Disciplined doctors: learning from the pain of the past
The discipline of physicians is an issue of public trust. In the majority of Western countries, physician misconduct is self-governed at a state-wide or provincial level by physician licensing and regulatory associations. In the USA, this responsibility falls under the jurisdiction of state medical licensing boards. These state boards review complaints against physicians and investigate whether standards of care and professionalism have been upheld; they also decide upon specific punishments for misconduct, including fines, extra training and education, and licence suspension and revocation. However, there is no overarchin...
Source: BMJ Quality and Safety - February 15, 2017 Category: Journals (General) Authors: Liu, J. J., Bell, C. M. Tags: Editorials Source Type: research
Exclusions in the denominators of process-based quality measures: the missing link in understanding performance or ecological fallacy?
Key messages Better process-based performance measures do not always correlate with better outcomes. For instance, hospitals that reduce door-to-balloon (D2B) time do not necessarily reduce 30-day mortality for patients with acute myocardial infarction (MI) treated with primary percutaneous coronary intervention. This disconnect may represent an ‘ecological fallacy’. For individual patients, a shorter D2B reduces the risk of death. But, hospitals that have reduced their D2B also tend to treat complex patients with a higher risk of death, hence the apparent failure to translate improved processes into better out...
Source: BMJ Quality and Safety - February 15, 2017 Category: Journals (General) Authors: Marang-van de Mheen, P. J., Nallamothu, B. K. Tags: Editorials Source Type: research
Why do we love to hate ourselves?
Dhaliwal's comment1 on Zwaan et al2 nicely refutes what has been called ‘the hypothesis of special cause’3—the notion that when things turn out wrong, the cognitive processes leading to that outcome must have been fundamentally different (ie, error-prone) from when they turn out right. Dhaliwal's argument recapitulates thinking that is over 100 years old; one of the early contributors to psychology, Ernst Mach,4 wrote (in 1905): ‘Knowledge and error flow from the same mental source; only success can tell one from the other’. What is interesting here is not that the hypothesis of special c...
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Wears, R. L. Tags: Correspondence Source Type: research
Financial incentives and mortality: taking pay for performance a step too far
In the USA, hospitals are increasingly evaluated and paid, based on a burgeoning list of publicly reported quality and safety metrics. Performance measurement is undoubtedly essential for improving healthcare quality, but developing the ‘right’ metrics has remained a formidable challenge1 and has resulted in significant discourse over the validity, authenticity and utility of several publicly reported measures.2–4 Yet, despite the debate, the amount of financial incentives tied to quality metrics continues to grow. As stakes for physicians and hospitals in the USA continue to rise, several of the measures...
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Gupta, K., Wachter, R. M., Kachalia, A. Tags: Viewpoints Source Type: research
International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process
Conclusions
We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Howell, A.-M., Burns, E. M., Hull, L., Mayer, E., Sevdalis, N., Darzi, A. Tags: Original research Source Type: research
Quality gaps identified through mortality review
Conclusions
Our institution-wide mortality review found many quality gaps among decedents, in particular inadequate discussion of goals of care. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Kobewka, D. M., van Walraven, C., Turnbull, J., Worthington, J., Calder, L., Forster, A. Tags: Open access Original research Source Type: research
Intelligent Monitoring? Assessing the ability of the Care Quality Commission's statistical surveillance tool to predict quality and prioritise NHS hospital inspections
Conclusions
Since the IM statistical surveillance tool cannot predict the outcome of NHS hospital trust inspections, it cannot be used for prioritisation. A new approach to inspection planning is therefore required. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Griffiths, A., Beaussier, A.-L., Demeritt, D., Rothstein, H. Tags: Open access Original research Source Type: research
The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals--a retrospective record review study
Conclusions
This first study of adverse events in Ireland reports similar rates to other countries. In a time of austerity, adverse events in adult inpatients were estimated to cost over 194 million. These results provide important baseline data on the adverse event burden and, alongside web-based chart review, provide an incentive and methodology to monitor future patient-safety initiatives. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Rafter, N., Hickey, A., Conroy, R. M., Condell, S., O'Connor, P., Vaughan, D., Walsh, G., Williams, D. J. Tags: Open access Original research Source Type: research
Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workups
Background
Many authors have implicated cognitive biases as a primary cause of diagnostic error. If this is so, then physicians already familiar with common cognitive biases should consistently identify biases present in a clinical workup. The aim of this paper is to determine whether physicians agree on the presence or absence of particular biases in a clinical case workup and how case outcome knowledge affects bias identification.
