Patient safety in health care professional educational curricula: examining the learning experience

This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

Learning about patient safety: organisational context and culture in the education of health care professionals

Objectives This study investigated the formal and informal ways pre-registration students from medicine, nursing, physiotherapy and pharmacy learn about keeping patients safe. This paper gives an overview of the study and explores findings in relation to organizational context and culture. Methods The study employed a phased design using multiple qualitative methods. The overall approach drew on ‘illuminative evaluation’. Ethical approval was obtained. Phase 1 employed a convenience sample of 13 pre-registration courses across the UK. Curriculum documents were gathered, and course directors interviewed. Phase 2 used eight case studies, two for each professional group, to develop an in-depth investigation of learning across university and practice by students and newly-qualified practitioners in relation to patient safety, and to examine the organizational culture that students and newly-qualified staff are exposed to. Analysis was iterative and ongoing throughout the study, using frameworks agreed by all researchers. Results Patient safety was felt to have become a higher priority for the health care system in recent years. Incident reporting was a key feature of the patient safety agenda within the organizations examined. Staff were often unclear or too busy to report. On the whole, students were not engaged and may not be aware of incident reporting schemes. They may not have access to existing systems in their organization. Most did not access employers' induction programmes. Some training sessions occasionally included students but this did not appear to be routine. Conclusions Action is needed to develop an efficient interface between employers and education providers to develop up-to-date curricula for patient safety

Measuring Youth Program Quality: A Guide to Assessment Tools

Thanks to growing interest in the subject of youth program quality, many tools are now available to help organizations and systems assess and improve quality. Given the size and diversity of the youth-serving sector, it is unrealistic to expect that any one tool or process will fit all programs or circumstances. This report compares the purpose, history, structure, methodology, content and technical properties of nine different program observation tools

Why and How Your Traceability Should Evolve: Insights from an Automotive Supplier

Traceability is a key enabler of various activities in automotive software and systems engineering and required by several standards. However, most existing traceability management approaches do not consider that traceability is situated in constantly changing development contexts involving multiple stakeholders. Together with an automotive supplier, we analyzed how technology, business, and organizational factors raise the need for flexible traceability. We present how traceability can be evolved in the development lifecycle, from early elicitation of traceability needs to the implementation of mature traceability strategies. Moreover, we shed light on how traceability can be managed flexibly within an agile team and more formally when crossing team borders and organizational borders. Based on these insights, we present requirements for flexible tool solutions, supporting varying levels of data quality, change propagation, versioning, and organizational traceability.Comment: 9 pages, 3 figures, accepted in IEEE Softwar

Preparedness is not enough: understanding transitions as critically intensive learning periods

Objectives: Doctors make many transitions whilst they are training and throughout their ensuing careers. Despite studies showing that transitions in other high risk professions such as aviation have been linked to increased risk in the form of adverse outcomes, the effects of changes on doctors’ performance and consequent implications for patient safety have been under-researched. The purpose of this project was to investigate the effects of transitions upon medical performance. Methods: The project sought to focus on the inter-relationships between doctors and the complex work settings into which they were transitioning. To this end, a ‘collective’ case study of doctors was designed. Key transitions for Foundation Year and Specialist Trainee doctors were studied. Four levels of the case were examined: the regulatory and policy context; employer requirements; the clinical teams in which doctors worked; and the doctors themselves. Data collection included interviews, observations and desk-based research.. Results: We identified a number of problems with doctors' transitions that can all adversely affect performance. A) Transitions are regulated but not systematically monitored. B) Actual practice (as observed and reported) was determined much more by situational and contextual factors than by the formal (regulatory and management) frameworks. C) Trainees’ and health professionals’ accounts of their actual experience of work showed how performance is dependent on local learning environment. D) We found that the increased regulation of clinical activity through protocols and care pathways helps trainees’ performance whilst the less regulated aspects of work such as rotas, induction and multiple transitions within rotations can impede the transition. Conclusions: Transitions may be reframed as critically intensive learning periods (CILPs) in which doctors engage with the particularities of the setting and establish working relationships with doctors and other professionals. Institutions and wards have their own learning cultures which may or may not recognise that transitions are CILPS. The extent to which these cultures take account of transitions as CILPs will contribute to the performance of new doctors. There are therefore implications for practice, and for policy, regulation and research

Understanding the role of local safety groups in managing safety practices between micro construction firms and principal contractors

Construction projects incorporate the input of a range of tradesmen and different sized firms, ranging from micro to large organisations. Working practices of micro construction firms are carried out in an informal manner while larger organisations tend to adopt more formal on-site management techniques. Many micro firms seek to develop long-term relationships with large principal contractors and a major strain on their relationships stem from the difference in safety management techniques they employ. Faced with a fundamental shift in their style of safety management, workers of micro construction firms must successfully negotiate this challenge. Against this background, records from the Health and Safety Executives show year on year reductions in accident and incident rates in the East Midlands, an indication that the safety practices on projects are being implemented more effectively. Some of this success has been attributed to the efforts of local safety groups, such as Nottinghamshire Occupational Safety and Health Association (NOSHA). As such, it is important that the interdependencies between large principal contractors and micro firms, and the role that safety groups such as NOSHA play in managing this relationship are better understood. This paper presents interviews conducted with some members of NOSHA. This is the first of two phases of empirical work. The roles that the members of the local safety group perform have been found to go beyond simply promoting safety awareness and safety knowledge on site. They have been found to help in conflict resolution among the various construction parties. Such practices help create a harmonious working environment and subsequently lead to long-term working relations