Quality and Safety From Evolution to Revolution

In order to improve safety, the organization of care is evolving from safety models centered on the individual, towards “systemic” models such as the “Swiss cheese” model developed by James Reason. I will describe how the University Hospitals of Geneva (HUG) have integrated such a model and has set up an incident reporting system. The use that can be made of such a system will then be illustrated by several case analyses, which include improvement strategies. To speak of errors invariably raises the question of disciplinary measures. Should one aim for a “Blame Free Culture” or adopt the concept of a “Just Culture”. To help managers develop a “Just Culture” and determine which errors deserve disciplinary measures, I will present the “incident decision tree”. Finally, I will explore the importance of human factors on safety through various research projects. One must not lose sight however, of the fact that safety is only one of the six dimensions of quality. The others, effectiveness, efficiency, patient-centeredness, timeliness and equity are equally important. Processes play a pivoting role in enabling one to juggle these different dimensions and thus provide optimal care. To master such processes one can look to the industry for concepts and tools. I will examine how these can be applied to reduce unjustified variability by for example developing clinical pathways. Strategies implemented to improve all aspects of health care quality are also evolving from an individual approach (centered on a practitioner or a hospital) to a more systemic one. The new challenges today are to decompartmentalize, to share expertise among the different actors (physicians, hospitals, insurance companies), to pool information vital for coordinating professionals and evaluating processes and to develop new regulation models between health care providers. The ultimate goal is not to provide more care, but care of higher value. That is why we can speak of a revolution and not merely an evolution

General and Vulnerable Population’s Satisfaction With the Healthcare System in Urban and Rural Areas: Findings From the European Social Survey

Introduction: Access to the healthcare system when patients are vulnerable and living outside metropolitan areas can be challenging. Our objective was to explore healthcare system satisfaction of urban and rural inhabitants depending on financial and health vulnerabilities. Methods: Repeated cross-sectional data from 353,523 European citizens (2002–2016). Multivariable associations between rural areas, vulnerability factors and satisfaction with the healthcare system were assessed with linear mixed regressions and adjusted with sociodemographic and control factors. Results: In unadjusted analysis, the people who lived in houses in the countryside and those who lived in the suburbs were the most satisfied with the healthcare system. In the adjusted model, residents living in big cities had the highest satisfaction. Financial and health vulnerabilities were associated with less satisfaction with the healthcare system, with a different effect according to the area of residence: the presence of health vulnerability was more negatively correlated with the healthcare system satisfaction of big city inhabitants, whereas financial vulnerability was more negatively correlated with the satisfaction of those living in countryside homes. Conclusion: Vulnerable residents, depending on their area of residence, may require special attention to increase their satisfaction with the healthcare system.</p

Does the patient's inherent rating tendency influence reported satisfaction scores and affect division ranking?

To determine the impact of adjusting for rating tendency (RT) on patient satisfaction scores in a large teaching hospital and to assess the impact of adjustment on the ranking of divisions

Variation in pressure ulcer prevalence and prevention in nursing homes: A multicenter study

To estimate the prevalence of pressure ulcers in nursing homes and its variability, the frequency of use of preventive measures and treatment

Effects of a pressure-ulcer audit and feedback regional programme at 1 and 2 years in nursing homes: A prospective longitudinal study

Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes