Implications of resource constraints and high workload on speaking up about threats to patient safety: a qualitative study of surgical teams in Ghana
Conclusion
Under-resourcing and high workload contribute significantly towards undermining employee voice about unsafe care. We highlight the central role that adequate funding and resourcing play in creating safe environments and that supporting ‘hearer’ courage may be as important as supporting speaking up in the first place. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Mawuena, E. K., Mannion, R. Tags: Original research Source Type: research
Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters
Conclusions
Use of PICCs in Brazilian hospitals appears to be safe and comparable with North America. However, opportunities to improve appropriateness remain. Future studies examining barriers and facilitators to improving device use in Brazil would be welcomed. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Rejane Rabelo-Silva, E., Lourenco, S. A., Maestri, R. N., Candido da Luz, C., Carlos Pupin, V., Bauer Cechinel, R., Bordini Ferro, E., Aurelio Lumertz Saffi, M., do Campo Silva, T. C., Martins de Andrade, L., Sales Gomes, L. F., Alves da Gama, L., Marques Tags: Open access Original research Source Type: research
Examining organisational responses to performance-based financial incentive systems: a case study using NHS staff influenza vaccination rates from 2012/2013 to 2019/2020
Conclusions
We provide compelling evidence that performance-based financial incentives produced threshold effects. Policymakers who set such incentives are encouraged to track threshold effects since they contain information on how organisations are responding to an incentive, what enquiries they may wish to make, how the incentive may be improved and what unintended effects it may be having. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Liaqat, A., Gallier, S., Reeves, K., Crothers, H., Evison, F., Schmidtke, K., Bird, P., Watson, S. I., Khunti, K., Lilford, R. Tags: Open access Original research Source Type: research
Unacceptable behaviours between healthcare workers: just the tip of the patient safety iceberg
Since the publication of the 1999 ‘To Err is Human’ report by the Institute of Medicine, healthcare researchers have been attentive to factors potentially associated with iatrogenic risk, or in other words medical care that exacerbates or complicates an existing patient condition. While studies have explored a variety of patient factors (eg, age and weight of neonates1) and situational constraints (eg, staffing ratios and healthcare worker (HCW) sleep deprivation2 3), the risks posed by negative interpersonal interactions in healthcare contexts remain understudied and poorly understood. It is therefore timely t...
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Bamberger, E., Bamberger, P. Tags: Editorials Source Type: research
Improving health equity through clinical innovation
Despite having the most expensive system of maternity care in the world, outcomes for birthing people in the USA are worse than other high-income nations. Critically, US outcomes also reflect deep and persistent racial and ethnic health disparities. The maternal mortality rate (deaths occurring within 42 days of pregnancy per 100 000 live births) in the USA was 23.8 in 2020, the highest of all comparable countries.1–5 Non-Hispanic black (NHB) and Native American individuals are two to three times more likely to die during or after childbirth compared with those who are non-Hispanic white (NHW).2 6 In contrast, matern...
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Alfred, M., Tully, K. P. Tags: Editorials Source Type: research
Speaking up in resource-constrained settings: how to secure safe surgical care in the moment and in the future?
The provision of safe surgical care in low- and middle-income countries is challenging. Mortality and morbidity in the perioperative period are high and likely to rise as the burden of non-communicable diseases increases in these countries.1 Both access to, and quality of, surgical and perioperative care remain challenging in much of the world. In many African countries, for example, risk of mortality following surgery is around twice the global average, despite more favourable patient risk profiles in terms of age and acuity of condition.2 Resource deficiencies appear to be heavily implicated in these poorer outcomes, esp...
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Martin, G. P., Armstrong, N. Tags: Editorials Source Type: research
Replicating and publishing research in different countries and different settings: advice for authors
At BMJ Quality & Safety, we frequently receive manuscripts that in some way replicate prior research. For example, authors submit research seeking to validate previously published tools such as safety climate surveys, to measure the frequency of a known safety event or quality concern or to test an existing intervention in new settings such as in different countries. This research is clearly important for stakeholders in the new setting concerned. However, a key question for us as editors is when such studies should be published in our journal, which has a broad and international remit, rather than a national or more c...
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Franklin, B. D., Thomas, E. J. Tags: Editorials Source Type: research
Pay-for-performance incentives for health worker vaccination: looking under the hood
Since the earliest days of the COVID-19 vaccines, voluntary uptake of the vaccine by healthcare workers has been below optimal levels in many countries and across different healthcare systems.1–5 Health systems have implemented diverse initiatives to both increase healthcare worker motivation to vaccinate and close intention–behaviour gaps. Despite substantial effort to promote COVID-19 vaccination among healthcare workers in the USA, for example, nearly a third were not fully vaccinated as of September 2021.6 Many employers and governments have since considered or implemented vaccine mandates,7–9 with st...
