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Speak up-related climate and its association with healthcare workers speaking up and withholding voice behaviours: a cross-sectional survey in Switzerland

Quality and Safety in Health Care Journal -

Objectives

To determine frequencies of healthcare workers (HCWs) speak up-related behaviours and the association of speak up-related safety climate with speaking up and withholding voice.

Design

Cross-sectional survey of doctors and nurses. Data were analysed using multilevel logistic regression models

Setting

4 hospitals with a total of nine sites from the German, French and Italian speaking part of Switzerland.

Participants

Survey data were collected from 979 nurses and doctors.

Main outcome measures

Frequencies of perceived patient safety concerns, of withholding voice and of speaking up behaviour. Speak up-related climate measures included psychological safety, encouraging environment and resignation.

Results

Perceived patient safety concerns were frequent among doctors and nurses (between 62% and 80% reported at least one safety concern during the last 4 weeks depending on the single items). Withholding voice was reported by 19%–39% of HCWs. Speaking up was reported by more than half of HCWs (55%–76%). The frequency of perceived concerns during the last 4 weeks was positively associated with both speaking up (OR=2.7, p<0.001) and withholding voice (OR=1.6, p<0.001). An encouraging environment was related to higher speaking up frequency (OR=1.3, p=0.005) and lower withholding voice frequency (OR=0.82, p=0.006). Resignation was associated with withholding voice (OR=1.5, p<0.001). The variance in both voicing behaviours attributable to the hospital-site level was marginal.

Conclusions

Our results strengthen the importance of a speak up-supportive safety climate for staff safety-related communication behaviours, specifically withholding voice. This study indicates that a poor climate, in particular high levels of resignation among HCWs, is linked to frequent ‘silence’ of HCWs but not inversely associated with frequent speaking up. Interventions addressing safety-related voicing behaviours should discriminate between withholding voice and speaking up.

Perceptions of rounding checklists in the intensive care unit: a qualitative study

Quality and Safety in Health Care Journal -

Background

Rounding checklists are an increasingly common quality improvement tool in the intensive care unit (ICU). However, effectiveness studies have shown conflicting results. We sought to understand ICU providers’ perceptions of checklists, as well as barriers and facilitators to effective utilisation of checklists during daily rounds.

Objectives

To understand how ICU providers perceive rounding checklists and develop a framework for more effective rounding checklist implementation.

Methods

We performed a qualitative study in 32 ICUs within 14 hospitals in a large integrated health system in the USA. We used two complementary data collection methods: direct observation of daily rounds and semistructured interviews with ICU clinicians. Observations and interviews were thematically coded and primary themes were identified using a combined inductive and deductive approach.

Results

We conducted 89 interviews and performed 114 hours of observation. Among study ICUs, 12 used checklists and 20 did not. Participants described the purpose of rounding checklists as a daily reminder for evidence-based practices, a tool for increasing shared understanding of patient care across care providers and a way to increase the efficiency of rounds. Checklists were perceived as not helpful when viewed as overstandardising care and when they are not relevant to a particular ICU’s needs. Strategies to improve checklist implementation include attention to the brevity and relevance of the checklist to the particular ICU, consistent use over time, and integration with daily work flow.

Conclusion

Our results provide potential insights about why ICU rounding checklists frequently fail to improve outcomes and offer a framework for effective checklist implementation through greater feedback and accountability.

Hospital-level care coordination strategies associated with better patient experience

Quality and Safety in Health Care Journal -

Background

Patient experience is a key measure of hospital quality and is increasingly contained in value-based payment programmes. Understanding whether strategies aimed at improving care transitions are associated with better patient experience could help clinical leaders and policymakers seeking to improve care across multiple dimensions.

Objective

To determine the association of specific hospital care coordination and transition strategies with patient experience.

