ObjectivesIn recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long‐Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital‐based teams’ experiences during the ED process improvement program implementation and the teams’ perceptions of the key factors that influenced the program's success or failure.MethodsA qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed.ResultsTwenty‐four interviews were coded and analyzed. The results are organized according to participants’ experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project.ConclusionsSeveral key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the development and implementation of future similar interventions in health care settings could be useful.
Our study found that walkrounds may inadvertently lead to counter-productive attitudes by senior leaders at odds with the recommended principles of walkrounds. The results demonstrate similar attitudes from senior leaders at two hospitals with quite different formats for walkrounds, suggesting that this pattern may exist elsewhere. Better preparation of senior leaders prior to the walkrounds may help to avoid the counter-productive attitudes and dynamics that we identified.
BackgroundHealthcare leaders look to high-reliability organisations (HROs) for strategies to improve safety, despite questions about how to translate these strategies into practice. Weick and Sutcliffe describe five principles exhibited by HROs. Interventions aiming to foster these principles are common in healthcare; however, there have been few examinations of the perceptions of those who have planned or experienced these efforts.ObjectiveThis single-site qualitative study explores how healthcare professionals understand and enact the HRO principles in response to an HRO-inspired hospital-wide safety programme.MethodsWe interviewed 71 participants representing hospital executives, programme leadership, and staff and physicians from three clinical services. We observed and collected data from unit and hospital-wide quality and safety meetings and activities. We used thematic analysis to code and analyse the data.ResultsParticipants reported enactment of the HRO principles ‘preoccupation with failure’, ‘reluctance to simplify interpretations’ and ‘sensitivity to operations’, and described the programme as adding legitimacy, training, and support. However, the programme was more often targeted at, and taken up by, nurses compared with other groups. Participants were less able to identify interventions that supported the HRO principles ‘commitment to resilience’ and ‘deference to expertise’ and reported limited examples of changes in practices related to these principles. Moreover, we identified inconsistent, and even conflicting, understanding of concepts related to the HRO principles, often related to social and professional norms and practices. Finally, an individualised rather than systemic approach hindered collective actions underlying high reliability.ConclusionOur findings demonstrate that the safety programme supported some HRO principles more than others, and was targeted at, and perceived differently across professional groups leading to inconsistent understanding and enactments of the principles across the organisation. Combining HRO-inspired interventions with more targeted attention to each of the HRO principles could produce greater, more consistent high-reliability practices.
Background and objectivesRecent years have seen increasing calls for more proactive use of patient complaints to develop effective system-wide changes, analogous to the intended functions of incident reporting and root cause analysis (RCA) to improve patient safety. Given recent questions regarding the impact of RCAs on patient safety, we sought to explore the degree to which current patient complaints processes generate solutions to recurring quality problems.Design/settingQualitative analysis of semistructured interviews with 21 patient relations personnel (PRP), nursing and physician leaders at three teaching hospitals (Toronto, Canada).ResultsChallenges to using the patient complaints process to drive hospital-wide improvement included: (1) Complaints often reflect recalcitrant system-wide issues (eg, wait times) or well-known problems which require intensive efforts to address (eg, poor communication). (2) The use of weak change strategies (eg, one-off educational sessions). (3) The handling of complaints by unit managers so they never reach the patient relations office. PRP identified giving patients a voice as their primary goal. Yet their daily work, which they described as ‘putting out fires’, focused primarily on placating patients in order to resolve complaints as quickly as possible, which may in effect suppress the patient voice.ConclusionsUsing patient complaints to drive improvement faces many of the challenges affecting incident reporting and RCA. The emphasis on ‘putting out fires’ may further detract from efforts to improve care for future patients. Systemically incorporating patients’ voices in clinical operations, as with co-design and other forms of authentic patient engagement, may hold greater promise for meaningful improvements in the patient experience than do RCA-like analyses of patient complaints.
We eat every day; it is both leisure and work for all of us. And yet, dramatically few of us have examined food practices with a leisure studies lens. Closer scrutiny, however, reveals a deeply political practice embedded in popular culture. Three cases are used to highlight the politics of leisure and food: the Slow Food Movement, the food justice movement, and the organic farming movement. Each case represents a particular dimension-pleasure, activism, and empowerment-of a political practice that is grounded in reflection, resistance, and alternative visions. Together they constitute a form of critically reflexive leisure that broadens our understanding of the field, builds interdisciplinary relationships between leisure studies and other disciplines, and helps us to better take into account vital issues such as sustainability, health, and climate change.Résumé. L'alimentation quotidienne est parfois un loisir et parfois du travail. Mais, peu de nous ont examiné ces pratiques d'alimentation avec un objectif d'études de loisirs. Cependant, un examen minutieux de l'alimentation et de la culture populaire indique une pratique profondément politique. Trois cas sont employés pour accentuer la politique des loisirs et de la nourriture : le mouvement « Slow Food », la Justice sociale au service de la sécurité alimentaire ; et le mouvement d'agriculture biologique. Chaque cas repré-sente une dimension particulière -plaisir, activisme, et l'autogestion -et pratique politique fondée sur une réflexivité, résistance et altemative. Ensemble elles constituent une réflexion critique qui nous aide à élargir notre compréhension des études de loisirs, éta-blir des rapports interdisciplinaires entre les études de loisirs et d'autres disciplines, et nous aident à mieux tenir compte de quelques questions essentielles telles que la durabilité, la santé, et les changements climatiques.Mots-clés, loisirs et critique réflexive, la justice sociale au service de la sécurité alimentaire, de la bouffe, pas des bombes, agriculture biologique, loisirs populaires, « Slow Food »
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