Analyze Customer Complaint in Healthcare Using Root Cause Analysis Technique

This project is to presents an approach for applying Root Cause Analysis (RCA) in improving the healthcare service for the purpose of investigating of need for corrective action, and tracking and trending the services problems. For trending the organization will be able to determine how often a particular error occurs or how often a particular unit or department of the hospital involved. Root Cause Analysis should be performed as soon as possible after the error or variance occurs and should be involved by all parties, to avoid speculation that will dilute the facts. Otherwise the important details may be missed. The development and utility of the proposed methodology presented in this research is iiiustrated using both a hypothetical example and a real world application

Systematic Review: Efektivitas Metode Failure Mode and Effect Analysis (FMEA) terhadap Mutu Pelayanan Rumah Sakit

Kejadian medication error, infeksi nosokomial, pasien jatuh, luka tekan (dekubitus) banyak ditemukan di rumah sakit. Kejadian tersebut dapat dicegah dengan mengidentifikasi risiko dan mencari akar masalahnya menggunakan Failure mode and effect analysis (FMEA). Penelitian ini bertujuan mengambarkan efektivitas metode FMEA terhadap mutu pelayanan rumah sakit dengan metode systematic review. Penelitian ini dimulai dari pencarian data menggunakan lima database dengan kata kunci “FMEA or Management Risk or HFMEA” and “service quality” and “hospital” kemudian melakukan skrinning dan penilaian kelayakan terdapat sebanyak 17 artikel. Hasil dari penelitian ini tujuh belas artikel menggambarkan metode FMEA di beberapa proses pelayanan di rumah sakit yang hasil evaluasi metode FMEA dapat meningkatkan mutu pelayanan. Oleh karena itu metode FMEA efektif diterapkan pada proses pelayanan dimulai dari mengidentifikasi resiko kegagalan dalam pelayanan, mengimplementasikan tindakan preventif sehingga meningkatkan mutu pelayanan rumah sakit dalam bentuk dimensi keamanan, efektif dan efisien. Sehingga penelitian ini merekomendasikan penggunaan metode FMEA dalam mengidentifikasi risiko kegagalan untuk meningkatkan kualitas pelayanan

Development and validation of surgical Patients’ own Safety Checklist – PASC : A new tool to involve patients in safety

