Striving for high reliability in healthcare: a qualitative study of the implementation of a hospital safety programme
Conclusion
Our 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. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Rotteau, L., Goldman, J., Shojania, K. G., Vogus, T. J., Christianson, M., Baker, G. R., Rowland, P., Coffey, M. Tags: Editor's choice Original research Source Type: research
Quality improvement as a primary approach to change in healthcare: a precarious, self-limiting choice?
Total quality management activities have produced undeniable positive results. However, I predict that the way these activities are implemented will lead to the programs becoming self-limiting...seeds for the deterioration of total quality management lie in the very practices that today produce successful outcomes. (Chris Argyris, professor of organizational behavior, Harvard Business School)1 Introduction Argyris’s contention above begs the question: Is quality improvement as a primary approach to change in healthcare potentially self-limiting? Our viewpoint is yes, particularly when fundamental underpinnings and me...
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Mandel, K. E., Cady, S. H. Tags: Open access Viewpoints Source Type: research
Overcoming the 'self-limiting nature of QI: can we improve the quality of patient care while caring for staff?
In this month’s edition, Mandel and Cady draw on organisational change theories to argue that quality improvement (QI), as currently deployed, is self-limiting.1 In other words, if left untamed it will fail to produce valuable change and may have a raft of negative consequences, including stress, reduced engagement and burnout among healthcare staff. While acknowledging that some improvement methods (eg, appreciative inquiry, positive deviance) do address the emotional experience of staff as well as their performance, and focus on socio-behavioural (teamwork, cultures, etc) as well as process-technical design element...
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Lawton, R., Thomas, E. J. Tags: Editorials Source Type: research
Medication review in hospitalised older people: what have we learnt?
Person-centred care is considered essential to clinical practice by regulatory and professional bodies around the world. For example, in the UK, the General Medical Council, General Pharmaceutical Council, Care Quality Commission and National Institute for Health and Care Excellence strongly advocate for it. The paper by Thevelin and colleagues1, in this edition of BMJ Quality & Safety, offers us the opportunity to reflect on medication review from the perspectives of both patients and healthcare professionals. In addition, it challenges us to consider how we can do better for our patients using a patient-centred appro...
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Barnett, N. L., Oboh, L. Tags: Editorials Source Type: research
Medication safety in nursing home patients
Globally, societies are ageing, and elderly patients take many drugs. As such, medication safety has long been a major issue in long-term care. This group of patients has substantial comorbidity and typically takes many medications, some of which are poorly tolerated in the elderly.1 This population also frequently suffers from memory impairment, and often cannot advocate for themselves effectively. Behavioural issues are frequent, and overuse of psychoactive drugs is common. In addition, electronic health record use is not as widespread as in acute care or ambulatory settings. The net impact is that many patients suffer a...
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Bates, D. W., Zebrowski, J. Tags: Editorials Source Type: research
High reliability organising in healthcare: still a long way left to go
Over 20 years ago, in its enduringly impactful report To Err is Human, the US Institute of Medicine (IOM) claimed that healthcare is not unique among high-risk, high-reliability industries, pointing out that it too is concerned with learning how to prevent, detect, recover and learn from mistakes and accidents.1 That observation was based on research conducted by an interdisciplinary group at the University of California at Berkeley who were ‘curious about the seemingly theory-defying ability of some organizations to avoid catastrophic operational outcomes despite operating technologies that were fraught with excepti...
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Myers, C. G., Sutcliffe, K. M. Tags: Editorials Source Type: research
Quality and Safety in the Literature: November 2022
Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals. Key points Addressing fundamental principles of age-friendly care through an ‘Eat Walk Engage’ programme, with a goal of decreasing hospital-associated complications in older people, reduced ...
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Admani, M. U., Gupta, A., Houchens, N. Tags: Quality & amp; safety in the literature Source Type: research
Comparing antibiotic prescribing between clinicians in UK primary care: an analysis in a cohort study of eight different measures of antibiotic prescribing
Conclusions
The wide variation seen in all measures of AB prescribing and weak correlation between them suggests that a single AB measure, such as prescribing rate, is not sufficient to underpin the optimisation of AB prescribing. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Van Staa, T., Li, Y., Gold, N., Chadborn, T., Welfare, W., Palin, V., Ashcroft, D. M., Bircher, J. Tags: Open access Original research Source Type: research
Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
Conclusion
Multi-level facilitation significantly improved escalation as per hospital policy at 6 months in the intervention group that was not sustained at 12 months. The intervention group had increased vital sign measurement by nurses, as well as shorter lengths of stay for patients at 12 months. Further research is required to understand the dose of facilitation required to impact clinical practice behaviours and patient outcomes.
