Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit

McCulloch, Peter; Kreckler, Simon; New, Steve; Sheena, Yezen; Handa, Ashok; Catchpole, Ken

doi:10.1136/bmj.c5469

Cited by 59 publications

(54 citation statements)

References 41 publications

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“…T h e g re ate s t s u c c e s s e s are usually achieved by involving physicians, nurses, and o t h e r p r a c t it i o n e r s i n t h e p r o c e s s o f d e ve l o p i ng improvements 15,16 and by designing systems around human needs. 1 7 This person-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems.…”

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confidence: 99%

A Human Factors Subsystems Approach to Trauma Care

et al. 2014

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A Human Factors Subsystems Approach to Trauma Care

et al. 2014

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“…3,4,16,18,19 When only some providers receive a quality improvement intervention, or receive it at different times, longitudinal data methods, such as fixed-effects regressions, can be used instead. 8 With the development of the longitudinal National Neurosurgery Quality and Outcomes Database (N 2 QOD, www.neuropoint.org) and other outcomes data sets, the scope for application of these methods to analyze effects of neurosurgery quality improvement initiatives will only increase.…”

Section: Discussionmentioning

confidence: 99%

Interrupted time-series analysis: studying trends in neurosurgery

Wong

Smieliauskas

Pan

et al. 2015

FOC

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OBJECT Neurosurgery studies traditionally have evaluated the effects of interventions on health care outcomes by studying overall changes in measured outcomes over time. Yet, this type of linear analysis is limited due to lack of consideration of the trend’s effects both pre- and postintervention and the potential for confounding influences. The aim of this study was to illustrate interrupted time-series analysis (ITSA) as applied to an example in the neurosurgical literature and highlight ITSA’s potential for future applications. METHODS The methods used in previous neurosurgical studies were analyzed and then compared with the methodology of ITSA. RESULTS The ITSA method was identified in the neurosurgical literature as an important technique for isolating the effect of an intervention (such as a policy change or a quality and safety initiative) on a health outcome independent of other factors driving trends in the outcome. The authors determined that ITSA allows for analysis of the intervention’s immediate impact on outcome level and on subsequent trends and enables a more careful measure of the causal effects of interventions on health care outcomes. CONCLUSIONS ITSA represents a significant improvement over traditional observational study designs in quantifying the impact of an intervention. ITSA is a useful statistical procedure to understand, consider, and implement as the field of neurosurgery evolves in sophistication in big-data analytics, economics, and health services research.

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“…The effects of redesign have been studied in various research papers [6,7]. These papers frequently report improvements in the timely delivery of services.…”

Section: Introductionmentioning

confidence: 99%

Redesigning mental healthcare delivery: is there an effect on organizational climate?

Joosten

Bongers

Janssen

2013

International Journal for Quality in Health Care

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Objective. Many studies have investigated the effect of redesign on operational performance; fewer studies have evaluated the effects on employees' perceptions of their working environment (organizational climate). Some authors state that redesign will lead to poorer organizational climate, while others state the opposite. The goal of this study was to empirically investigate this relation.Design. Organizational climate was measured in a field experiment, before and after a redesign intervention. At one of the sites, a redesign project was conducted. At the other site, no redesign efforts took place.Setting. Two Dutch child-and adolescent-mental healthcare providers.Participants. Professionals that worked at one of the units at the start and/or the end of the intervention period. Intervention(s). The main intervention was a redesign project aimed at improving timely delivery of services (modeled after the breakthrough series).Main outcome measures. Scores on the four models of the organizational climate measure, a validated questionnaire that measures organizational climate.Results. Our analysis showed that climate at the intervention site changed on factors related to productivity and goal achievement (rational goal model). The intervention group scored worse than the comparison group on the part of the questionnaire that focuses on sociotechnical elements of organizational climate. However, observed differences were so small, that their practical relevance seems rather limited.Conclusions. Redesign efforts in healthcare, so it seems, do not influence organizational climate as much as expected.

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Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit

Cited by 59 publications

References 41 publications

A Human Factors Subsystems Approach to Trauma Care

A Human Factors Subsystems Approach to Trauma Care

Interrupted time-series analysis: studying trends in neurosurgery

Redesigning mental healthcare delivery: is there an effect on organizational climate?

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