Bakgrunn: Sjekklister for bruk av kirurgisk helsepersonell er vist å ha forbedret teamarbeid og pasientsikkerhet. Fremdeles opplever et stort antall pasienter feil som kunne ha vært forebygget. Verdenshelseorganisasjons globale pasientsikkerhetsplan (2021-2030) har som mål å eliminere alle feil som kan forebygges innenfor helsesektoren. De anerkjenner at for å nå dette målet må pasientene bli mere involvert i pasientsikkerhetsarbeid, et behov som også er anerkjent i forskning og av helseorganisasjoner, sykehus og helsearbeidere. Det er derfor behov for initiativ som styrker pasientinvolvering. En sjekkliste for kirurgiske pasienter er et slikt initiativ. I denne avhandlingen er en slik sjekkliste utviklet og validert, samt at sjekklistens gjennomførbarhet er undersøkt. Mål: 1. Undersøke og beskrive risikoelementer og muligens innhold for en kirurgisk pasient sjekkliste før og etter kirurgi. 2. Utvikle og validere kirurgiske pasienters sjekkliste til bruk før og etter kirurgi. 3. Undersøke gjennomførbarheten av kirurgiske pasienters sjekkliste, ved å identifisere dens bruk, rekrutering, barrierer og drivere for videre implementering i en stegvis klynge-randomisert kontrollert studie. Metode: Kvalitative og kvantitative metoder er brukt, med et rammeverk for komplekse intervensjoner som overordnet struktur. Alle data ble samlet inn på Haukeland Universitets sykehus, og Førde Sentralsykehus. I studie I, ble data samlet inn fra fem kirurgiske avdelinger (en fra Førde og 4 fra Haukeland universitetssykehus). I studie II og III, deltok en avdeling i tillegg, fra Haukeland universitetssykehus. Studie I hadde en kvalitativ tilnærming, mens både kvalitative og kvantitative tilnærminger ble brukt i studie II og III. Induktiv innholdsanalyse ble brukt i studienes kvalitative deler. I studie I, ble fokusgruppeintervju gjennomført med post-operative pasienter og helsearbeidere. Under sjekklistens utviklingsprosess, i studie II, ble en konsensusmetode som inkluderte et ekspertpanel brukt for å oppnå enighet om innholdet i sjekklisten. Det ble gjennomført en samlet datainnsamling fra de samme kirurgiske avdelingene i studie II og III, både for de kvalitative og kvantitative data. Tre fokusgruppeintervju ble gjennomført med post-operative pasienter som hadde brukt pasientenes kirurgiske sjekkliste. Her ble også kvantitative data samlet fra kirurgiske pasienter som hadde brukt sjekklisten. Dataen ble analysert med deskriptiv statistikk for å undersøke bruken av sjekkpunktene og rekruteringen. En kji-kvadrat test ble brukt for å sammenligne pasientkarakteristikken. I studie II, ble pasientene bedt om å skåre hvert sjekklistepunkt ved bruk av en valideringsindeks for innholdet. Reliabiliteten av pasientenes sjekkliste validering ble undersøkt med Intraclass Correlation Coefficient. For punktene som pasientene skåret lavt på relevans på valideringsindeksen, ble det gjort en risikovurdering av hvert enkelt punkt med Health Failure Mode Effect hazard skåring. Risikovurderingen ble utført for å sikre at punkter på sjekklisten som kunne ha høy risiko for feil ikke ble fjernet fra sjekklisten grunnet lav relevans på pasientenes valideringsindeks. Resultat: I studie I, identifiserte pasienter og helsearbeidere riskområder som kunne brukes som innhold i kirurgiske pasienters sjekkliste. Mulige riskområder ble plassert under fire hovedkategorier som representerte når og hvilke informasjon pasientene bør få gjennom det kirurgiske forløpet. De fire kategoriene er; "Pre-operativ informasjon", "Pre-operativ forberedelser", "Post-operativ informasjon" og "Videre plan og oppfølging". I tillegg utrykte både pasientene og helsearbeidere et behov for en mer systematisk praksis for pasientinformasjon, før og etter operasjon. I studie II, ble funnene fra studie I presenter for et ekspertpanel og gjennom en konsensusprosess ble det oppnådd enighet om innholdet i sjekklisten. 215 av 428 inviterte kirurgiske pasienter deltok i studien og validerte punktene på pasientenes sjekkliste. Pasientene var enige om relevansen av de fleste sjekklistepunktene, men fem punkter ble fjernet grunnet lav relevans og risiko for komplikasjoner. Seks punkter ble redesignet for å forbedre brukervennligheten. Scale-level Content Validity Index/Averages på sjekklistens to pre-operative og post-operative deler var henholdsvis 0,89 og 0.93, som indikerer en god aksept av sjekklistens innhold. Intraclass Correlation Coefficient indikerte en utmerket reliabilitet av pasientenes validering med en skår på 0.97, og et smalt 95% konfidensintervall på 0.96-0.99. Funnene fra fokusgruppeintervjuene viste god face-validitet for innholdet i sjekklisten. I tillegg understøttet funnene de kvantitative resultatene som viste behov for å redesignet enkelte sjekklistepunkt. I studie III, brukte 50.2% (428/215) (de samme pasientene som i studie II) den kirurgiske pasient sjekklisten og 86.5% (186/215) av pasientene svarte på mer enn 80% av sjekklistepunktene. Årsaker for ikke å bruke sjekklisten var for 24.1% (103/428) av pasientene relatert til kirurgisk strykninger, 19.1% (85/428) leverte ikke samtykke, 5.1% (22/428) mistet eller glemte å levere sjekklisten, og 0.7% (3/428) døde mens de var på sykehuset. Fokusgruppeintervjuene identifiserte barrierer og drivere for bruken og implementering av sjekklisten som; viktigheten av å la pasientene ha tid til å bruke sjekklisten, design (brukervennlighet), og viktigheten at helsearbeidere fremmet sjekklistebruken. Driverne for å bruke sjekklisten var at den ga støtte gjennom det kirurgiske forløpet og økte kommunikasjonen mellom pasient og helsearbeider. Konklusjon: Kirurgiske pasienters sjekkliste ble utviklet gjennom studie I og II og dens gjennomførbarhet ble undersøkt i studie III, i forbindelse med en planlagt klinisk studie. Det er sterke bevis at den kirurgiske pasienters sjekklisten er relevant for pasientene og at den systematiserer pre-operativ og post-operativ informasjon. Det er også en indikasjon at kirurgiske pasientenes sjekklister er et steg i riktig retning for å øke pasientinvolvering i pasientsikkerhet, men det er behov for en klinisk studie for å undersøke dens effekter på komplikasjoner