Improving patient safety: the comparative views of patient-safety specialists, workforce staff and managers

Braithwaite, Jeffrey; Westbrook, Mary T.; Robinson, Maureen; Michael, Sarah; Pirone, Christy; Robinson, Philip

doi:10.1136/bmjqs.2010.047605

Cited by 26 publications

(31 citation statements)

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“…There is now a strong body of literature establishing that senior managers in acute care health services have responsibility for, and play a pivotal role in, ensuring the success of quality and safety programs [16][17][18][19]. This study addressed a gap in the literature by exploring the views of senior managers on current and future strategies to improve hand hygiene compliance.…”

Section: Discussionmentioning

confidence: 99%

“…The health care system is complex and multidisciplinary, comprising senior executive personnel, clinicians, technical, support/service staff and administrators. Senior hospital managers are those clinical and nonclinical staff with delineated formal responsibility for administrating health care services and divisions, are involved in executive decision-making regarding budgets and staffing, and have responsibility for dealing with the outcomes of adverse events and for implementing systems level change [16][17][18]. As senior health care managers play an important role in patient safety and having input into the design and operationalization of quality improvement programs they can offer a unique perspective on how to improve areas of practice with which healthcare organizations are often struggling to improve [19].…”

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confidence: 99%

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A qualitative study of senior hospital managers¿ views on current and innovative strategies to improve hand hygiene

et al. 2014

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Background: Despite universal recognition of the importance of hand hygiene in reducing the incidence of healthcare associated infections, health care workers' compliance with best practice has been sub-optimal. Senior hospital managers have responsibilities for implementing patient safety initiatives and are therefore ideally placed to provide suggestions for improving strategies to increase hand hygiene compliance. This is an under-researched area, accordingly the aim of this study was to identify senior hospital managers' views on current and innovative strategies to improve hand hygiene compliance. Methods: Qualitative design comprising face-to-face interviews with thirteen purposively sampled senior managers at a major teaching and referral hospital in Sydney, Australia. Data were analysed thematically. Results: Seven themes emerged: culture change starts with leaders, refresh and renew the message, connect the five moments to the whole patient journey, actionable audit results, empower patients, reconceptualising non-compliance and start using the hammer. Conclusions: To strengthen hand hygiene programmes, strategies based on the five moments of hand hygiene should be tailored to specific roles and settings and take into account the whole patient journey including patient interactions with clinical and non-clinical staff. Senior clinical and non-clinical leaders should visibly champion and mandate best practice initiatives and articulate that hand hygiene non-compliance is culturally and professionally unacceptable to the organization. Strategies that included a disciplinary component and which conceptualise hand hygiene non-compliance as a patient safety error may be worth evaluating in terms of staff acceptability and effectiveness.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A qualitative study of senior hospital managers¿ views on current and innovative strategies to improve hand hygiene

et al. 2014

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“…Differences in the stories and narratives15 of professionals can serve to highlight differences in the conceptualisation and language used by different groups. This in turn can provide insights into both why ‘generic’ improvement strategies fail to engage specific groups of professionals16 17 and why interprofessional practice has proven difficult to achieve. In effective interprofessional practice, a shared sense of context is essential if risk is to be viewed as a form of collective responsibility 18…”

Section: Introductionmentioning

confidence: 99%

“…Based on our previous research into differences in perspectives of professional groups, we hypothesised that the language used by various professions to describe quality and safety within their organisation would reflect these ‘preassembled parts.’17 22 That is, discernible differences would be evident across groups, reflecting underlying differences in their roles, values and primary concerns. We were interested in including the perspectives of the administrative staff: this group remains under-researched as participants in the patient safety agenda, outside care providers 23…”

Section: Introductionmentioning

confidence: 99%

Visualising differences in professionals' perspectives on quality and safety

et al. 2012

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“…28,146,302 Overall, as noted by Shekelle et al, 223 many previous applications of realist inquiry have failed to agree on what elements of context are most influential and how context should be conceptualised. 27,303,304 We have tried to avoid this problem by using a multilevel approach to this issue (see Context: structural conditioning).…”

Section: Contextmentioning

confidence: 98%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Improving patient safety: the comparative views of patient-safety specialists, workforce staff and managers

Abstract: Differences between safety specialists' and workforce groups' beliefs about how to improve patient safety may impede the successful implementation of patient-safety programmes.

Cited by 26 publications

References 5 publications

A qualitative study of senior hospital managers¿ views on current and innovative strategies to improve hand hygiene

A qualitative study of senior hospital managers¿ views on current and innovative strategies to improve hand hygiene

Visualising differences in professionals' perspectives on quality and safety

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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