The balance between professional autonomy and organizational obligations in resilient management of specialized health care: A Norwegian document study

BACKGROUND: Adverse events in hospitals may jeopardize the safety of patients. Failure in professional autonomy, organizational learning or in the contact between these two factors may explain the occurrence of injurious incidents in hospitals. OBJECTIVE: To study reasons for failure in contact between professional autonomy and organizational learning in resilient management of specialized health care through document analysis. METHODS: A total of 20 reports from the Norwegian Board of Health Supervision were evaluated by a retrospective in-depth document analysis. In the analysis of adverse events, we applied the Braut model to identify function or failure of 1. Professional autonomy, 2. Organizational learning and 3. Contact between professional autonomy and organizational learning. RESULTS: Multivariable regression analysis showed that ‘Failure in organizational learning’ was the only explanatory variable for ‘Failure in contact between doctors and nurses’ autonomy and organizational learning’. ‘Failure in organizational learning’ had the strongest effect on ‘Failure in contact between doctors and nurse’s autonomy and organizational learning’ (B = 1.69; 95% CI = 0.45 to 2.92). ‘Failure in professional autonomy’ showed no significant effect on this contact. CONCLUSIONS: ‘Failure in organizational learning’ is associated with ‘Failure in contact between professional autonomy and organizational learning’. ‘Failure in professional autonomy’ did not influence this contact.

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Leadership assumptions on implementation of patient involvement methods

BMC Health Services Research ◽

10.1186/s12913-021-06497-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kathrine Håland Jeppesen ◽

Kirsten Frederiksen ◽

Marianne Johansson Joergensen ◽

Kirsten Beedholm

Keyword(s):

Health Care ◽

Organizational Learning ◽

Health Care Professionals ◽

Large Scale ◽

Patient Involvement ◽

Hospital Setting ◽

Implementation Process ◽

University Hospital ◽

Structured Interviews ◽

Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

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The survival of patients admitted because of health-care-related adverse events is similar to that after admission for other reasons

European Journal of Internal Medicine ◽

10.1016/j.ejim.2015.01.003 ◽

2015 ◽

Vol 26 (2) ◽

pp. 146-147

Author(s):

Fabienne J.H. Magdelijns ◽

L. Schepers ◽

E. Pijpers ◽

C.D.A. Stehouwer ◽

P.M. Stassen

Keyword(s):

Health Care ◽

Adverse Events

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Development of the perceptions of preventable adverse events assessment tool (PPAEAT): measurement properties and patients’ mental health status

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab063 ◽

2021 ◽

Vol 33 (2) ◽

Author(s):

Franziska Maria Keller ◽

Christina Derksen ◽

Lukas Kötting ◽

Martina Schmiedhofer ◽

Sonia Lippke

Keyword(s):

Mental Health ◽

Health Care ◽

Patient Safety ◽

Primary Health Care ◽

Adverse Events ◽

Health Care Professionals ◽

Discriminant Validity ◽

Assessment Tool ◽

Primary Health ◽

Item Scale

Abstract Background Patient-centered care and patient involvement have been increasingly recognized as crucial elements of patient safety. However, patient safety has rarely been evaluated from the patient perspective with a quantitative approach aiming at making patient safety and preventable adverse events measurable. Objectives The objectives of this study were to develop and evaluate the psychometric properties of a questionnaire assessing patient safety by perceived triggers of preventable adverse events among patients in primary health-care settings while considering mental health. Methods Two hundred and ten participants were recruited through various digital and print channels and asked to complete an online survey between November 2019 and April 2020. Exploratory factor analysis was performed to identify domains of triggers of preventable adverse events affecting patient safety. Furthermore, a multi-trait scaling analysis was performed to evaluate internal reliability as well as item-scale convergent–discriminant validity. A multivariate analysis of covariance evaluated whether individuals below and above the symptom threshold for depression and generalized anxiety perceive triggers of preventable adverse events differently. Results The five factors determined were information and communication with patients, time constraints of health-care professionals, diagnosis and treatment, hygiene and communication among health-care professionals, and knowledge and operational procedures. The questionnaire demonstrated a good total and subscale internal consistency (α = 0.90, range = 0.75–0.88), good item-scale convergent validity with significant correlations between 0.57 and 0.78 (P < 0.05; P < 0.01) for all items with their associated subscales, and satisfactory item-scale discriminant validity between 0.14 and 0.55 (P > 0.05) with no significant correlations between the items and their competing subscales. The questionnaire further revealed to be a generic measure irrespective of patients’ mental health status. Patients older than 50 years of age perceived a significantly greater threat to their own safety compared to patients below that age. Conclusion The developed Perceptions of Preventable Adverse Events Assessment Tool (PPAEAT) exhibits good psychometric properties, which supports its use in future research and primary health-care practice. Further validation of the PPAEAT in different settings, languages and larger samples is needed. The results of this study need to be considered when assessing patient safety in the context of health-care research.

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Health Systems Factors Associated With Adverse Events Among Hospitalized Obstetric Clients in a Tertiary Health Care Facility in Ghana

Journal of Patient Safety ◽

10.1097/pts.0000000000000904 ◽

2021 ◽

Vol 17 (8) ◽

pp. e890-e897

Author(s):

Elom Hillary Otchi ◽

Reuben Kwasi Esena ◽

Emmanuel Srofenyoh ◽

Emmanuel Ogbada Ameh ◽

Kwaku Asah-Opoku ◽

...

