scholarly journals Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Laura Lamming ◽  
Jane Montague ◽  
Kate Crosswaite ◽  
Muhammad Faisal ◽  
Eileen McDonach ◽  
...  
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Control Charts ◽  
Safety Climate ◽  
Scale Up ◽  
Statistical Process ◽  
Frontline Staff ◽  
Statistical Process Control Charts ◽  
Role Based ◽  
The Impact

Abstract Background The Patient Safety Huddle (PSH) is a brief multidisciplinary daily meeting held to discuss threats to patient safety and actions to mitigate risk. Despite growing interest and application of huddles as a mechanism for improving safety, evidence of their impact remains limited. There is also variation in how huddles are conceived and implemented with insufficient focus on their fidelity (the extent to which delivered as planned) and potential ways in which they might influence outcomes. The Huddle Up for Safer Healthcare (HUSH) project attempted to scale up the implementation of patient safety huddles (PSHs) in five hospitals – 92 wards - across three UK NHS Trusts. This paper aims to assess their fidelity, time to embed, and impact on teamwork and safety culture. Methods A multi-method Developmental Evaluation was conducted. The Stages of Implementation Checklist (SIC) was used to determine time taken to embed PSHs. Observations were used to check embedded status and fidelity of PSH. A Teamwork and Safety Climate survey (TSC) was administered at two time-points: pre- and post-embedding. Changes in TSC scores were calculated for Trusts, job role and clinical speciality. Results Observations confirmed PSHs were embedded in 64 wards. Mean fidelity score was 4.9/9. PSHs frequently demonstrated a ‘fear free’ space while Statistical Process Control charts and historical harms were routinely omitted. Analysis showed a positive change for the majority (26/27) of TSC questions and the overall safety grade of the ward. Conclusions PSHs are feasible and effective for improving teamwork and safety culture, especially for nurses. PSH fidelity criteria may need adjusting to include factors deemed most useful by frontline staff. Future work should examine inter-disciplinary and role-based differences in TSC outcomes.

scholarly journals Fidelity and the Impact of Patient Safety Huddles on Teamwork and Safety Culture: An Evaluation of the Huddle Up for Safer Healthcare (HUSH) Project

2021 ◽  
Author(s):  
Laura Lamming ◽  
Kate Crosswaite ◽  
Muhammad Faisal ◽  
Eileen McDonach ◽  
Jane Montague ◽  
...  
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Safety Climate ◽  
Scale Up ◽  
Statistical Process ◽  
Frontline Staff ◽  
Role Based ◽  
Job Role ◽  
Future Work ◽  
The Impact

Abstract Background: The Patient Safety Huddle (PSH) is a brief multidisciplinary daily meeting held to discuss patient safety and action to mitigate risk. Despite growing interest and application of huddles as a mechanism for improving safety, evidence of their impact remains limited. There is also variation in how huddles are conceived and implemented with little focus on their fidelity (the extent to which delivered as planned) and potential ways in which they might influence outcomes. The Huddle Up for Safer Healthcare (HUSH) project attempted to scale up the implementation of patient safety huddles in five hospitals – 92 wards - across three UK NHS Trusts. This paper aims to assess their fidelity, time to embed, and impact on teamwork and safety culture. Methods: A multi-method Developmental Evaluation was conducted. The Stages of Implementation Checklist (SIC) was used to determine time taken to embed PSHs. Observations confirmed embedded status and fidelity of PSH. A Teamwork and Safety Climate survey (TSC) was administered at two time-points: pre- and post-embedding. Changes in TSC scores were calculated for Trusts, job role and clinical speciality.Results: Observations confirmed Patient Safety Huddles were embedded in 64 wards. Mean fidelity score was 4.9/9. PSHs frequently demonstrated a ‘fear free’ space while Statistical Process Control (SPC) charts and historical harms were routinely neglected. Analysis showed a positive change for the majority of TSC questions and the overall safety grade of the ward.Conclusions: PSHs are feasible and effective for improving teamwork and safety culture, especially for nurses. PSH fidelity criteria may need adjusting to include factors deemed most useful by frontline staff. Future work should examine inter-disciplinary and role-based differences in TSC outcomes.

Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

2021 ◽  
pp. 019459982110133
Author(s):  
Ellen S. Deutsch ◽  
Sonya Malekzadeh ◽  
Cecelia E. Schmalbach
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Control Charts ◽  
Neck Surgery ◽  
Resident Training ◽  
Statistical Process ◽  
Ensure Patient Safety ◽  
Statistical Process Control Charts ◽  
The Individual ◽  
The Impact

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

scholarly journals Using safety culture results to guide the merger of four general practices in the UK

2020 ◽  
Vol 9 (1) ◽  
pp. e000860
Author(s):  
Alistair Martin Lockwood ◽  
Joshua Proulx ◽  
Matthew Hill ◽  
Joanna Pendray
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Safety Climate ◽  
Transition Process ◽  
Accurate Identification ◽  
Burn Out ◽  
General Improvement ◽  
The Uk ◽  
The Impact ◽  
Gp Model

BackgroundThe rapid merger in a crisis of three GP practices to incorporate the patients from a neighbouring closing surgery, led to the redesign of primary care provision. A deliberate focus on patient safety and staff engagement was maintained throughout this challenging transition to working at scale in an innovative, integrated and collaborative GP model.Method3 cycles of a staff culture tool (Safety, Communication, Organizational Reliability, Physician & Employee burn-out and Engagement) were performed at intervals of 9–12 months with structured feedback and engagement with staff after each round. The impact of different styles of feedback, the effect of specific interventions, and overall changes in safety climate and culture domains were observed in detail throughout this time period.ResultsStrong themes demonstrated were that: there was a general improvement in all culture domains; specific focus on teams that expressed they were struggling created the most effective outcomes; an initial lack of trust of the management structure improved; adapting and tailoring the styles of feedback was most efficacious; and burn-out scores dropped progressively. A unique observation of the rate at which different modalities of safety climate and culture change with time is demonstrated.ConclusionWith limited time, resources and energy, especially at times of crisis or change, the rapid and accurate identification of which domains of ‘culture’ and which teams required the most input at each stage of the journey is invaluable. Using this tool and prioritising patient safety, enables rapid and effective positive change to the culture and shape of expanding practices. It affirms that new models of working at scale in GP can be positively embraced with improvements in safety culture, if this is deliberately focused on and included in the transition process.

scholarly journals Importance of safety climate, teamwork climate and demographics: understanding nurses, allied health professionals and clerical staff perceptions of patient safety

2018 ◽  
Vol 7 (4) ◽  
pp. e000433
Author(s):  
Shahram Zaheer ◽  
Liane R Ginsburg ◽  
Hannah J Wong ◽  
Kelly Thomson ◽  
Lorna Bain
Keyword(s):  
Patient Safety ◽  
Health Professionals ◽  
Allied Health ◽  
Safety Climate ◽  
Outcome Variable ◽  
Senior Leadership ◽  
Staff Perceptions ◽  
Allied Health Professionals ◽  
Leadership Support ◽  
The Impact

BackgroundThere is growing evidence regarding the importance of contextual factors for patient/staff outcomes and the likelihood of successfully implementing safety improvement interventions such as checklists; however, certain literature gaps still remain—for example, lack of research examining the interactive effects of safety constructs on outcomes. This study has addressed some of these gaps, together with adding to our understanding of how context influences safety.PurposeThe impact of staff perceptions of safety climate (ie, senior and supervisory leadership support for safety) and teamwork climate on a self-reported safety outcome (ie, overall perceptions of patient safety (PS)) were examined at a hospital in Southern Ontario.MethodsCross-sectional survey data were collected from nurses, allied health professionals and unit clerks working on intensive care, general medicine, mental health or emergency department.ResultsHierarchical regression analyses showed that perceptions of senior leadership (p<0.001) and teamwork (p<0.001) were significantly associated with overall perceptions of PS. A non-significant association was found between perceptions of supervisory leadership and the outcome variable. However, when staff perceived poorer senior leadership support for safety, the positive effect of supervisory leadership on overall perceptions of PS became significantly stronger (p<0.05).Practice implicationsOur results suggest that leadership support at one level (ie, supervisory) can substitute for the absence of leadership support for safety at another level (ie, senior level). While healthcare organisations should recruit into leadership roles and retain individuals who prioritise safety and possess adequate relational competencies, the field would now benefit from evidence regarding how to build leadership support for PS. Also, it is important to provide on-site workshops on topics (eg, conflict management) that can strengthen working relationships across professional and unit boundaries.

scholarly journals The Impact of Patient Safety Climate on Medical Errors in a Sample of Nurses: Creating Safer Health Care.

