Improving the quality of self-management support in ambulatory cancer care: a mixed-method study of organisational and clinician readiness, barriers and enablers for tailoring of implementation strategies to multisites
Conclusions
The CFIR and CFIR-ERIC were valuable tools for tailoring SMS implementation to readiness and barriers/enablers, whereas NPT helped to clarify the clinical work of implementation. Our approach to tailoring of implementation strategies may have relevance for other studies. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - December 16, 2021 Category: Health Management Authors: Howell, D., Powis, M., Kirkby, R., Amernic, H., Moody, L., Bryant-Lukosius, D., O'Brien, M. A., Rask, S., Krzyzanowska, M. Tags: Original research Source Type: research
Measuring overuse: a deceptively complicated endeavour
Choosing Wisely is a campaign aimed at reducing unnecessary tests, procedures and treatments.1 The goals of the campaign have been to both reduce healthcare expenditures and to prevent harms associated with inappropriate care—such as adverse effects of medications or radiation exposure from unwarranted imaging. The premise is clear and rather simple—do not order something the patient does not need. Yet, when applying a rigorous scientific improvement lens to reducing overuse, measurement nuances make evaluating this phenomenon anything but simple. Appropriateness is specific to clinical scenarios rather than be...
Source: Quality and Safety in Health Care - December 16, 2021 Category: Health Management Authors: Soong, C., Wright, S. M. Tags: Editorials Source Type: research
Peripherally inserted central catheters: spreading the MAGIC beyond Michigan
Central venous access catheters are often used for patients requiring repeated infusions, blood sampling, invasive monitoring or where peripheral access is difficult. For intravenous access of up to 2 weeks in duration, a midline catheter is usually satisfactory, but for longer-term use, peripherally inserted central catheters (PICCs) are increasingly used, including in clinical areas outside of critical care.1 Despite enabling complex care to be delivered more easily, these catheters are associated with significant complications—including central line associated bloodstream infections (CLABSI), venous thromboembolis...
Source: Quality and Safety in Health Care - December 16, 2021 Category: Health Management Authors: Wilson, P., Rhodes, A. Tags: Editorials Source Type: research
The need for quality self-management support in cancer care
The number of people living with and beyond cancer is rising rapidly. With earlier detection and better treatments many people are living for years following a diagnosis of cancer. Healthcare systems need to adapt to manage this demand and better meet the needs of this growing population.1 The consequences of cancer and its treatment are common, can arise at any point and may be long lasting.2 They can have a significant impact on daily life and include a range of physical symptoms and late effects such as pain, fatigue, bowel dysfunction; psychological concerns such as anxiety, depression and fear of recurrence; and socia...
Source: Quality and Safety in Health Care - December 16, 2021 Category: Health Management Authors: Foster, C. Tags: Editorials Source Type: research
High Reliability and 'Cargo Cult QI: response to Sutcliffe et al. BMJ Qual Saf 2017;26:248-51
In their article regarding high-reliability organisations, Sutcliffe et al1 argue that healthcare's failure to understand the fundamental concepts that underlie high reliability has limited their impact on patient safety and healthcare quality. In considering their claims, an important issue arises that extends beyond the pursuit of high reliability: the failure within healthcare to develop a nuanced understanding of the theoretical basis for improvement methodologies. More specifically, the pressure to pursue quality improvement (QI) initiatives may presently exceed our expertise for achieving them successfully. This is a...
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Smaggus, A., Goldszmidt, M. Tags: Correspondence Source Type: research
Incident reporting: rare incidents may benefit from national problem solving
We would like to congratulate the authors on the pragmatic nationwide approach that they have adopted in Denmark to address the key issues around incident reporting. Rabol and colleagues1 highlight again the challenges of collecting and meaningfully using such data. Though experts in Denmark have drawn many of the same conclusions reached in our Delphi exercise,2 it is interesting that our findings differed on the usefulness of incident reports to detect rare events. The Danish Society concluded that rare events are difficult to detect due to deficiencies in data mining and that efforts are better spent solving known safet...
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Howell, A.-M., Burns, E. M., Hull, L., Mayer, E., Sevdalis, N., Darzi, A. Tags: Correspondence Source Type: research
Incident reporting must result in local action
It was with great interest that we read the study of Howell and colleagues.1 In 2003, Denmark was the first country in the world to adopt a law on patient safety that obligated hospital staff to report, the hospitals to react and the National Board of Health to communicate the learning from patient safety incidents. The national reporting system was made strictly confidential, with a clear division between disciplinary and learning functions. Local data are transmitted anonymously to the national level. In 2010 and 2011, the law was expanded to cover all of healthcare, including primary care, and allowing incident reportin...