Keyword(s):

Health Care ◽

Adverse Events ◽

Health Systems ◽

Care Facility ◽

Health Care Facility ◽

Factors Associated

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Separation or Synthesis: A Holistic Approach to Therapeutics

Pediatrics in Review ◽

10.1542/pir.17.8.279 ◽

1996 ◽

Vol 17 (8) ◽

pp. 279-283

Author(s):

Kathi J. Kemper

Keyword(s):

Health Care ◽

Nurse Practitioners ◽

Low Cost ◽

Self Regulation ◽

Holistic Approach ◽

Medical Settings ◽

The Public ◽

Specialized Health Care ◽

Definition Of ◽

Spiritual Healers

Over the past 50 years, health care has grown more complex and specialized. Health-care institutions now are staffed with an array of specialist physicians, social workers, psychologists, therapists, and nutritionists as well as general practitioners and nurses. The types of providers outside of the hospital are even more numerous and diverse: physicians; nurses; nurse practitioners; chiropractors; counselors; acupuncturists; herbalists; spiritual healers; and purveyors of nutritional supplements, aromatherapy, crystals, and more. Intent on distinguishing their "products," providers focus on differences, polarizing into distinct camps such as "mainstream or traditional" versus "alternative or unconventional." Although these dichotomies are simple, they also can mislead. The definition of "alternative" is very dependent on the definition "mainstream"; acupuncture may be an alternative in one setting, but it clearly is traditional within Asian communities. Therapies that once were considered unconventional, such as hypnosis and meditation, have moved into many mainstream medical settings. (See Sugarman article "Hypnosis: Teaching Children Self-regulation" in the January 1996 issue of Pediatrics in Review.) The public wants health care that is low-cost, safe, effective, and personalized. Practitioners of "natural" therapies often are viewed as more humanistic and less technological than busy physicians. According to one study, in 1990, alternative medical therapies were used by nearly one third of Americans.1

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Surgeons in the operating theatre: preparing to lead by example

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363508x359529 ◽

2008 ◽

Vol 90 (9) ◽

pp. 306-307

Author(s):

K Woo

Keyword(s):

Health Care ◽

Patient Safety ◽

Adverse Events ◽

Operating Theatre ◽

Traditional Practices ◽

Consent Forms ◽

Operative Site ◽

Current Climate ◽

Theatre Staff

Surgeons, anaesthetists and theatre staff have always worked to ensure that no harm comes to their patients, particularly within the operating theatre environment. Patient safety and the prevention of adverse events underlie many of our traditional practices such as the use of identity bracelets, consent forms and marking of the operative site. Perhaps even more so today than ever, unnecessary or avoidable mistakes in the operating theatre cannot be afforded, with the current climate of increasing standards of health care and rising expectations.

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Clinical Predictors for Unsafe Direct Discharge Home Patients From Intensive Care Units

Journal of Intensive Care Medicine ◽

10.1177/0885066618811810 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1067-1073

Author(s):

Vincent Issac Lau ◽

Fran Priestap ◽

Joyce N. H. Lam ◽

John Basmaji ◽

Ian M. Ball

Keyword(s):

Health Care ◽

Substance Abuse ◽

Intensive Care ◽

Adverse Events ◽

Intensive Care Units ◽

Care Facility ◽

Health Care Facility ◽

Surgical Trauma ◽

Home Discharge ◽

Return Visits

Purpose: To describe factors (demographics and clinical characteristics) that predict patients who are at an increased risk of adverse events or unplanned return visits to a health-care facility following discharge direct to home (DDH) from intensive care units (ICUs). Methods: Prospective cohort study of all adult patients who survived their stay in our medical–surgical–trauma ICU between February 2016 and 2017 and were discharged directly home. Patients were followed for 8 weeks postdischarge. Univariable and multivariable logistic regression analyses were performed to identify factors associated with adverse events or unplanned return visits to a health-care facility following DDH from ICU. Results: A total of 129 DDH patients were enrolled and completed the 8-week follow-up. We identified 39 unplanned return visits (URVs). There was 0% mortality at 8 weeks postdischarge. Eight potential predictors of hospital URVs ( P < .2) were identified in the univariable analysis: prior substance abuse (odds ratio [OR] of URV of 2.50 [95% confidence interval: 1.08-5.80], hepatitis (OR: 6.92 [1.68-28.48]), sepsis (OR: 11.03 [1.19-102.29]), admission nine equivalents of nursing manpower score (NEMS) <24 (OR: 2.28 [1.03-5.04], no fixed address (OR: 22.9 [1.2-437.3]), ICU length of stay (LOS) <2 days (OR: 2.95 [1.28-6.78]), home discharge within London, Ontario (OR: 2.44 [1.00-5.92]), and left against medical advice (AMA; OR: 6.06 [2.04-17.98]). Conclusions: Our study identified 8 covariates that were potential predictors of URV: prior substance abuse, hepatitis, sepsis, admission NEMS <24, no fixed address, ICU LOS <2 days, home discharge within London, Ontario, and left AMA. The practice of direct discharges home from the ICU would benefit from adequately powered multicenter study in order to construct a clinical prediction model (that would require further testing and validation).

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