Health Scope ◽  
2013 ◽  
Vol 1 (4) ◽  
Author(s):  
Seyed Bagher Mortazavi ◽  
Morteza Oostakhan ◽  
Amirabbas Mofidi ◽  
Aliakbar Babaei
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Medical Errors ◽  
Safety Climate ◽  
Patient Safety Climate ◽  
The Impact

Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Olivia Ostrow ◽  
Deena Savlov ◽  
Susan E. Richardson ◽  
Jeremy N. Friedman
Keyword(s):  
Control Charts ◽  
Respiratory Infections ◽  
Audit And Feedback ◽  
Improvement Strategy ◽  
Statistical Process ◽  
Process Control Charts ◽  
Statistical Process Control Charts ◽  
Viral Testing ◽  
Return Visits ◽  
Viral Respiratory Infections

BACKGROUND AND OBJECTIVES: Viral respiratory infections are common in children, and practice guidelines do not recommend routine testing for typical viral illnesses. Despite results often not impacting care, nasopharyngeal swabs for viral testing are frequently performed and are an uncomfortable procedure. The aim of this initiative was to decrease unnecessary respiratory viral testing (RVT) in the emergency department (ED) and the pediatric medicine wards (PMWs) by 50% and 25%, respectively, over 36 months. METHODS: An expert panel reviewed published guidelines and appropriate evidence to formulate an RVT pathway using plan-do-study-act cycles. A multifaceted improvement strategy was developed that included implementing 2 newer, more effective tests when testing was deemed necessary; electronic order modifications with force functions; audit and feedback; and education. By using statistical process control charts, the outcomes analyzed were the percentage of RVT ordered in the ED and the rate of RVT ordered on the PMWs. Balancing measures included return visits leading to admission and inpatient viral nosocomial outbreaks. RESULTS: The RVT rate decreased from a mean of 3.0% to 0.5% of ED visits and from 44.3 to 30.1 per 1000 patient days on the PMWs and was sustained throughout the study. Even when accounting for the new rapid influenza test available in the ED, a 50% decrease in overall ED RVT was still achieved without any significant impact on return visits leading to admission or inpatient nosocomial infections. CONCLUSIONS: Through implementation of a standardized, electronically integrated RVT pathway, a decrease in unnecessary RVT was successfully achieved. Audit and feedback, reminders, and biannual education all supported long-term sustainability of this initiative.

Statistical Tests of Type I Error

2021 ◽  
pp. 90-120
Author(s):  
Charles Auerbach
Keyword(s):  
Control Charts ◽  
Sampling Error ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Data Sets ◽  
Chi Square ◽  
Statistical Process ◽  
Incorrect Decision ◽  
Type 1 Error ◽  
Statistical Process Control Charts

This chapter covers tests of statistical significance that can be used to compare data across phases. These are used to determine whether observed outcomes are likely the result of an intervention or, more likely, the result of sampling error or chance. The purpose of a statistical test is to determine how likely it is that the analyst is making an incorrect decision by rejecting the null hypothesis, that there is no difference between compared phases, and accepting the alternative one, that true differences exist. A number of tests of significance are presented in this chapter: statistical process control charts (SPCs), proportion/frequency, chi-square, the conservative dual criteria (CDC), robust conservative dual criteria (RCDC), the t test, and analysis of variance (ANOVA). How and when to use each of these are also discussed, and examples are provided to illustrate each. The method for transforming autocorrelated data and merging data sets is discussed further in the context of utilizing transformed data sets to test of Type 1 error.

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