The 100 000 Lives Campaign

Berwick, Donald M.; Calkins, David R.; McCannon, C. Joseph; Hackbarth, Andrew

doi:10.1001/jama.295.3.324

Cited by 606 publications

(163 citation statements)

References 17 publications

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“…88,[162][163][164][165][166][167] In England, a special health authority of the NHS, the National Patient Safety Agency, was established in 2001 with the remit of monitoring patient safety. It identified the need to introduce patient safety improvement programmes to help foster local capacity and progress from a 'blame' culture to one that was perceived to be 'just' and capable of facilitating the open reporting of errors and near-misses.…”

Section: Patient Safety Improvement Programmesmentioning

confidence: 99%

“…It identified the need to introduce patient safety improvement programmes to help foster local capacity and progress from a 'blame' culture to one that was perceived to be 'just' and capable of facilitating the open reporting of errors and near-misses. 168 Informed by the work of the US-based IHI, 162 and advances in safety within other industries, 22,169,170 NHS hospital patient safety programmes have typically sought to achieve improvements by implementing evidence-based clinical practices and enhancing performance monitoring systems. [171][172][173] Although the National Patient Safety Agency was dissolved in 2012, these policy goals continue to be pursued, in England, through the NHS Commissioning Board and the Safer Patients initiative sponsored by the Health Foundation, a charitable trust, and in Wales through the 1000 Lives campaign and its successor, the 1000 Lives + national programme, the focus of this study.…”

Section: Patient Safety Improvement Programmesmentioning

confidence: 99%

“…162,177 Both are informed by the Model for Improvement (MI), developed by Langley et al, 178 depicted in Figure 2. This model 179,180 first directs attention to three questions: what are we trying to accomplish?…”

Section: Lives + National Programme In Nhs Walesmentioning

confidence: 99%

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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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Section: Patient Safety Improvement Programmesmentioning

confidence: 99%

Section: Patient Safety Improvement Programmesmentioning

confidence: 99%

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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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“…An RRS consists of an afferent limb (detecting patients at risk and obtaining adequate help), an efferent limb (consisting of a dedicated rapid response team) and an administrative and data analysis limb. The RRS is highly recommended by the Institute for Healthcare Improvement [6] and implemented in many countries [7] .…”

Section: Introductionmentioning

confidence: 99%

Effect of implementation of a rapid response system on protocol adherence in a surgical ward

Simmes

Schoonhoven²,

Mintjes

et al. 2013

JHA

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Objective: To describe the implementation of a rapid response system and adherence to its afferent limb in order to identify key elements for improvement. Implementation:We developed a multifaceted implementation strategy to introduce the Rapid Response System (RRS) on a 60-bed surgical ward of a university hospital. The strategy included the use of clear objectives, key leaders, an early warning score (EWS) observation protocol and a two-tiered medical emergency team (MET) warning protocol, a 1-day training program including a before-after knowledge test, mandatory for nurses and optional for ward physicians, reminders and feedback. Study design and methods:We retrospectively analyzed a sample of 10,653 patient days and 101 medical records of patients with a serious adverse event (SAE). Outcome measures were EWS recording rates, the nurse to ward physician and the ward physician to the MET calling rates following abnormal EWS recordings, and the indicators triggering these calls.Results: EWS recordings were present in 90% of the day shifts, 88% of the evening shifts and 80% of the night shifts. EWSs were recorded at least once in 92/101 medical records in the three days before an SAE; in 91/101 records EWSs were abnormal at least once. In case of an abnormal score, the nurse called the ward physician once or more in 87% (79/91). After being called by the nurse, the ward physician called the MET once or more in 75% (59/79). However, in 18% (15/79) there was a delay of one or two days before the ward physician/MET was called. Overall, medical emergency team calls were absent or delayed in over 50%. Conclusions:After RRS implementation, recording of the EWS was high. Adequate warning in case of abnormal scores was suboptimal in nurses as well as ward physicians. Future implementation strategies should therefore be aimed at the interdisciplinary team.

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“…Observational studies have shown that early, adequate instauration of antibiotic therapy can improve the survival rates of these patients (13). Moreover, it has been shown that some interventions can prevent conditions associated with the development of sepsis, such as ventilatorassociated pneumonia and intravascular deviceassociated sepsis (14). It is of critical importance to determine the incidence, the prevalence, and the outcomes of severely ill septic patients in order to calculate the resources required for the management of septic patients in intensive care units, as well as to implement strategies aimed at improving their outcome.…”

mentioning

confidence: 99%