Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety

Vincent, Charles; Burnett, Susan; Carthey, Jane

doi:10.1136/bmjqs-2013-002757

Cited by 199 publications

(298 citation statements)

References 14 publications

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“…[5][6][7][8] There are several sources from which hospital boards can gather quality and safety information, for example safety walk-arounds, patient safety indicators, incident reports, infection rates, patient satisfaction surveys, risk registers and adverse events meetings. [9,10] In almost every Dutch hospital, boards use information deriving from internal audits. [11] The Dutch internal audit system is an "objective assurance and consulting system for detecting patients' risks of adverse events early, and it should encourage the continuous improvement of patient safety".…”

Section: Introductionmentioning

confidence: 99%

Optimal governance of patient safety: A qualitative study on barriers to and facilitators for effective internal audit

Gelderen

Hesselink

Westert

et al. 2017

JHA

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Objective: While internal audits are widely used, insight into the essential components of the internal audit to govern patient safety is limited. The aim of this study is to explore factors that hinder and stimulate internal audits as an effective patient safety governance tool for hospital boards. Methods: A qualitative interview study in six Dutch hospitals. Interviews (n = 43) were held with auditees, quality officers, boards of directors and boards of supervisors. Data were collected and analysed using Grounded Theory. Results: Barriers and facilitators were classified into 14 categories from which four themes emerged: (1) board positioning of audits, (2) organisation and content of audits, (3) competences and composition of audit team, and (4) cultural factors and attitudes towards auditing. Conclusions: We found two themes consisting of factors related to the audit itself (organisation and content of audits, and competences and composition of audit team) and two themes consisting of contextual factors (board positioning of audits, and cultural factors and attitudes towards auditing). These may contribute to support for auditing and to the generation of reliable audit results, which subsequently could result in effective audits for governance of patient safety. Hospital boards and executives can optimise the patient safety auditing system in their hospitals by increasing active leadership engagement, by promoting audits as an opportunity for staff to learn from safety problems (rather than a mandatory examination instrument) and by providing vital resources for a smooth audit process, such as a medical specialist in the audit team.

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Section: Introductionmentioning

confidence: 99%

Optimal governance of patient safety: A qualitative study on barriers to and facilitators for effective internal audit

Gelderen

Hesselink

Westert

et al. 2017

JHA

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“…That said, few authors talk in any detail about data or information systems. 8,9 The 2013 report by Donald Berwick, the respected US physician, is one of the exceptions to the general rule. He identified a range of routine data that ward staff -and wider clinical teams -needed to investigate unwarranted variations in services and to support service improvement ( Table 1).…”

Section: High-quality Datamentioning

confidence: 99%

Quality and safety between ward and board: a biography of artefacts study

Keen

Nicklin

Long

et al. 2018

Health Serv Deliv Res

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BackgroundThere have been concerns about the quality and safety of NHS hospital services since the turn of the millennium. This study investigated the progress that acute NHS hospital trusts have made in developing and using technology infrastructures to enable them to monitor quality and safety following the publication in 2013 of the second Francis report on the scandal at Mid Staffordshire NHS Foundation Trust (The Mid Staffordshire NHS Foundation Trust Public Inquiry. Chaired by Sir Robert Francis QC.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. HC 898. London: The Stationery Office; 2013).MethodsA telephone survey of 15 acute NHS trusts in the Yorkshire and the Humber region, and a review of board papers of all acute NHS trusts in England for January 2015, were undertaken. The telephone survey was used to identify trusts for a larger field study, which was undertaken in four acute NHS trusts between April 2015 and September 2016. The methods included the direct observation of the use of whiteboards and other technologies on two wards in each trust, an observation of board quality committees, semistructured interviews and an analysis of the quality and safety data in board papers. Published sources about national and local agencies were reviewed to identify the trust quality and safety data that these agencies accessed and used. An interview programme was also undertaken with those organisations. The Biography of Artefacts approach was used to analyse the data.FindingsThe data and technology infrastructures within trusts had developed over many years. The overall design had been substantially determined by national agencies, and was geared to data processing: capturing and validating data for submission to national agencies. Trust boards had taken advantage of these data and used them to provide assurance about quality and safety. Less positively, the infrastructures were fragmented, with different technologies used to handle different quality and safety data. Real-time management systems on wards, including electronic whiteboards and mobile devices, were used and valued by nurses and other staff. The systems support the proactive management of clinical risks. These developments have occurred within a broad context, with trusts focusing on improving the quality and safety of services and publishing far more data on their performance than they did just 3 years earlier. Trust-level data suggest that quality and safety improved at all four trusts between 2013 and 2016. Our findings indicate that the technology infrastructures contributed to these improvements. There remains considerable scope to rationalise those infrastructures.LimitationsThe four trusts in the main study were, in part, purposively selected, and deliberately biased towards sites that had made progress with designing and deploying real-time ward management systems. This limits the generalisability of the study. The study focused more on the work of nurses and nurse managers, and has relatively little to say about the experiences of doctors or allied health professionals.Future workFuture research might focus on the effects of mobile technologies and electronic whiteboards on acute wards, the value of current national data returns, and the uses and value of trust data warehouses.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…[3] To improve patient safety, detection and risk analysis should lead to the development of preventive strategies. [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…by pursuing specific guidelines), new strategies could be applied to minimize the negative impact of human factors on patient safety. [4,5] In this context, simulation provides skills and experience in solving specific situations included in a realistic scenario, facilitating the transfer of cognitive, psychomotor and affective capacity within daily clinical practice (in practice, proper communication within the team), thus helping to improve behavior in critical situations. [6,7] Simulation in anesthesia and intensive care (AIC) is a practical method to provide a kind of educational realistic significance for practicing anesthesiologists in order to improve the quality of care and patient safety.…”

Section: Introductionmentioning

confidence: 99%

Role of advanced simulation in undergraduate and postgraduate medical education

Fodale¹,

Penna²,

Amato³

et al. 2015

Int Arch Med

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Medical simulations are effective education complements for medical training, demonstrating effective learning, level of participation, and improvement in knowledge, skills and attitudes.In undergraduate medical education, simulation provides the potential for valid, cost-benefit teaching and assessment of clinical skills, especially clinical reasoning skills, bridging the gap between theory and practice. Simulation as a training tool in postgraduate medical training is a practical method to provide a kind of educational realistic significance for practicing specialty in order to improve quality of care and patient safety. In particular, simulation is an excellent opportunity to implement reports of security which can be considered a true strategy in order to minimize clinical risk and ensure appropriate levels of quality in daily clinical practice.

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Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety

Cited by 199 publications

References 14 publications

Optimal governance of patient safety: A qualitative study on barriers to and facilitators for effective internal audit

Optimal governance of patient safety: A qualitative study on barriers to and facilitators for effective internal audit

Quality and safety between ward and board: a biography of artefacts study

Role of advanced simulation in undergraduate and postgraduate medical education

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