In a high-reliability organisation (HRO), safety and quality (SQ) is an organisational priority, and all workforce members are engaged, continuously learning and improving their work. To build organisational capacity for SQ work, we have developed a role-tailored capacity-building framework that we are currently employing at the Johns Hopkins Armstrong Institute for Patient Safety and Quality as part of an organisational strategy towards HRO. This framework considers organisation-wide competencies for SQ that includes all staff and faculty and is integrated into a broader organisation-wide operating management system for improving quality. In this framework, achieving safe, high-quality care is connected to healthcare workforce preparedness. Capacity-building efforts are tailored to the needs of distinct groups within the workforce that fall within three categories: (1) front-line providers and staff, (2) managers and local improvement personnel and (3) SQ leaders and experts. In this paper we describe this framework, our implementation efforts to date, challenges met and lessons learnt.
An interprofessional pre-qualifying curriculum for health and social care professionals was introduced at an English university in September 2000. This study explored the experiences of academic staff from a range of professional backgrounds involved in this interprofessional initiative. Data were collected via questionnaires, individual interviews and focus groups and were analysed using Interpretative Phenomenological Analysis. Sixty-one questionnaires were returned out of a possible two hundred (response rate 30.5%); twenty-nine respondents participated in interviews and focus groups. Four main themes emerged from the data: (i) Huge: Size does matter; (ii) Isolation: Together but separate; (iii) Facilitation: Anything but easy; and (iv) Faculty: Do we walk the talk? The study found a cross-Faculty commitment to interprofessional education, but revealed considerable difficulties for those staff responsible for the management and delivery of the curriculum. The vast scale, the complex nature of interprofessional education delivery, the logistics and organizational challenges created significant difficulties for staff, who could at times feel overwhelmed and isolated. Attitudinal barriers to interprofessional education were identified, although the interprofessional curriculum had enhanced interprofessional working within the Faculty. In order to optimize the success of interprofessional education, the significant challenges that exist for academic staff must be addressed, and ownership by staff enabled.
This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.
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