Improving patient safety in two French hospitals: why teamwork training is not enough

Abstract

PurposeThe persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France.Design/methodology/approachData were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015–2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations.FindingsDespite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted “patient safety”, a paradoxical injunction to do more with less and conflicting organizational priorities.Originality/valueThis paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.

Enhancing capability for continuous organisational improvement and learning in healthcare organisations: a systematic review of the literature 2013–2022

“…The two studies that did not report an increase in COIL capability generally shared the same attributes as the interventions that did, for example, focusing on teamwork 31 and the use of a method such as the PDSA cycle. 32 Some exceptions were that the allocated resources were being decreased in the unsuccessful studies, that plans were made but not followed through, that priorities for the unit and organisation were not aligning with each other, that there were differing perceptions of the goal 31 and that there existed frustration which was noticed but not addressed. 32 In the study by Waring et al , 32 there was also a focus from management to overcome change fatigue and change the culture of the organisation, with initial promotional activities including a pledge campaign that was not evident in the other reports.…”

“…All studies except the ones by Petit dit Dariel et al 31 and Waring and Crompton 32 reported on improvements in COIL capability. Therefore, 34 articles were included in the data extraction and synthesis concerning attributes of interventions that were successful in increasing COIL capability, while attributes from the remaining two 31 32 were analysed separately. All studies were included in the data extraction and synthesis concerning factors that hinder or facilitate the interventions.…”

rpavirtual: Key lessons in healthcare organisational resilience in the time of COVID‐19

“…The infrastructure established was an integrated soci‐technical system suitable for a virtual care facility. 8 This included an executive team and clinical leadership with integrated corporate and clinical governance systems; a virtual nursing care centre; a flexible, scalable location and care model; and ehealth, medical record, videoconferencing and telephone systems. Collaboration work focussed on identifying opportunities with clinical specialties and primary care.…”

“…Hence, the initial emphasis was on developing necessary infrastructure and extensive consultation to inform the initial model of care. The infrastructure established was an integrated soci‐technical system suitable for a virtual care facility 8 . This included an executive team and clinical leadership with integrated corporate and clinical governance systems; a virtual nursing care centre; a flexible, scalable location and care model; and ehealth, medical record, videoconferencing and telephone systems.…”

Interprofessional Teamwork in Hospital Units: A human factors approach to patient safety

“…Hierarchical structures and professional cultures can act as barriers to change, rooted in the work system elements [204]. Team training programs are not always enough; well-trained frontline staff do not necessarily achieve long-term patient safety results without systemic organizational changes [205]. Hierarchy and silos can be seen as latent failures in the work system.…”