scholarly journals A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

2014 ◽  
Vol 2 (32) ◽  
pp. 1-118 ◽  
Author(s):  
Graeme Currie ◽  
Nicola Burgess ◽  
Leroy White ◽  
Andy Lockett ◽  
John Gladman ◽  
...  
Keyword(s):  
Patient Safety ◽  
Service Delivery ◽  
Older Persons ◽  
Medication Management ◽  
Research Programme ◽  
Clinical Governance ◽  
Middle Level ◽  
Service Improvement ◽  
Knowledge Brokering ◽  
Lower Status

BackgroundBrokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people.ObjectivesGenerate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs.DesignWe utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups.SettingNHS East and NHS West Midlands.ParticipantsOne hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK.Main outcome measuresWhich H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care?ResultsHealth-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement.ConclusionsClinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs are central. Intervention needs to mediate interprofessional and intraprofessional hierarchy, which, combined with compliance pressures, engender a ‘broken’ chain for applying PSK for service improvement, rather than a ‘brokering’ chain. Lower-status H-MLMs need to have their legitimacy and disposition enhanced to broker knowledge for service improvement. More informal ‘social mechanisms’ are required to complement clinical governance for development of a brokering chain. More research is needed to (1) examine why some H-MLMs are more disposed and able than others to broker PSK for service improvement, and (2) understand how knowledge brokering might be enhanced so that exogenous and endogenous knowledge is better fused for service improvement.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Transitional nursing care for older inpatients: a person-centred research programme

2021 ◽  
Vol 11 (1) ◽  
pp. 1-3
Author(s):  
Cédric Mabire ◽  
◽  
Joanie Pellet ◽  
Keyword(s):  
Older Persons ◽  
Nursing Practice ◽  
Transitional Care ◽  
Medication Management ◽  
Research Programme ◽  
Healthcare Services ◽  
Western World ◽  
Levels Of Care ◽  
Transitions Theory ◽  
Hospital To Home

Across the Western world, healthcare services are contending with the challenge of ageing populations. Switzerland is no exception, and faces the need to adapt its healthcare system to the needs of older persons. A disease-oriented approach is ill suited to the varied abilities, preferences and degrees of resilience among older people, and person-centred care is better placed to respond effectively to this situation (Ekman et al., 2013). Our team at the Institute of Higher Education and Research in Healthcare (IUFRS) of the University of Lausanne has developed a research programme to improve the healthcare experiences of older persons during hospitalisation and transition to discharge. We have identified different models and theories that promote a better understanding of the factors that impact on older persons ’lives during these phases and of how to take them into account in nursing practice in order to encourage a person-centred approach. The transition of care from hospital to home is a vulnerable time in the continuum of care for older persons (Arbaje et al., 2014). Transitional care is defined by Coleman and Boult (2003, p 549) as a ‘set of actions designed to ensure the coordination and continuity of healthcare as patients transfer between different locations or different levels of care within the same location’. At the theoretical level, Meleis ’transitions theory (2000) provides a perspective for interpreting and planning comprehensive discharge for hospitalised older persons. In designing our research programme, this theory helped us to link the older person’s health problems (conditions of transition) in relation to hospitalisation (nature of transition), discharge preparation (nursing interventions) and the effects on the person (response models) (Mabire et al., 2015). From the transitions theory, Naylor et al. (2017) developed their transitional care model to guide nursing practice during this period. This model includes eight components: Patient engagement Caregiver engagement Complexity and medication management Patient education Caregiver education Patient and caregiver wellbeing Care continuity Accountability

scholarly journals Usability Flaws in Medication Alerting Systems: Impact on Usage and Work System

2015 ◽  
Vol 24 (01) ◽  
pp. 55-67 ◽  
Author(s):  
E. Ammenwerth ◽  
E. Roehrer ◽  
S. Pelayo ◽  
F. Vasseur ◽  
M.-C. Beuscart-Zéphir ◽  
...  
Keyword(s):  
Patient Safety ◽  
New Technology ◽  
Medication Management ◽  
Secondary Analysis ◽  
Previous Attempt ◽  
Negative Consequences ◽  
Negative Outcomes ◽  
Work Systems ◽  
Work System ◽  
Alerting Systems

Summary Objectives: Previous research has shown that medication alerting systems face usability issues. There has been no previous attempt to systematically explore the consequences of usability flaws in such systems on users (i.e. usage problems) and work systems (i.e. negative outcomes). This paper aims at exploring and synthesizing the consequences of usability flaws in terms of usage problems and negative outcomes on the work system. Methods: A secondary analysis of 26 papers included in a prior systematic review of the usability flaws in medication alerting was performed. Usage problems and negative outcomes were extracted and sorted. Links between usability flaws, usage problems, and negative outcomes were also analyzed. Results: Poor usability generates a large variety of consequences. It impacts the user from a cognitive, behavioral, emotional, and attitudinal perspective. Ultimately, usability flaws have negative consequences on the workflow, the effectiveness of the technology, the medication management process, and, more importantly, patient safety. Only few complete pathways leading from usability flaws to negative outcomes were identified.Conclusion: Usability flaws in medication alerting systems impede users, and ultimately their work system, and negatively impact patient safety. Therefore, the usability dimension may act as a hidden explanatory variable that could explain, at least partly, the (absence of) intended outcomes of new technology.

scholarly journals Mixed-methods study protocol: do national reporting and learning system medication incidents in palliative care reflect patient and carer concerns about medication management and safety?

