiteration and of the poor quality of patient care. Despite much theoretical debate, there currently exist no experimental studies that directly investigate the presence and pervasiveness of the blame and punishment culture in health care contexts. In order to document empirical evidence for this culture in medicine and nursing, we conducted an experimental study asking physicians and nurses to express their fear of blame or punishment in the context of having made an error that would cause: (i) no; (ii) mild; (iii) severe consequences; or (iv) the death of the patient. Methods Two hundred and forty‐nine health care providers (38 physicians, 11 medical students, 127 nurses and 73 nursing students) were included in the study. Two main data emerged: first, in general, the fear of being blamed is higher than the fear of being punished. Second, while the fear of being blamed is equally distributed among all participants, the fear of being punished varies according to the experience of subjects (it is higher in nursing students than in seniors nurses) and to their professional role (student and senior nurses are more susceptible to it than medical students and senior physicians). Conclusion Given the relevance of these factors in medical error reporting and the evidence that they are so deep‐seated not only in senior professionals, but also in students, we argue that an educational approach, together with an organization‐based intervention, is desirable to shape cultural attitudes of health care providers in the direction of a ‘safety culture’.     

The clinical nurse leader: a catalyst for improving quality and patient safety

Aim  The clinical nurse leader (CNL^®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice.
Background  Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources.
Method  A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region.
Results  Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model.
Conclusions  With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs.
Implications for nursing management  Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings.     

Smartphone distraction during nursing care: Systematic literature review

AimTo investigate the impact of smartphone distraction on the quality and safety of care provided by the nursing population during work.BackgroundAbout 80% of nurses use the smartphone in the workplace both for personal purposes and as a useful support to improve the quality of care. Distraction from smartphones during care is a phenomenon that should be known and managed within each health service.MethodsA systematic review of the literature was conducted using the PRISMA methodology. The sources included in the review study were subjected to a qualitative assessment using the GRADE method.ResultsSixteen articles were included in the review. Studies included highlight the positive and negative consequences of using mobile devices during nursing practice. Findings identify the smartphone as a generator of stimuli capable of diverting the attention of the person from the priority activities and absorbing the cognitive resources useful for carrying out these activities. Some studies aimed to show the restriction policies and/or the strategies for reducing disruptions. This review highlights how the free and indiscriminate use of the smartphone can negatively affect patient safety and the nurse-patient relationship through the dehumanization and depersonalization of care.ConclusionsMobile technology can improve nurses' performance and the quality of care provided. However, the application of regulations and policies by healthcare facilities is desirable to avoid inappropriate use of these devices by nurses. The available data do not provide a precise estimate of the effect that distraction from smartphones has on the outcomes of nursing care.