ObjectivesHealth and social care systems, organisations and providers are under pressure to organise care around patients’ needs with constrained resources. To implement patient-centred care (PCC) successfully, barriers must be addressed. Up to now, there has been a lack of comprehensive investigations on possible determinants of PCC across various health and social care organisations (HSCOs). Our qualitative study examines determinants of PCC implementation from decision makers’ perspectives across diverse HSCOs.DesignQualitative study of n=24 participants in n=20 semistructured face-to-face interviews conducted from August 2017 to May 2018.Setting and participantsDecision makers were recruited from multiple HSCOs in the region of the city of Cologne, Germany, based on a maximum variation sampling strategy varying by HSCOs types.OutcomesThe qualitative interviews were analysed using an inductive and deductive approach according to qualitative content analysis. The Consolidated Framework for Implementation Research was used to conceptualise determinants of PCC.ResultsDecision makers identified similar determinants facilitating or obstructing the implementation of PCC in their organisational contexts. Several determinants at the HSCO’s inner setting and the individual level (eg, communication among staff and well-being of employees) were identified as crucial to overcome constrained financial, human and material resources in order to deliver PCC.ConclusionsThe results can help to foster the implementation of PCC in various HSCOs contexts. We identified possible starting points for initiating the tailoring of interventions and implementation strategies and the redesign of HSCOs towards more patient-centredness.

ObjectivesPrevious studies on patient-centred care (PCC) and its facilitators and barriers usually considered specific patient groups, healthcare settings and aspects of PCC or focused on expert perspectives. The objective of this study was to analyse patients’ perspectives of facilitators and barriers towards implementing PCC.DesignWe conducted semistructured individual interviews with chronically ill patients. The interviewees were encouraged to share positive and negative experiences of care and the related facilitators and barriers in all settings including preventive, acute and chronic health issues. Interview data were analysed based on the concept of content analysis.SettingInterviews took place at the University Hospital Cologne, nursing homes, at participants’ homes or by telephone.ParticipantsAny person with at least one chronic illness living in the region of Cologne was eligible for participation. 25 persons with an average age of 60 years participated in the interviews. The participants suffered from various chronic conditions including mental health problems, oncological, metabolic, neurological diseases, but also shared experiences related to acute health issues.ResultsParticipants described facilitators and barriers of PCC on the microlevel (eg, patient–provider interaction), mesolevel (eg, health and social care organisation, HSCO) and macrolevel (eg, laws, financing). In addition to previous concepts, interviewees illustrated the importance of being an active patient by taking individual responsibility for health. Interviewees considered functioning teams and healthy staff members a facilitator of PCC as this can compensate stressful situations or lack of staff to some degree. A lack of transparency in financing and reimbursement was identified as barrier to PCC.ConclusionIndividual providers and HSCOs can address many facilitators and barriers of PCC as perceived by patients. Large-scale changes such as reduction of administrative barriers, the expansion of care networks or higher mandatory nurse to patient ratios require political action and incentives.Trial registration numberDRKS00011925

This paper aimed to evaluate how transformational leadership behaviour is associated with patient safety culture in a hospital context. In line with findings from other high-hazard industries, we predicted that in hospitals, executives' perceived emphasis on transformational behaviour would positively influence the frequency of events reported by staff on the front line of service provision. Our hypothesis was confirmed by fitting a multivariable regression model to a sample of 507 medical directors of German acute-care hospitals. Results revealed transformational leadership in hospitals was a significant predictor of the reporting frequency of safety events, as perceived by medical directors. Our findings highlighted the critical role that executive behaviour plays in staff participation in patient safety initiatives. Preventing patients from unintended harm can then be traced back to the organisational level that is the farthest away from direct patient interaction. Consequently, these findings may provide guidance for hospitals aiming to raise employees' awareness of patient safety and prevent unintended patient harm prospectively.

Aim To explore leading nurses’ work values and their effect on the safety climate in neonatal intensive care units (NICUs). Background Despite their significance for behaviour, the work values of leading nurses are still insufficiently studied. We explore the impact of work value dimensions (self‐transcendence, self‐enhancement, conservation, and openness to change) on the safety climate. Methods A cross‐sectional study was conducted in 86 German NICUs between September 2015 and August 2016. Our analyses relate questionnaire data from 75 leading nurses to the shared perceptions regarding safety among their team members (n = 1,277). We used fractional response modelling to identify important work values. Results The analysis showed differences between the dimensions of work values and their association with the safety climate. A significant positive association was found between the work value dimension self‐transcendence (including the work values relationships with others and altruism) and safety climate (β = 0.255, p = .001). A large team size has a negative impact on the safety climate. Conclusion The findings indicate that the leading nurse's score on self‐transcendence is positively related to the safety climate. Implications for Nursing Management The results demonstrate that it might be useful to consider work values in the selection of nurse leaders.

IntroductionHealth and social care systems are under pressure to organise care around patients’ needs with constrained resources. Several studies reveal that care is constantly challenged by balancing economic requirements against individual patients’ preferences and needs. Therefore, value-based health and social care aims to facilitate patient-centredness while taking the resources spent into consideration. The OrgValue project examines the implementation of patient-centredness while considering the health and social care organisations’ resource orientation in the model region of the city of Cologne, Germany.Methods and analysisFirst, the implementation status of patient-centredness as well as its facilitators and barriers—also in terms of resource orientation—will be assessed through face-to-face interviews with decision-makers (at least n=18) from health and social care organisations (HSCOs) in Cologne. Second, patients’ understanding of patient-centredness and their preferences and needs will be revealed by conducting face-to-face interviews (at least n=15). Third, the qualitative results will provide the basis for a quantitative survey of decision-makers from all HSCOs in Cologne, which will include questions on patient-centredness, resource orientation and determinants of implementation. Fourth, qualitative interviews with decision-makers from different types of HSCOs will be conducted to develop a uniform measurement instrument on the cost and service structure of HSCOs.Ethics and disseminationFor all collected data, the relevant data protection regulations will be adhered to. Consultation and a positive vote from the ethics committee of the Medical Faculty of the University of Cologne have been obtained. All personal identifiers (eg, name, date of birth) will be pseudonymised. Dissemination strategies include a feedback report as well as research and development workshops for the organisations with the aim of initiating organisational learning and organisational development, presenting results in publications and at conferences, and public relations.Trial registration numberDRKS00011925.