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048696
Author(s):  
Sarah Yardley ◽  
Sally-Anne Francis ◽  
Antony Chuter ◽  
Stuart Hellard ◽  
Julia Abernethy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Safety ◽  
Professional Learning ◽  
Public Involvement ◽  
Medication Management ◽  
Patient And Public Involvement ◽  
Learning System ◽  
Mixed Methods Study ◽  
Professional Perspectives ◽  
Medication Incidents

IntroductionApproximately 20% of serious safety incidents involving palliative patients relate to medication. These are disproportionately reported when patients are in their usual residence when compared with hospital or hospice. While patient safety incident reporting systems can support professional learning, it is unclear whether these reports encompass patient and carer concerns with palliative medications or interpersonal safety.AimTo explore and compare perceptions of (un)safe palliative medication management from patient, carer and professional perspectives in community, hospital and hospice settings.Methods and analysisWe will use an innovative mixed-methods study design combining systematic review searching techniques with cross-sectional quantitative descriptive analysis and interpretative qualitative metasynthesis to integrate three elements: (1) Scoping review: multiple database searches for empirical studies and first-hand experiences in English (no other restrictions) to establish how patients and informal carers conceptualise safety in palliative medication management. (2)Medication incidents from the England and Wales National Reporting and Learning System: identifying and characterising reports to understand professional perspectives on suboptimal palliative medication management. (3) Comparison of 1 and 2: contextualising with stakeholder perspectives.Patient and public involvementOur team includes a funded patient and public involvement (PPI) collaborator, with experience of promoting patient-centred approaches in patient safety research. Funded discussion and dissemination events with PPI and healthcare (clinical and policy) professionals are planned.Ethics and disseminationProspective ethical approval granted: Cardiff University School of Medicine Research Ethics Committee (Ref 19/28). Our study will synthesise multivoiced constructions of patient safety in palliative care to identify implications for professional learning and actions that are relevant across health and social care. It will also identify changing or escalating patterns in palliative medication incidents due to the COVID-19 pandemic. Peer-reviewed publications, academic presentations, plain English summaries, press releases and social media will be used to disseminate to the public, researchers, clinicians and policy-makers.

scholarly journals Experiential Learning Curriculum Delivery Approach for Quality Improvement in Resource Limited Settings: Mobile Learning for Point-of-Care Technologies

2019 ◽  
Vol 11 (13) ◽  
pp. 158
Author(s):  
Nkosinothando Chamane ◽  
Tivani Phosa Mashamba-Thompson
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Experiential Learning ◽  
Service Delivery ◽  
Point Of Care ◽  
Service Improvement ◽  
Quality Service ◽  
Resource Limited Settings ◽  
Primary Health ◽  
Resource Limited

BACKGROUND: Despite impressive progress that has been made in the provision of health care services to all, the issue of quality service delivery still remains a challenge particularly for point-of-care (POC) diagnostics in resource-limited-settings. Poor competency of primary health care workers in these settings has been shown to be amongst the main contributors to poor quality service delivery. FINDINGS: Participatory-based continuous professional development (CPD) strategies to support technology advancements in health care are recommended. Experiential learning approaches have been shown to be efficient in supplementing traditional teaching methods for both health care students and professionals. These approaches have been shown to further contribute towards continuous skills development and lifelong learning. CONCLUSION: This review therefore provided an overview of literature on experiential learning as one of CPD approaches in relation to health care service improvement in resource-limited setting. In addition, this review has recommended a mobile-based experiential learning approach to help deliver a quality POC technology curriculum to Primary health care-based workers in resource-limited settings.

scholarly journals Electronic Health Records and Patient Safety

2015 ◽  
Vol 06 (01) ◽  
pp. 136-147 ◽  
Author(s):  
D. Gans ◽  
J. White ◽  
R. Nath ◽  
J. Pohl ◽  
C. Tanner
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Electronic Health Records ◽  
Medication Management ◽  
Health Records ◽  
Safety Practices ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices ◽  
Promote Patient Safety

Summary Background: The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective: This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods: We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results: Data from 209 primary care practices responding between 2006–2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions: Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings. Citation: Tanner C, Gans D, White J, Nath R, Pohl J. Electronic health records and patient safety – co-occurrence of early EHR implementation with patient safety practices in primary care settings. Appl Clin Inf 2015; 6: 136–147http://dx.doi.org/10.4338/ACI-2014-11-RA-0099

scholarly journals Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marléne Lindblad ◽  
Maria Unbeck ◽  
Lena Nilsson ◽  
Kristina Schildmeijer ◽  
Mirjam Ekstedt
Keyword(s):  
Patient Safety ◽  
Medication Management ◽  
Home Healthcare ◽  
Moderate Pain ◽  
Trigger Tool ◽  
System Failures ◽  
Sources Of Knowledge ◽  
Safety Work ◽  
Risk Areas ◽  
Record Review

Abstract Background Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare. Methods A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. Results In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were “fall without harm,” “deficiencies in medication management,” and “moderate pain.” The type “deficiencies in medication management” was deemed to have a preventability rate twice as high as those of “fall without harm” and “moderate pain.” The most common potential contributing cause was “deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care.” Conclusion This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.

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