Revealing and Resolving Patient Safety Defects: The Impact of Leadership WalkRounds on Frontline Caregiver Assessments of Patient Safety

Frankel, Allan; Grillo, Sarah Pratt; Pittman, Mary; Thomas, Eric J.; Horowitz, Lisa M.; Page, Martha; Sexton, Bryan

doi:10.1111/j.1475-6773.2008.00878.x

Cited by 147 publications

(161 citation statements)

References 14 publications

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“…Measuring patient safety culture is an important tool for patient safety improvements [25,26] and should be monitored as close to the patient context as possible [27]. Such mapping might provide information for managers and involved professionals to take action to increase patient safety [28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Patient safety culture in Norwegian home health nursing: a cross-sectional study of healthcare provider’s perceptions of the teamwork and safety climates

Olsen

Bjerkan

2017

Saf Health

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Background: The threefold aim of this study was to (1) describe attitudes to patient safety among healthcare providers in home health nursing (HHN), (2) investigate differences in attitudes due to age, education level, years of healthcare work experience, and years at current workplace, and (3) compare attitudes of these HHN healthcare providers with available benchmark data from other healthcare settings. Methods: One hundred sixty HHN healthcare providers in Mid-Norway answered a survey covering the teamwork climate and safety climate in the Safety Attitudes Questionnaire (SAQ). Data were analyzed by descriptive statistics, t test, and ANOVA.Results: The overall mean score was 79.1 for teamwork climate and 72.3 for safety climate. The proportion of positive responses (i.e., scale scores ≥ 75) was 73% on teamwork climate and 53% on safety climate. For teamwork and safety climates, employees with the longest employment at the current workplace had significantly higher mean scores than those with shorter employment. No significant differences were found in mean scores for age, education level, and length of experience in healthcare. Compared to benchmark data from other studies, the mean HHN scores for both safety and teamwork climates were higher than in the vast majority of other healthcare settings and significant differences were found for both dimensions.Conclusion: HHN has higher scores for both safety climate and teamwork climate compared to the vast majority of other healthcare settings, but there is room for improvement in the patient safety culture within the Norwegian HHN. Further research on patient safety culture in HHN is needed.

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Section: Introductionmentioning

confidence: 99%

Patient safety culture in Norwegian home health nursing: a cross-sectional study of healthcare provider’s perceptions of the teamwork and safety climates

Olsen

Bjerkan

2017

Saf Health

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“…Both facilitate cooperation between frontline workers, their unit leader and an executive leader to improve patient safety culture. After the intervention of the previously mentioned (p.55) Leadership Walk Rounds, staff perceptions on safety climate improved for all staff categories, except for charge nurses (77). Charge nurses' perceptions became worse after the intervention, approaching the level of nurses and staff physicians.…”

Section: Opportunities For Leadership To Improve Patient Safety Culturementioning

confidence: 90%

Roadmap for patient safety research: approaches and roadforks

Hofoss

Deilkås

2008

Scand J Public Health

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Patient safety improvement is a healthcare priority worldwide. Pioneer research reports include the 1984 Harvard Medical Practice Study, and the 1999 report "To err is human''. Patient safety research is expanding rapidly. Among the Scandinavian countries, Denmark is the patient safety improvement leader, and Norway is the laggard, having only recently institutionalized safety research and then having started with industrial safety research, and only recently having expanded into patient safety research. Aims: To produce a roadmap for patient safety research, indicationg three main roadforks. Patient safety research can be conducted along a number of lines. To identify patient safety problems and come up with ideas for patient safety improvement one can investigate 1) particular cases of adverse events, 2) the design of healthcare delivery systems, or 3) the culture of the care-giving institutions. The study of safety culture can be subdivided into the study of organization culture in general (and in particular of leadership culture) and the study of patient safety culture. The article provides a number of references to existing instruments of patient safety research. Methods: Qualitative interpretation of the referenced literature. Results: Scrutinizing adverse events for errors is health care's traditional way of improving patient safety. The idea of rethinking the design of care delivery systems has been accompanied by claims of modernity. The study of patient safety culture is the most recent approach. The three approaches are discussed in separate sub-chapters. Conclusions: Although chronology suggests a developmental trend, the three approaches should not necessarily be seen as steps up the ladder of evolution. Each approach does have its merits.

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“…506 Improvements in patient safety have been linked to the frequency of exposure to WalkRounds 507 but their sustained operation demands significant organisational will, project management and commitment from board-level leaders. 499 Research is now beginning to penetrate the complex social processes that underpin WalkRounds so that their potential to foster executive-level learning is enhanced. 508,509 However, the development and maintenance of appropriate organisational feedback mechanisms is known to be a significant challenge.…”

Section: Walkroundsmentioning

confidence: 99%

“…497 One means to achieve this is WalkRounds. [498][499][500] Perceived as a key leadership practice in health care, WalkRounds foster situational awareness and help management to periodically assess new or unresolved vulnerabilities that may affect safety and care quality. WalkRounds, therefore, potentially provide (i) a forum for front-line 40 staff to report and discuss patient safety problems with local leaders, so that the voice of the caregiver influences the ongoing board-level debate; 501 (ii) an opportunity to improve teamwork and communication within and across units; and (iii) a supportive environment in which staff and leaders help to develop potential solutions for patient safety and service delivery issues [502][503][504][505] -all refined through the underpinning MI-PDSA approach.…”

Section: Walkroundsmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Revealing and Resolving Patient Safety Defects: The Impact of Leadership WalkRounds on Frontline Caregiver Assessments of Patient Safety

Cited by 147 publications

References 14 publications

Patient safety culture in Norwegian home health nursing: a cross-sectional study of healthcare provider’s perceptions of the teamwork and safety climates

Patient safety culture in Norwegian home health nursing: a cross-sectional study of healthcare provider’s perceptions of the teamwork and safety climates

Roadmap for patient safety research: approaches and roadforks

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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