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Buttenheim, A. M., Thirumurthy, H. Tags: Editorials Source Type: research
What is the potential of patient shadowing as a patient-centred method?
Introduction A recently published study by Yanes et al1 suggests that observation in clinical environments may have an especially valuable role in capturing the organisational and situational factors that shape clinical processes. In data-dense and high-risk environments, observation sheds light on the specific subprocesses of complex clinical activities (eg, information transfer, communication patterns, distractions) and their effects on patient care. Observation also captures aspects of patients’ and providers' experiences that may be missed by traditional research (eg, interviews or questionnaires) and that people...
Source: BMJ Quality and Safety - March 19, 2017 Category: Journals (General) Authors: Liberati, E. G. Tags: Viewpoints Source Type: research
Implementation of the trigger review method in Scottish general practices: patient safety outcomes and potential for quality improvement
Conclusions
The great majority of clinician reviewers ‘successfully’ applied the TRM, uncovering important but previously undetected PSIs, which prompted care teams to take action during and after the trigger reviews. The method and data generated have the potential to drive improvements in related care processes at the practice, regional and national health system level. TRM arguably increased ‘ownership’ of the safety challenge and clinician engagement in implementing their solutions to specific problems identified. Our results suggest that the TRM has potential as a feasible, pragmatic approach t...
Source: BMJ Quality and Safety - March 19, 2017 Category: Journals (General) Authors: de Wet, C., Black, C., Luty, S., McKay, J., O'Donnell, C. A., Bowie, P. Tags: Research and reporting methodology Source Type: research
Theory-based and evidence-based design of audit and feedback programmes: examples from two clinical intervention studies
Background
Audit and feedback (A&F) is a common intervention used to change healthcare provider behaviour and, thus, improve healthcare quality. Although A&F can be effective its effectiveness varies, often due to the details of how A&F interventions are implemented. Some have suggested that a suitable conceptual framework is needed to organise the elements of A&F and also explain any observed differences in effectiveness. Through two examples from applied research studies, this article demonstrates how a suitable explanatory theory (in this case Kluger & DeNisi's Feedback Intervention Theory (FIT)) can...
Source: BMJ Quality and Safety - March 19, 2017 Category: Journals (General) Authors: Hysong, S. J., Kell, H. J., Petersen, L. A., Campbell, B. A., Trautner, B. W. Tags: Narrative review Source Type: research
A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships
Conclusions
Patients and care partners reported potential safety concerns in about one-quarter of reports, often resulting in a change to the record or care. Early data from an OpenNotes patient reporting tool may help engage patients as safety partners without apparent negative consequences for clinician workflow or patient-clinician relationships. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - March 19, 2017 Category: Journals (General) Authors: Bell, S. K., Gerard, M., Fossa, A., Delbanco, T., Folcarelli, P. H., Sands, K. E., Sarnoff Lee, B., Walker, J. Tags: Original research Source Type: research
A scoping review of online repositories of quality improvement projects, interventions and initiatives in healthcare
Discussion
With growing interest in sharing and spreading best practices and increasing reliance on QI as a key contributor to health system performance, the role of QI repositories is likely to expand. Designing future QI repositories based on knowledge of the range and type of features available is an important starting point for improving their usefulness and impact. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - March 19, 2017 Category: Journals (General) Authors: Bytautas, J. P., Gheihman, G., Dobrow, M. J. Tags: Original research Source Type: research
Assessing content validity and user perspectives on the Team Check-up Tool: expert survey and user focus groups
Conclusion
The findings support the conclusion that the TCT measures meaningful areas of context and implementation in team-based QI initiatives, particularly intervention activity tracking, review and sharing of performance data and team progress barriers. We offer a modified instrument with a framework for real-time measurement of important elements of implementation and context of QI teams based on the findings. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - March 19, 2017 Category: Journals (General) Authors: Marsteller, J. A., Hsu, Y.-J., Chan, K. S., Lubomski, L. H. Tags: Original research Source Type: research
How does audit and feedback influence intentions of health professionals to improve practice? A laboratory experiment and field study in cardiac rehabilitation
Conclusions
When confronted with clinical performance feedback, performance scores and benchmark comparisons influenced health professionals' intentions to improve practice. However, there was substantial variation in these intentions, because professionals disagreed with benchmarks, deemed improvement unfeasible or did not consider the indicator an essential aspect of care quality. These phenomena impede intentions to improve practice, and are thus likely to dilute the effects of audit and feedback interventions.
Trial registration number
NTR3251, pre-results. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - March 19, 2017 Category: Journals (General) Authors: Gude, W. T., van Engen-Verheul, M. M., van der Veer, S. N., de Keizer, N. F., Peek, N. Tags: Original research Source Type: research