Methods
We conducted a web survey of 37 physicians. Each participant read eight cases and listed which biases were present from a list provided. In half the cases the outcome implied a correct...
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Zwaan, L., Monteiro, S., Sherbino, J., Ilgen, J., Howey, B., Norman, G. Tags: Editor's choice Original research Source Type: research
Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care
Conclusions
Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Poksinska, B. B., Fialkowska-Filipek, M., Engström, J. Tags: Original research Source Type: research
'Smart intravenous pumps: how smart are they?
Smart pumps, incorporating dose error reduction software, are widely promoted as a patient safety intervention.1 2 This software checks programmed intravenous infusion rates against preset limits for each drug in the pump's ‘drug library’ with the aim of reducing the risk of infusion rates that are too high or too low. Smart pumps were reported to be in use in 68% of US hospitals in 2011,3 although this figure does not tell about how they are used nor in which clinical areas. A UK study indicated less widespread use and that although smart pumps may be in use within an organisation, they may only be used in som...
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Franklin, B. D. Tags: Editorials Source Type: research
Learning how to make routinely available data useful in guiding regulatory oversight of hospital care
Though the past 20 years have seen a series of changes to the independent regulation of healthcare,1 there is surprisingly little empirical work that evaluates the effectiveness of different approaches. Even in the related area of accreditation, where there are more studies of impact, the literature is ‘limited’.2 There is no shortage of strongly held opinions on the best approach. Though most agree about the need for some form of regulation to offer an independent review of the quality of healthcare, there is less agreement about the best style and methods to be adopted. In England, the situation is furth...
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Bardsley, M. Tags: Editorials Source Type: research
Premature closure? Not so fast
Dual process theory (DPT) and the intertwined concepts of heuristics and biases, popularised by Kahneman's book Thinking Fast and Slow, are widely discussed models for analysing decision-making processes inside and outside medicine.1 The basic premise of DPT is that the brain has a fast, intuitive, but occasionally error-prone system (system 1) and a slower, energy-intensive but more accurate analytical system (system 2). Inexorably tied up with the DPT model is the idea that the errors made in system 1 are a result of shortcuts (heuristics) and predispositions (biases) and the hope that if we spent more time in system 2, ...
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Dhaliwal, G. Tags: Editorials Source Type: research
Lean and the perfect patient experience
The term Lean means different things to different people. At Virginia Mason, it is applied to the management system based on the systematic identification and elimination of waste, defined as any activity that does not add value from the standpoint of the customer. First developed in manufacturing, and championed by the Toyota Motor Corporation, efforts to introduce Lean into healthcare have been met with some scepticism. ‘People are not cars’ has been the refrain of those unwilling to view healthcare as made up of processes that produce products and services, and that is thus amenable to improvement. Healthcar...
Source: BMJ Quality and Safety - January 17, 2017 Category: Journals (General) Authors: Blackmore, C. C., Kaplan, G. S. Tags: Editorials Source Type: research
The problem with red, amber, green: the need to avoid distraction by random variation in organisational performance measures
‘The Problem with...’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution. Introduction Many healthcare organisations now track a number of performance measures like infection and complication rates, waiting times, staff adherence to guidelines, etc. Our own organisation, The Capital Region of Denmark, provides healthcare for 1.7 million people and runs 6 hospitals and 11 mental health centres. Measures of clinical quality have been widely used in...
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Anhoj, J., Hellesoe, A.-M. B. Tags: The problem with... Source Type: research