Design

We surveyed leadership at 1600 acute care hospitals and categorised respondents into three groups based on the strategies used: low-strategy (bottom quartile of number of strategies), mid-strategy (quartiles 2 and 3) and high-strategy (highest quartile). We used linear regression models to examine the association between use of these strategies and performance on measures of patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

Results

We achieved a 62% response rate. High-strategy hospitals reported using 7.7 strategies on average usually or always on their patient populations, while mid-strategy and low-strategy hospitals reported using 5.0 and 2.3 strategies, respectively. Compared with low-strategy hospitals, high-strategy hospitals had a higher overall rating (+2.23 percentage points (pp), P<0.001), higher recommendation score (+2.5 pp, P<0.001), and higher satisfaction with discharge process (+1.35 pp, P=0.01) and medication communication (+1.44 pp, P=0.002). Mid-strategy hospitals had higher scores than low-strategy hospitals except for discharge satisfaction. Patient-facing strategies, like sharing discharge summaries with patients prior to discharge, using discharge coordinators and calling patients 48 hours after discharge, were each individually associated with a higher overall hospital rating, and higher satisfaction with discharge process and medication communication.

Conclusions

Hospitals with greater reported use of care coordination and transition strategies have better patient experience than hospitals with fewer reported strategies. Strategies that most directly involve patients have the strongest association with better experience.

Implementing electronic patient-reported outcomes measurements: challenges and success factors

Quality and Safety in Health Care Journal -

Determining how to collect and use patient-reported outcome measures (PROMs) continues to be an area of discussion, and in some cases frustration.1–5 Gaining a greater depth of knowledge concerning a patient’s initial health status as well as improvement after a medical or surgical intervention, would provide a clearer understanding of needed care paths and outcomes of treatments, oftentimes missing from our current healthcare processes.6 7 While PROMs are not a new idea, the ability to electronically collect, report and use the data has become more relevant in recent years. As such, this work focuses on the challenges and lessons learnt from implementing electronic PROMs (ePROMs) within a destination medical centre which provides team-based comprehensive care for patients.

Implementations in multiple departments and disease specific areas of care throughout the organisation took place between January 2016...

Role of patient and public involvement in implementation research: a consensus study

Quality and Safety in Health Care Journal -

Background

Patient and public involvement (PPI) is often an essential requirement for research funding. Distinctions can be drawn between clinical research, which generally focuses on patients, and implementation research, which generally focuses on health professional behaviour. There is uncertainty about the role of PPI in this latter field. We explored and defined the roles of PPI in implementation research to inform relevant good practice guidance.

Methods

We used a structured consensus process using a convenience sample panel of nine experienced PPI and two researcher members. We drew on available literature to identify 21 PPI research roles. The panel rated their agreement with roles independently online in relation to both implementation and clinical research. Disagreements were discussed at a face-to-face meeting prior to a second online rating of all roles. Median scores were calculated and a final meeting held to review findings and consider recommendations.

Results

Ten panellists completed the consensus process. For clinical research, there was strong support and consensus for the role of PPI throughout most of the research process. For implementation research, there were eight roles with consensus and strong support, seven roles with consensus but weaker support and six roles with no consensus. There were more disagreements relating to PPI roles in implementation research compared with clinical research. PPI was rated as contributing less to the design and management of implementation research than for clinical research.

Conclusions

The roles of PPI need to be tailored according to the nature of research to ensure authentic and appropriate involvement. We provide a framework to guide the planning, conduct and reporting of PPI in implementation research, and encourage further research to evaluate its use.

Visual Management Board

Institute for Healthcare Improvement -

A visual management board is used as a key communication tool that provides at-a-glance information about current process performance, both quantitative and qualitative data, to help clinical unit staff coordinate and guide their daily work and monitor ongoing improvement projects.

Visual Management Board

Institute for Healthcare Improvement -

A visual management board is used as a key communication tool that provides at-a-glance information about current process performance, both quantitative and qualitative data, to help clinical unit staff coordinate and guide their daily work and monitor ongoing improvement projects.

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