Nurse Work Environment and Hospital-Onset Clostridioides difficile Infection

Jung, Olivia; Aiken, Linda H.; Sloane, Douglas M.; Fridkin, Scott K.; Yin, Li; Kang, Yu Jin; Becker, Edmund R.; Joski, Peter; Cimiotti, Jeannie P.

doi:10.1097/mlr.0000000000001854

Cited by 2 publications

(1 citation statement)

References 46 publications

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“… 1 Frontline engagement in such activities has been shown to improve quality of care and patient safety. 2 , 3 Engaging frontline workers to identify improvement opportunities may be particularly fruitful in federally qualified health centers (FQHCs) and similar safety-net settings, as large-scale, top-down transformation initiatives are often associated with declining morale and increasing burnout among frontline workers in these settings. 4 , 5 Thus, it is important to understand what frontline workers want to see changed to improve work environments and care delivery processes.…”

Section: Introductionmentioning

confidence: 99%

Ideas from the Frontline: Improvement Opportunities in Federally Qualified Health Centers

Jung,

Begum,

Dorbu

et al. 2023

J GEN INTERN MED

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Background Engaging frontline clinicians and staff in quality improvement is a promising bottom-up approach to transforming primary care practices. This may be especially true in federally qualified health centers (FQHCs) and similar safety-net settings where large-scale, top-down transformation efforts are often associated with declining worker morale and increasing burnout. Innovation contests, which decentralize problem-solving, can be used to involve frontline workers in idea generation and selection. Objective We aimed to describe the ideas that frontline clinicians and staff suggested via organizational innovation contests in a national sample of 54 FQHCs. Interventions Innovation contests solicited ideas for improving care from all frontline workers—regardless of professional expertise, job title, and organizational tenure and excluding those in senior management—and offered opportunities to vote on ideas. Participants A total of 1,417 frontline workers across all participating FQHCs generated 2,271 improvement opportunities. Approaches We performed a content analysis and organized the ideas into codes (e.g., standardization, workplace perks, new service, staff relationships, community development) and categories (e.g., operations, employees, patients). Key Results Ideas from frontline workers in participating FQHCs called attention to standardization (n = 386, 17%), staffing (n = 244, 11%), patient experience (n = 223, 10%), staff training (n = 145, 6%), workplace perks (n = 142, 6%), compensation (n = 101, 5%), new service (n = 92, 4%), management-staff relationships (n = 82, 4%), and others. Voting results suggested that staffing resources, standardization, and patient communication were key issues among workers. Conclusions Innovation contests generated numerous ideas for improvement from the frontline. It is likely that the issues described in this study have become even more salient today, as the COVID-19 pandemic has had devastating impacts on work environments and health/social needs of patients living in low-resourced communities. Continued work is needed to promote learning and information exchange about opportunities to improve and transform practices between policymakers, managers, and providers and staff at the frontlines.

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Section: Introductionmentioning

confidence: 99%

Ideas from the Frontline: Improvement Opportunities in Federally Qualified Health Centers

Jung,

Begum,

Dorbu

et al. 2023

J GEN INTERN MED

Self Cite

View full text Add to dashboard Cite

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Exploring the Relationship Between Hospital Patient Safety Culture and Performance on Measures of Hospital-Acquired Conditions

Noghrehchi,

Hefner,

Stegall

et al. 2024

J Patient Saf

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Objective The aim of the study is to examine the relationship between hospital perceptions of patient safety culture and the incidence of hospital-acquired conditions (HACs) included in Medicare’s HAC Reduction Program utilizing updated and standardized metrics. Methods The pooled cross-sectional study design utilized the 2018 and 2021 datasets from (1) the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture (HSOPS), (2) the American Hospital Association’s annual survey, and (3) the Center for Medicare and Medicaid’s Hospital Compare dataset. The final analytic sample included 131 acute care, nonfederal, U.S. facilities. Multivariable linear regression models were used to compare the HSOPS domains of patient safety culture to CMS’s HAC metrics. Results Controlling for hospital structural and patient-mix characteristics, hospitals with higher staff-reported ratings of overall patient safety culture (‘overall perceptions of patient safety’ and ‘patient safety grade’) had significantly lower rates of HACs, including total HAC rate, catheter-associated urinary tract infections, and central line-associated blood stream infections (P’s < 0.000–0.044). Higher HSOPS domain scores were variably associated with lower HAC rates, with consistently significant associations found for domains related to nonpunitive, open communication (P’s < 0.05). Conclusions Our relatively robust results suggest that while patient safety culture may not be the only strategy necessary to improve HAC rates, it needs to be aligned with other efforts to improve quality and safety. This underscores the importance of cultivating a culture of psychological safety that promotes open feedback and communication about errors.

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Nurse Work Environment and Hospital-Onset Clostridioides difficile Infection

Cited by 2 publications

References 46 publications

Ideas from the Frontline: Improvement Opportunities in Federally Qualified Health Centers

Ideas from the Frontline: Improvement Opportunities in Federally Qualified Health Centers

Exploring the Relationship Between Hospital Patient Safety Culture and Performance on Measures of Hospital-Acquired Conditions

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