og dødelighet.Background: Checklists used by healthcare professionals in the surgical field have contributed to improved teamwork and patient safety. Still, the large number of patients experiencing preventable errors worldwide is unacceptable. WHO’s Global Safety Action plan (2021-2030) aims to eliminate all preventable harm in healthcare. They acknowledge that patient involvement in safety must be more prominent to achieve this, a need which is also recognised in current research and by healthcare organisations, hospitals, and healthcare professionals. Therefore, patient involvement initiatives are warranted. The surgical patient’s safety checklist is such an initiative. This thesis has developed and validated the surgical patients’ safety checklist, and investigated its feasibility. Aims: 1. To explore and describe the risk elements and perceived content for a safety checklist for patients before and after surgery. 2. To develop and validate a surgical patients’ safety checklist before and after surgery. 3. To investigate the feasibility of the surgical patients’ safety checklist usage, recruitment, barriers and drivers to implementation before a large-scale Stepped Wedged Cluster Randomised Controlled Trial. Methods: Qualitative and quantitative methods have been applied, with a complex intervention model as an overarching framework. All data was collected at Haukeland University Hospital, and Førde Central Community Hospital. In study I, data were collected from five surgical wards (one from Førde, four from Haukeland University Hospital). In study II and III, an additional surgical ward participated from Haukeland University Hospital. A qualitative approach was applied in study I, while both quantitative and qualitative approaches were applied in study II and III. Inductive categorical content analyses were used for the qualitative parts in all three studies. In study I, focus group interviews were carried out with post-surgical patients and healthcare professionals. The checklist development processes in study II, used expert panel consensus processes to achieve agreement on the checklist content. In study II and III, qualitative and quantitative data were collected from the same sample of surgical patients. Three focus groups interviews were conducted with post-surgical patients who had used the patient’s safety checklist. Quantitative data were also collected from surgical patients who had used patients’ surgical safety checklists. The data were analysed using descriptive statistics on checklist item usage and recruitments, and a Chi-squared test to describe patient characteristics. In study II patients were asked to score each checklist item using an item content validation index, and Intraclass Correlation Coefficients were applied to assess the reliability of the patients’ total PASC item validation scoring. Finally, Health Failure Mode Effect Hazard scoring was applied to the items that received a low patient item content relevance score to ensure that high-risk safety items were not removed from the checklist. Results: In study I, patients and healthcare professionals identified patient risk areas that could be used for content in patients’ surgical safety checklist. The possible risk areas were placed under four main categories that representing when the information should be given and type of information patients should receive throughout the surgical pathway. The four categories are: “Pre-operative information”, “Pre-operative preparation”, “Post-operative information”, and “Further plans and follow-ups”. In addition, both patients and healthcare workers expressed a need to systemise information given to the patients before and after surgery. In study II, the findings from study I were presented to an expert panel through several meetings until consensus on the checklist content was achieved. Then, 215 of 428 invited patients, answered and validated each item of the patients’ safety checklist. Most patients agreed on the importance of each item however, five checklist items were removed, due to low patient relevance scoring, while six items were redesigned to improve user-friendliness. The Scale-level Content Validity Index/Averages on the checklist before and after surgery were 0.86 and 0.93 respectively, indicating good patient acceptance of the checklist content. Further, Intraclass Correlation Coefficient indicated excellent reliability of the patients’ validation with a scoring of 0.97 and a narrow confidence interval of 0.96 - 0.99. The data from the focus group interview showed good face validity of the surgical patient’s safety checklist, it also supported the quantitative findings regarding the need for redesigning some items. In study III, 50.2% (428/ 215) patients used the checklist (same patients as in study II). Out of these, 86.5% (186/215) of the patients answered more than 80% of the checklist items. As to patients who did not return the checklist, 24.1% (103/428) were related to surgical cancellations, 19.1% (85/428) did not consent, 5.1% (22/428) lost or just forgot to return it, and 0.7% (3/428) died during hospitalisation. The qualitative interviews identified barriers and drivers for the checklist usage and implementation; such as the importance of allowing time to use the checklist, the design (user-friendliness), and healthcare professionals actively participating in the checklist usage. In Addition, the drivers for the checklist use was that it impetus communication and gave support throughout the surgical pathway. Conclusion: The surgical patients’ safety checklist has been developed through study I and II, and its feasibility has been investigated in study III, prior to an upcoming clinical trial. Overall, there is strong evidence that the checklist content is relevant for patients and that the checklist systemises pre-surgical and pre-discharge information. There is also an indication that a safety checklist for surgical patients is a step in the right direction for increasing patient involvement in safety. However, a clinical trial is necessary to study its effects on complications and mortality.Doktorgradsavhandlin

