The Association of Organizational Culture and Quality Improvement Implementation With Neonatal Outcomes in the NICU

Mahl, Sukhy K.; Lee, Shoo K.; Baker, G. Ross; Cronin, Catherine; Stevens, Bonnie; Ye, Xiang Y.

doi:10.1016/j.pedhc.2015.01.011

Cited by 34 publications

(12 citation statements)

References 26 publications

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“…For example, higher scores on group culture measures, that is those that emphasised teamwork, cohesiveness and participation, were associated with significantly lower rates of survival without major morbidity, whereas in one study, higher scores on hierarchical culture measures were associated with higher rates of survival without major morbidity. 66 ‘Mixed’ refers to both positive and negative associations presented in the one paper. A study reported that intensive care units in which nurses perceived the culture as positive had higher rates of central line-associated bloodstream infections, but were 39% less likely to develop a catheter-associated urinary tract infection.…”

Section: Resultsmentioning

confidence: 99%

Association between organisational and workplace cultures, and patient outcomes: systematic review

et al. 2017

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Design and objectivesEvery organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes.SettingA variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts.ParticipantsThe articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review.Primary and secondary outcome measuresPatient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience.ResultsThe search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction.ConclusionsSynthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.

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Section: Resultsmentioning

confidence: 99%

Association between organisational and workplace cultures, and patient outcomes: systematic review

et al. 2017

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“…The correlation between ethics consultation and quality of care provided is also the result of a US survey among neonatologists (Weiss et al 2007 ). A similar point is also supported by a Canadian survey that suggests that organizational culture has an impact on the improvement of quality of care at a NICU (Mahl 2015 ). Since ethics support may improve the organizational culture through making the ethical tension points become transparent and to some extent solved within the teams, it may indirectly improve the service delivered.…”

Section: Professional Ethicsmentioning

confidence: 60%

“…Since ethics support may improve the organizational culture through making the ethical tension points become transparent and to some extent solved within the teams, it may indirectly improve the service delivered. The survey concludes that group oriented culture leads to better outcomes, however particularly in Canadian NICUs, hierarchical culture is associated with even better patient outcomes (Mahl 2015 ). For that reason, ethics consultations from the outside, but also the need of team buildings for NICU professionals within teams, are necessary to support the team cohesion for the sake of improved decisions.…”

Section: Professional Ethicsmentioning

confidence: 99%

Professional ethics: the case of neonatology

Stanak

2018

Med Health Care and Philos

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Neonatal professionals encounter many ethical challenges especially when it comes to interventions at the limit of viability (weeks 22-25 of gestation). At times, these challenges make the moral dilemmas in neonatology tragic and they require a particular set of intellectual and moral virtues. Intellectual virtues of episteme and phronesis, together with moral virtues of courage, compassion, keeping fidelity to trust, and integrity were highlighted as key virtues of the neonatal professional. Recognition of the role of ethics requires a recognition that answering the obvious question (what shall we do?) does not always suffice. Acknowledging the tragic question (is any of the alternatives open to us free from serious moral wrongdoing) and recognizing the ethical dilemmas, where the lines between right and wrong are blurred, leads to actions taken towards establishing ethics frameworks to support decision-making. In neonatology units, such organizational support can help in allowing the team members to recognize the ethical dilemmas, avoid moral distress, and improve team cohesion and the quality of care provided. Only when the organizational structure allows ethical dilemmas to be recognized, adequate decisions can be made.

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“…Strategies for implementing potentially better practices varied and units identified their barriers to implementation, developed tools for improvement, and subsequently shared their experience. This approach of collaborative quality improvement techniques enhanced local quality improvement efforts and resulted in effective implementation of potentially better practices in all centers [65, 66]. Research to further improve the knowledge on pain management is obviously also needed.…”

Section: Developmental Pharmacology Of Analgesics In Neonates: a Movimentioning

confidence: 99%

Neonatal pain management: still in search for the Holy Grail

Allegaert

Anker

2016

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Inadequate pain management but also inappropriate use of analgesics in early infancy has negative effects on neurodevelopmental outcome. As a consequence, neonatal pain management is still in search for the Holy Grail. At best, effective pain management is based on prevention, assessment, and treatment followed by a re-assessment of the pain to determine if additional treatment is still necessary. Unfortunately, epidemiological observations suggest that neonates are undergoing painful procedures very frequently, unveiling the need for effective preventive, non-pharmacological strategies. In addition, assessment is still based on validated, multimodal, but subjective pain assessment tools. Finally, in neonatal intensive care units, there is a shift in clinical practices (e.g., shorter intubation and ventilation), and this necessitates the development and validation of new pharmacological treatment modalities. To illustrate this, a shift in the use of opioids to paracetamol has occurred and short-acting agents (remifentanil, propofol) are more commonly administered to neonates. In addition to these new modalities and as part of a more advanced approach of the developmental pharmacology of analgesics, pharmacogenetics also emerged as a tool for precision medicine in neonates. To assure further improvement of neonatal pain management the integration of pharmacogenetics with the usual covariates like weight, age and/or disease characteristics is needed.

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The Association of Organizational Culture and Quality Improvement Implementation With Neonatal Outcomes in the NICU

Cited by 34 publications

References 26 publications

Association between organisational and workplace cultures, and patient outcomes: systematic review

Association between organisational and workplace cultures, and patient outcomes: systematic review

Professional ethics: the case of neonatology

Neonatal pain management: still in search for the Holy Grail

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