Trial registration number
ACTRN12616000544471p (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Bucknall, T. K., Considine, J., Harvey, G., Graham, I. D., Rycroft-Malone, J., Mitchell, I., Saultry, B., Watts, J. J., Mohebbi, M., Bohingamu Mudiyanselage, S., Lotfaliany, M., Hutchinson, A. Tags: Open access Original research Source Type: research
How safe are paediatric emergency departments? A national prospective cohort study
Conclusion
In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Plint, A. C., Newton, A. S., Stang, A., Cantor, Z., Hayawi, L., Barrowman, N., Boutis, K., Gouin, S., Doan, Q., Dixon, A., Porter, R., Joubert, G., Sawyer, S., Crawford, T., Gravel, J., Bhatt, M., Weldon, P., Millar, K., Tse, S., Neto, G., Grewal, S., Cha Tags: Open access, Editor's choice Original research Source Type: research
Framework to optimise learning network activities for long-term success
Learning networks (LNs) have demonstrated success as a useful model for building a learning health system, envisioned by the National Academy of Medicine as a system in which innovation and continuous improvement are achieved through stakeholder alignment and in which both known best practices and new knowledge generation are embedded in healthcare delivery processes.1 The results-oriented LN model has become increasingly popular in paediatrics, where there is often a lack of evidence-based best practices. Paediatric LNs aim to improve outcomes and generate new knowledge by using an actor-oriented network structure compose...
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Bates, K. E., Madsen, N. L., Lyren, A., Krack, P., Anderson, J. B., Lannon, C. M., Wooton, S. Tags: Viewpoints Source Type: research
Documenting the indication for antimicrobial prescribing: a scoping review
Conclusion
There is growing interest in the importance of documenting an indication when prescribing antimicrobials. While antimicrobial indication documentation is not uniformly implemented, several studies have shown that multipronged approaches can be used to improve this practice. Emerging evidence demonstrates that antimicrobial indication documentation is associated with improved prescribing and patient outcomes both in community and hospital settings. But setting-specific and larger trials are needed to provide a more robust evidence base for this practice. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Saini, S., Leung, V., Si, E., Ho, C., Cheung, A., Dalton, D., Daneman, N., Grindrod, K., Ha, R., McIsaac, W., Oberai, A., Schwartz, K., Shiamptanis, A., Langford, B. J. Tags: Systematic review Source Type: research
Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach
Overprescribing of antibiotics in primary care is one of the important drivers of antimicrobial resistance (AMR) internationally.1 Previous studies estimated that one-fifth to one-third of UK antibiotic prescriptions in primary care are unnecessary or inappropriate.2 The study by van Staa and colleagues3 published in this issue of BMJ Quality & Safety delivers additional insights into prescribing practices by primary care physicians (general practitioners, GPs) in the UK. Analysing data from more than 6000 GPs in 466 general practices between 2012 and 2017, they found large variability in prescribing practices as measu...
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Krockow, E. M., Harvey, E. J., Ashiru-Oredope, D. Tags: Editorials Source Type: research
Reporting on implementation trials with null findings: the need for concurrent process evaluation reporting
The Prioritising Responses of Nurses to deteriorating patient Observations (PRONTO) trial reported in this issue of BMJ Quality and Safety describes results of a trial that overall, despite a few positive findings among the large number of planned comparisons performed, produced results that supported rather than rejected the study null hypotheses.1 This is a disappointing result for the investigators, who put considerable time and energy into this study; for funders, who hoped to learn how to positively influence the quality and safety of nursing care for seriously ill adults; and for readers, who also hoped to learn how ...
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Sales, A. Tags: Editorials Source Type: research
Why identifying adverse events in paediatric emergency care matters
The emergency department (ED) abounds with hazards that might lead to adverse events (AEs). Clinicians must make frequent, high-consequence decisions with high diagnostic uncertainty as part of ad hoc teams taking care of patients not generally known to them.1 This occurs in the context of a sometimes chaotic environment with frequent interruptions, handoffs and shift changes. As a result, the ED tends to magnify cognitive biases that can result in AEs—particularly diagnostic AEs.2 This is especially problematic for children who account for 23 million ED visits in the USA annually and are particularly vulnerable to A...
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Michelson, K. A., Griffey, R. T. Tags: Editorials Source Type: research