Analyze Customer Complaint in Healthcare Using Root Cause Analysis Technique

This project is to presents an approach for applying Root Cause Analysis (RCA) in improving the healthcare service for the purpose of investigating of need for corrective action, and tracking and trending the services problems. For trending the organization will be able to determine how often a particular error occurs or how often a particular unit or department of the hospital involved. Root Cause Analysis should be performed as soon as possible after the error or variance occurs and should be involved by all parties, to avoid speculation that will dilute the facts. Otherwise the important details may be missed. The development and utility of the proposed methodology presented in this research is iiiustrated using both a hypothetical example and a real world application

Looking for the “Little Things”: A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource

As prescribing has become the dominant modality of medical treatment, the “pharmaceuticalization” of practice has often resulted in treatment “at a distance”, with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. This paper advocates a team approach to checking patients in care homes systematically for ADRs, using information from manufacturers’ guidelines. It explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation and falls. The ADRe profile is a sophisticated paper-based check-list, which helps nurses and carers play an active role in monitoring signs symptoms that indicate problems. Better monitoring allows doctors and pharmacists to adjust prescribing and respond to identified ADRs. We argue that Implementation of tools like ADRe can be accelerated by changes to the regulatory regime and better inter-professional cooperation

Monitoring Hospital Safety Climate Using Control Charts of Non-harm Events in Reporting Systems

