Context: Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety ...organizing and other contextual factors that help foster safety. Objectives: Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors. Subjects: A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004. Research Design: Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing. Results: Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways. Conclusions: Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.
Physicians are being increasingly called upon to engage in leadership at all levels of modern health organizations, leading many to call for greater research and training interventions regarding ...physician leadership development. Yet, within these calls to action, the authors note a troubling trend toward siloed, medicine-specific approaches to leadership development and a broad failure to learn from the evidence and insight of other relevant disciplines, such as the organizational sciences. The authors describe how this trend reflects what has been called the "not-invented-here syndrome" (NIHS)-a commonly observed reluctance to adopt and integrate insights from outside disciplines-and highlight the pitfalls of NIHS for effective physician leadership development. Failing to learn from research and interventions in the organizational sciences inhibits physician leadership development efforts, leading to redundant rediscoveries of known insights and reinventions of existing best practices. The authors call for physician leaders to embrace ideas that are "proudly developed elsewhere" and work with colleagues in outside disciplines to conduct collaborative research and develop integrated training interventions to best develop physician leaders who are prepared for the complex, dynamic challenges of modern health care.
The factors that compel individuals to exert the extraordinary effort needed to create high reliability—consistent error-free performance under trying conditions—remain unspecified. Here, we propose ...that when individuals experience emotional ambivalence and prosocial motivation, it induces the broad thinking and other-orientation that undergird mindful organizing and high reliability.
Drawing together research in the upper echelon perspective, strategy, and organizational sociology, this paper examines (1) the relationship between the finance expertise of a venture capital (VC) ...firm's management team and investment selection, and (2) the moderation of this relationship by the VC firm's social position. We find that while finance expertise is associated with a lower proportion of early-stage investments, this relationship is
weaker for firms with high reputation and
stronger for firms with high status. We conclude with a discussion of the importance and nuances of external image considerations on investment decisions as well as insights into the importance of the requisite nature of expertise.
Objective
We apply the high-reliability organization (HRO) paradigm to the diagnostic process, outlining challenges to enacting HRO principles in diagnosis and offering solutions for how diagnostic ...process stakeholders can overcome these barriers.
Background
Evidence shows that healthcare is starting to organize for higher reliability by employing various principles and practices of HRO. These hold promise for enhancing safer care, but there has been little consideration of the challenges that clinicians and healthcare systems face while enacting HRO principles in the diagnostic process. To effectively deploy the HRO perspective, these barriers must be seriously considered.
Method
We review key principles of the HRO paradigm, the diagnostic errors and harms that potentially can be prevented by its enactment, the challenges that clinicians and healthcare systems face in executing various principles and practices, and possible solutions that clinicians and organizational leaders can take to overcome these challenges and barriers.
Results
Our analyses reveal multiple challenges including the inherent diagnostic uncertainty; the lack of diagnosis-focused performance feedback; the fact that diagnosis is often a solo, rather than team, activity; the tendency to simplify the diagnostic process; and professional and institutional status hierarchies. But these challenges are not insurmountable—there are strategies and solutions available to overcome them.
Conclusion
The HRO lens offers some important ideas for how the safety of the diagnostic process can be improved.
Application
The ideas proposed here can be enacted by both individual clinicians and healthcare leaders; both are necessary for making systematic progress in enhancing diagnostic performance.
Changing the narratives for patient safety Pronovost, Peter J; Sutcliffe, Kathleen M; Basu, Lopa ...
Bulletin of the World Health Organization,
06/2017, Letnik:
95, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Patient safety is recognized as a global public health issue, causing death and suffering in all types of patients and incurring costs in all countries. The global health community has made ...significant and sustained efforts to improve safety and quality of health services. However, progress in reducing preventable harm has been too limited, little and local. This article proposes that narratives or mental models are reasons for the limited progress. Narratives inform how you interpret reality and how to act in the world and those told about patient safety and poor quality care often inhibit rather than facilitate momentum to make changes. This paper discusses how changing these narratives may accelerate the efforts to improve safety and quality of care.
Abstract
Background
Eliminating hepatitis C virus (HCV) will require effective treatment delivery to persons with substance use disorders (SUDs). We evaluated the relationship between ...ledipasvir/sofosbuvir treatment persistence (receiving 84 tablets), adherence, and sustained virologic response (SVR) in persons with human immunodeficiency virus (HIV)/HCV coinfection.
Methods
Of the 144 participants with HIV/HCV and SUDs, 110 initiated a 12-week treatment course under 1 of 3 conditions (usual care, peer mentors, and cash incentives). We used self-report, pharmacy pill counts, and expected date of refill to examine adherence. Persistent participants were categorized as high adherence (taking ≥90% of doses) or low adherence (taking <90% of doses).
Results
Most participants persisted on treatment after initiation (n = 105), with 95% (n = 100) achieving SVR. One third (34%) of participants had moderate/heavy alcohol use by the biomarker phosphatidylethanol (Peth ≥50 ng/mL), and 44% had urine toxicology positive for cocaine or heroin at enrollment. The proportion of persons with high adherence was 72% (n = 76), and the proportion of persons with low adherence was 28%. Although low adherence was associated with moderate/heavy alcohol use by PEth (relative risk = 2.77; 95% confidence interval, 1.50–5.12), SVR did not vary according to adherence (P = .702), and most participants (97%) with low adherence achieved SVR.
Conclusions
Treatment persistence led to high SVR rates among persons with HIV/HCV, despite imperfect adherence and SUDs.
In this RCT of persons with HIV, HCV, and substance use disorders, 76% initiated a 12-week treatment course for HCV. Participants with high adherence (≥90% of doses) and low adherence (<90% of doses) had high rates of sustained virologic response.
This is a study of a method of mortality review, adopted by the Michigan Society of Thoracic and Cardiovascular Surgeons, to enhance understanding of mortality and potentially avoidable deaths after ...cardiac surgery, utilizing a voluntary statewide database.
A system to categorize mortality was developed utilizing a phase of care mortality analysis approach as well as providing criteria to classify mortality as potentially "avoidable." For each mortality, the operating surgeon categorized a cardiac surgery mortality trigger into 1 of 5 time frames: preoperative, intraoperative, intensive care unit (ICU), postoperative floor, and discharge.
A total of 53,674 adult cardiac operations were performed from January 1, 2006 to June 30, 2010 with a crude mortality of 3.5% (1,905 of 53,674). Of the mortalities analyzed, 35% (618 of 1,780) were preoperative, 25% (451 of 1,780) were ICU, 19% (333 of 1,780) were intraoperative, 11% (198 of 1,780) were floor, and 10% (180 of 1,780) were discharge phase. "Avoidable" mortality triggers occurred in 53% (174 of 333) of the intraoperative, 41% (253 of 618) and (184 of 451) of the preoperative and ICU phases, 42% (83 of 198) of the floor, and 19% (35 of 180) of the discharge phase. Overall potentially avoidable mortality was 41% (729 of 1780). Thirty-six percent (644 of 1,780) of the mortalities were coronary artery bypass grafting patients and 29% (188 of 644) of these were in the preoperative phase, with a mean predicted risk of 16%.
This analysis identifies the occurrence of potentially avoidable mortalities in the 4 hospital phases of care, with the largest absolute number of avoidable mortalities occurring in the preoperative phase. A focus on these phases of care provides significant opportunity for quality improvement initiatives. Utilizing phase of care mortality analysis stimulates surgeons and hospitals to develop and refine mortality reviews and provides a structured statewide platform for discussion, education, quality improvement, and enhanced outcomes.
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