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Rabol, L. I., Gaardboe, O., Hellebek, A. Tags: Correspondence Source Type: research
Learning from near misses in aviation: so much more to it than you thought
Since its inception, the patient safety movement has been obsessed with reporting systems; roughly 20% of the To Err Is Human report1 dealt with some aspect of reporting; similarly, about 10% of the articles in BMJ Quality & Safety (and its predecessors) mention ‘reporting’ in their title, abstract or keywords. This interest sprang from an unholy trinity—an infortuitous combination of the epidemiological bent of many health professionals interested in safety, the epistemological blinders that a medical education produces2 and a kind of ‘aviation envy’—a fascination with aviation safe...
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Wears, R. L. Tags: Book reviews Source Type: research
Patient and family empowerment as agents of ambulatory care safety and quality
The objectives of this viewpoint are twofold. The first is to hypothesise pathways through which an empowered patient–family partnership may effectively advance healthcare safety and quality in ambulatory... (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Roter, D. L., Wolff, J., Wu, A., Hannawa, A. F. Tags: Viewpoints Source Type: research
Can we use patient-reported feedback to drive change? The challenges of using patient-reported feedback and how they might be addressed
Introduction The resolve to put patients at the heart of the National Health Service (NHS) has been ubiquitous in the aftermath of the Francis Report, and the policy agenda is beginning to reflect attempts to deliver that promise. The introduction of new care models at NHS ‘vanguard’ sites, the 3-year target to give all patients access to their electronic care records, and the expansion of integrated care services all exemplify the salience of patient-centricity at the national level.1 This pattern has been witnessed across many developed health systems.2 The ideals of this paradigm have also captured the atten...
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Flott, K. M., Graham, C., Darzi, A., Mayer, E. Tags: Viewpoints Source Type: research
Implementation and de-implementation: two sides of the same coin?
Avoiding low value care received increasing attention in many countries, as with the Choosing Wisely campaign and other initiatives to abandon care that wastes resources or delivers no benefit to patients. While an extensive literature characterises approaches to implementing evidence-based care, we have limited understanding of the process of de-implementation, such as abandoning existing low value practices. To learn more about the differences between implementation and de-implementation, we explored the literature and analysed data from two published studies (one implementation and one de-implementation) by the same ort...
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: van Bodegom-Vos, L., Davidoff, F., Marang-van de Mheen, P. J. Tags: Special article Source Type: research
The global burden of diagnostic errors in primary care
Diagnosis is one of the most important tasks performed by primary care physicians. The World Health Organization (WHO) recently prioritized patient safety areas in primary care, and included diagnostic errors as a high-priority problem. In addition, a recent report from the Institute of Medicine in the USA, ‘Improving Diagnosis in Health Care’, concluded that most people will likely experience a diagnostic error in their lifetime. In this narrative review, we discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. We synthesize available literature to discu...
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., Thompson, M. J. Tags: Open access Narrative review Source Type: research
Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation
Conclusions
Our results provide support for the reliability and validity of the HVCCS to assess high-value care culture among front-line clinicians. HVCCS may be used by healthcare groups to identify target areas for improvements and to monitor the effects of high-value care initiatives. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Gupta, R., Moriates, C., Harrison, J. D., Valencia, V., Ong, M., Clarke, R., Steers, N., Hays, R. D., Braddock, C. H., Wachter, R. Tags: Original research Source Type: research
A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety
Conclusions
Some interruptions appear beneficial. Technologists' self-initiated strategies to support safe work practices appear to be an important element in supporting a resilient work environment in nuclear medicine. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Larcos, G., Prgomet, M., Georgiou, A., Westbrook, J. Tags: Open access Original research Source Type: research
Bed utilisation and increased risk of Clostridium difficile infections in acute hospitals in England in 2013/2014
Conclusions
While policymakers and managers wishing to target healthcare providers with high CDI rates should look at bed utilisation measures, focusing on these alone is unlikely to have the desired impact. Instead, strategies to combat CDI must take a wider perspective on contributory factors at the institutional level. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 18, 2017 Category: Health Management Authors: Vella, V., Aylin, P. P., Moore, L., King, A., Naylor, N. R., Birgand, G. J. C., Lishman, H., Holmes, A. Tags: Original research Source Type: research
