Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.
Central to efforts to assure the quality of patient care in hospitals is having accurate data about quality and patient problems. The purpose was to describe the reporting rates of medication administration errors (MAE), patient falls, and occupational injuries. A questionnaire was distributed to staff nurses (N = 1105 respondents) in a national sample of 25 hospitals. This addressed voluntary reporting, work environment factors, and reasons for not reporting occurrences. More than 80% indicated that all MAEs should be reported, but only 36% indicated that near misses should be reported. Perceived levels of actual reporting were: 47% of MAEs, 77% of patient falls, 48% of needlesticks, 22% of other exposures to body fluids, and 17% of back injuries. Administrative response to reports, personal fears, and unit quality management were related to reporting. Patient and staff safety occurrences are underreported. Strong quality management processes and positive responses to reports of occurrences may increase reporting and enhance safety.
The SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence) guidelines were published in 2015 to increase the completeness, precision, and transparency of published reports about efforts to improve the safety, value, and quality of health care. The principles and methods applied in work to improve health care are often applied in educational improvement as well. In 2016, a group was convened to develop an extension to SQUIRE that would meet the needs of the education community. This article describes the development of the SQUIRE-EDU extension over a three-year period and its key components. SQUIRE-EDU was developed using an international, interprofessional advisory group and face-to-face meeting to draft initial guidelines; pilot testing of a draft version with nine authors; and further revisions from the advisory panel with a public comment period. SQUIRE-EDU emphasizes three key components that define what is necessary in systematic efforts to improve the quality and value of health professions education. These are a description of the local educational gap; consideration of the impacts of educational improvement to patients, families, communities, and the health care system; and the fidelity of the iterations of the intervention. SQUIRE-EDU is intended for the many and complex range of methods used to improve education and education systems. These guidelines are projected to increase and standardize the sharing and spread of iterative innovations that have the potential to advance pedagogy and occur in specific contexts in health professions education.
Although there were limitations to this study, it is one of the first to describe the patterns of using PS in nursing schools for clinical education. As the use of this technology grows in BSN programs, addressing the issues resulting from this study are essential to understanding the use of this technology in nursing education.
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