Measuring a Safety Culture: Critical Pathway or Academic Activity?

he Institute of Medicine (IOM) identified six core needs in a health care system, the first of which was safety. 1 Furthermore, several IOM committees and others have identified the creation of a “culture of safety ” as the key institutional requirement to achieve safe medical care. 1–3 In this issue of the journal, Modak et al. 4 present an instrument that may help measure the extent to which a patient safety culture exists in an ambulatory setting. While these authors and others have done considerable work on defining and measuring a culture of safety in the hospital setting, 5,6 few have tackled the difficult task of measuring a safety culture in the ambulatory arena within the US health care system. Even in the hospital setting, where there has been more effort, the development of a culture of safety within all US hospitals has been spotty and, for some safety advocates, too slow. 7 There are many potential reasons for the poor progress in developing a culture of safety: confusion about the difference between safety and quality, concerns that increasing safety will further erode profits, or perhaps simply a lack of attention by institutional leaders. Whatever the reasons for the slow pace of transformation across the nation’s 5,000-plus hospitals, it is likely that this transformation will be even more difficult to achieve in the much larger and more diverse ambulatory setting. Thus, it is important to define and measure an ambulatory culture of safety. It is also difficult, perhaps impossible, to change beliefs, attitudes, knowledge, or actions (all components of a “culture”) without some form of feedback. Therefore, a necessary step in creating a culture of safety is to develop tools to measure the components of that culture. For those individuals and institutions that wish to truly improve the safety of the care they deliver, the creation and testing of tools such as the Safety Attitudes Questionnaire-Ambulatory (SAQ-A) version is critical. Beliefs, attitudes, and knowledge do not always lend themselves to clear-cut end points. Thus, we can expect to see more than one safety culture measuremen

A draft framework for measuring progress towards the development of a national health information infrastructure

BACKGROUND: American public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014. This will require a National Health Information Infrastructure (NHII) that is far more complete than the one that is currently in its formative stage of development. We describe a conceptual framework to help measure progress toward that goal. DISCUSSION: The NHII comprises a set of clusters, such as Regional Health Information Organizations (RHIOs), which, in turn, are composed of smaller clusters and nodes such as private physician practices, individual hospitals, and large academic medical centers. We assess progress in terms of the availability and use of information and communications technology and the resulting effectiveness of these implementations. These three attributes can be studied in a phased approach because the system must be available before it can be used, and it must be used to have an effect. As the NHII expands, it can become a tool for evaluating itself. SUMMARY: The NHII has the potential to transform health care in America – improving health care quality, reducing health care costs, preventing medical errors, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care. While the President has set an ambitious goal of assuring that most Americans have electronic health records within the next 10 years, a significant question remains "How will we know if we are making progress toward that goal?" Using the definitions for "nodes" and "clusters" developed in this article along with the resulting measurement framework, we believe that we can begin a discussion that will enable us to define and then begin making the kinds of measurements necessary to answer this important question

Human resources for health policies: a critical component in health policies

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM. There are three broad arguments for modernizing the ways in which human resources for health are managed: • the central role of the workforce in the health sector; • the various challenges thrown up by health system reforms; • the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems. The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs. Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH): • to move beyond the traditional approach of personnel administration to a more global concept of HRM; • to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy; • to foster a more proactive attitude among human resources (HR) policy-makers and managers; • to promote the full commitment of all professionals and sectors in all phases of the process. The development of explicit human resources policies is a crucial link in health policies and is needed both to address the imbalances of the health workforce and to foster implementation of the health services reforms

Classism and dehumanization in chronic pain: A qualitative study of nurses’ inferences about women of different socio‐economic status

Objectives: Class-based dehumanization in health is poorly investigated. Beliefs about social class are often shared across cultures, with people of lower socio-economic status (SES) being typically dehumanized. This study specifically examined how nurses’ perceptions of pain patients’ SES were associated with (more or less) dehumanizing inferences about their pain and different treatment recommendations. Design: Sequential mixed methods including Similitude Analysis (statistical analysis of qualitative data) and a Thematic Analysis. Fifty female nurses watched short videos of two white women of different SES (low vs. middle) and similar levels of pain behaviours. Afterwards, nurses were asked to complete (1) a Free Association Task (associating characteristics and a profession to the women) and (2) a Story-Completion Task (writing a story describing women's lives, pain, and recommending treatments). Data were analysed with Similitude and Thematic Analysis. Results: The women's SES was recognized, linked to distinct professions, and associated with distinct inferences. The middle-SES woman was depicted with both Uniquely Human (e.g., autonomous) and Human Nature (e.g., communicative) traits, positive future prospects, and competence to self-manage pain. The low-SES woman was associated with Human Nature traits (hard-working) but denied Uniquely Human traits associated with competence; she was imagined as passive towards pain, with poor future prospects and referred to psychoeducation. Conclusion: Findings reveal the role of class-based cultural belief systems in pain care, showing how nurses’ recognition of low SES is associated with dehumanizing inferences and recommendations, which may contribute to reproducing pain care disparities. Theoretical implications of these findings for social and health psychology are drawn. Statement of contribution What is already known on the subject? • Psychosocial research on health and pain care disparities has paid more attention to the role of race/racism and gender/sexism than the role of social class/classism; Belief systems about social class are shared across cultures; people from lower SES are often dehumanized by being denied competence, civility, and self-determination; Class-based dehumanization may influence the relational and technical aspects of clinical encounters but little is still known about these processes. What does this study add? Drawing upon a mixed-methods approach, this study provides novel findings on class-based dehumanization inferences made by female nurses on female chronic pain patients; Nurses perceived the lower SES patient with fewer Uniquely Human traits, that is, less competent, with more pain-related disability, and recommended her more psychoeducation. Class-based dehumanization processes may contribute to reproducing pain care disparities and may prove to be important targets for intervention development.info:eu-repo/semantics/acceptedVersio