The primary aim of this thesis is to design an approach and demonstrate a methodology to supplement safety culture assessment efforts. The framework affords an enhanced understanding of hospital safety climate, specifically reporting culture, through the use of control charts to monitor non-harm patient safety events documented in reporting systems. Assessing safety culture and climate remains difficult. One of the most common methods to assess safety culture is a self-report survey administered annually. Surveys assess safety climate, because they are a snapshot of the management\u27s and front-line staff\u27s perceptions of safety within their settings. One component of safety culture is reporting culture, which is assessed by survey questions targeting the total number and frequency of events reported by individuals. Surveys use subjective data to measure outcome variables with regard to patient safety event reporting. Relying on subjective data when organizations also collect data on actual reporting rates may not be optimal. Additionally, the time lag limits management\u27s ability to efficiently assess the need for, and the effect of improvements. Strategic interventions may result in effective change, but annual summary data may mask the effects. Additionally, there are advantages to focusing on non-harm events, and capturing non-harm event reporting rates may aid safety climate assessment. Despite the limitations of reporting systems, incorporating actual data may allow organizations to gain a more accurate depiction of the safety climate and reporting culture. With the increased prevalence of reporting systems in healthcare organizations, the data can be used to track and trend reporting rates of the organization. Incorporating control charts can help identify expected non-harm event reporting rates, and can be used to monitor trends in reporting culture. Data in reporting systems are continuously updated allowing quicker assessment and feedback than annual surveys. The methodology is meant to be prescriptive and uses data that hospitals typically collect. Hospitals can easily follow the summarized approach: check for underlying data assumptions, construct control charts, monitor and analyze those charts, and investigate special cause variation as it arises. The methodology is described and demonstrated using simulated data for a hospital and three of its departments

Narrowing the QSEN Competency Gap in New Graduate Registered Nurses

This intervention is an evidence based, change of practice, quality improvement project that evaluates achievement of the six Quality and Safety Education for Nurses (QSEN) competencies of new registered nurse graduates. No intervention with a similar focus was found in an extensive review of the literature. The participants included 16 new graduate registered nurse hires enrolled in a new graduate RN residency program at Tucson Medical Center located in southern Arizona. The Nursing Quality and Safety Self Inventory© (NQSSI©) was used to identify practice gaps perceived by the new RN graduates related to the six QSEN competencies. Once QSEN gaps were identified, the knowledge, attitudes and skills where the greatest gaps existed were analyzed. The emphasis of this project were two QSEN competency gaps that have a significant impact on nursing quality and safe practice; evidence based practice and quality improvement. Evidence based teaching/learning strategies were developed and implemented. A resurvey of the participants was accomplished using the same NQSSI© survey tool as with the initial survey. Data revealed the new graduate RN scores improved by the largest percentage in those QSEN competencies where the evidence based teaching/learning interventions had been focused. Even though a small sample size was involved, the results indicate that the attainment of QSEN core competencies by new graduate RNs can be accelerated with targeted intervention and ultimately improve new graduate RN competence and confidence, job satisfaction, retention, and patient safety and quality patient care

Osteopathic clinical reasoning: an ethnographic study of perceptual diagnostic judgments, metacognition, and reflective practice

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Professional DoctorateThis thesis explores the use of reflective practice in osteopathic medicine and uses the method to narrate my work as an osteopathic practitioner. It explores the development of perceptual diagnostic judgments, and the role of metacognition, intuition and palpation in osteopathic clinical reasoning. A qualitative interpretive approach was used with a novel narrative method as an organising structure. This was broadly based around reflective practice models of Gibbs, (1988), Kolb, (1984) and Carper (1978) and the ideas of Schön (1983). Descriptive texts were constructed from notes taken of my thoughts whilst in the presence of patients. This allowed access, as closely as possible, to my decision making process. Finally, the descriptive texts were expanded into narratives through dialogue with the existing literature and peer review. The narratives were then analysed using thematic analysis to derive an understanding of concepts arising from the data. This thesis argues that osteopathic clinical reasoning involves multisensory perceptual diagnostic judgments that begin as soon as the patient enters the clinic, and arise as a result of the use of mental and visual imagery and embodied senses. The multisensory information that is detected by a practitioner activates pattern recognition, analytic reasoning and provides explicit feedback used in decision making. Diagnosis occurs as a result of piecing together and interpreting the multisensory information whilst maintaining awareness of other diagnostic possibilities. The findings also suggest that osteopathic clinical reasoning involves the supervision of cognition by the metacognitive processes of meta-knowledge (MK), meta-experiences (ME), and meta-skills (MS). The latter are used to plan, monitor, analyse, predict, evaluate and revise the consultation and patient management as suggested by Pesut and Herman (1992). ME is demonstrated by the presence of judgments of learning used to ensure sufficient information has been gathered, and feelings of rightness that are used to perceive the correctness of information arriving and decisions made. The use of reflective practice in this research has developed the understanding of osteopathic clinical reasoning, and demonstrated that it provides a powerful conduit for change in practice. As a result, it enables the provision of better patient-centred osteopathic healthcare incorporating the biopsychosocial model of healthcare. Although rooted in my own osteopathic practice style and strategies, it should have resonance for those within the discipline of osteopathy and has implications for osteopathic education, training and research

Assessment of Nurses Perception towards Medication Errors in Palestinian Hospitals

Background: Medication errors are one of the most common causes of accidental errors affecting patients’ safety and can cause serious consequences for patients. Medication errors are underreported worldwide, particularly in developing countries. Which lead to the lack of information regarding the problems of medication errors. Aim: To assess the input from nurses’ regarding several issues in medication error, exploring their perception towards medication error causes, types, rate, and reporting. which might help in pinpointing some areas in medication safety issues where there is potential for making improvement to be reflected in the nurses practices regarding medication managements at hospitals. Methods: A cross-sectional design was used. Data was collected using a self-administered questionnaire. The study was conducted in three hospitals; public, private, and NGO. A total of 267 nurses participated in the study Findings: The overall response rate was (57.17%). Female were 59.8%, and males 40.2%. The most perceived causes of MEs were lack of pharmacological knowledge and skills (82%), and heavy workload and shortage of staff (77.7%). As for the most common types of MEs, wrong medication dose (57.5%) and wrong time (53.2%) were the most prevalent. The mean number ofcommitted MEs in the past 12 months was 1.94, and the mean number of reporting medication errors in the past 12 months was 1.6. With regard to the most common type of medications involved in MEs, antibiotics was given the highest frequency in MEs. Regarding the level of harm resulted from medication error that occurs in the past 12 months, the higher frequency was for MEs causing temporary harm to patients (28.2%). Moreover, participants from the NGO and public hospitals scored higher than private hospital participants inregard to shortage of nursing staff and heavy work overload cause (P<0.001). Also 57.9% of participants with bachelor’s degree indicated the effect of lacking pharmacological knowledge and skills more than diploma and graduate studies participants (P<0.001). Finally a statistically significant relationship was found in the frequency of committing MEs (P=0.001) and frequency of reporting MEs (P<0.001) in relation to the hospital ownership. Conclusions: the results of the study indicate that there are areas of potential improvements in Palestinian hospitals. Medication safety interventions should be formulated to address strategies to reduce and eliminate medication errors

Improving a Discharge Process to Decrease Readmission Rates

PURPOSE: The purpose of this quality improvement (QI) project was to improve the case management discharge instructions for patients in an inpatient psychiatric and medical unit. It utilized very specific directions on how to address disease progression symptoms outside of the acute care setting in an effort to achieve readmission rates below the 10th percentile (the unit desired). The current case management discharge process was modified in three ways, including: 1) modification of the case management discharge instructions into a user-friendly, one-page format written on a fifth-grade reading level, 2) dividing the discharge instructions section of warning signs into three categories: mild, moderate, and severe symptoms, and 3) the inclusion of a treatment sheet into the new discharge instructions which was given to the patient at discharge. Chart audits, interviews, observation, and pre- and post-intervention surveys were methods used to collect data regarding patient and nurse perceptions of the usefulness of the discharge instructions, as well as compliance with the new discharge process. OUTCOMES: User-friendliness of the discharge instruction was improved significantly from 20% to 87%. Post implementation, all nurses instructed patients about the warning symptoms on the new discharge form. The completion of the discharge compliance summary improved from 75% to 100%. IMPACT: The nurses and QI team reported satisfaction with the new form’s content and user-friendliness, increasing the likelihood that it will be used and potentially reduce readmission rates