Patient safety culture lives in departments and wards: Multilevel partitioning of variance in patient safety culture

<p>Abstract</p> <p>Background</p> <p>Aim of study was to document 1) that patient safety culture scores vary considerably by hospital department and ward, and 2) that much of the variation is across the lowest level organizational units: the wards. Setting of study: 500-bed Norwegian university hospital, September-December 2006.</p> <p>Methods</p> <p>Data collected from 1400 staff by (the Norwegian version of) the generic version of the Safety Attitudes Questionnaire (SAQ Short Form 2006). Multilevel analysis by MLwiN version 1.10.</p> <p>Results</p> <p>Considerable parts of the score variations were at the ward and department levels. More organization level variation was seen at the ward level than at the department level.</p> <p>Conclusions</p> <p>Patient safety culture improvement efforts should not be limited to all-hospital interventions or interventions aimed at entire departments, but include involvement at the ward level, selectively aimed at low-scoring wards. Patient safety culture should be studied as closely to the patient as possible. There may be such a thing as "hospital safety culture" and the variance across hospital departments indicates the existence of department safety cultures. However, neglecting the study of patient safety culture at the ward level will mask important local variations. Safety culture research and improvement should not stop at the lowest formal level of the hospital (wards, out-patient clinics, ERs), but proceed to collect and analyze data on the micro-units within them.</p

Women in senior post-graduate medicine career roles in the UK: a qualitative study

Objectives:This qualitative study sought to elicit the views, experiences, career journeys and aspirations of women in senior post-graduate medical education roles to identify steps needed to help support career progression.Design:In-depth semi-structured telephone interviews.Setting:UKParticipants:Purposive sample of 12 women in a variety of senior leadership roles in post-graduate medical education in the UK.Main outcome measures:Self reported motivating influences, factors that helped and hindered progress, key branch points, and key educational factors and social support impacting on participants' career in postgraduate medicine.Results:Respondents often reported that career journeys were serendipitous, rather than planned, formal or well structured. Senior women leaders reported having a high internal locus of control, with very high levels of commitment to the NHS. All reported significant levels of drive, although the majority indicated that they were not ambitious in the sense of a strong drive for money, prestige, recognition or power. They perceived that there was an under-representation of women in senior leadership positions and that high-quality female mentorship was particularly important in redressing this imbalance. Social support, such a spouse or other significant family member, was particularly valued as reaffirming and supporting women’s chosen career ambition. Factors that were considered to have hindered career progression included low self-confidence and self-efficacy, the so-called glass ceiling and perceived self-limiting cultural influences. Factors indirectly linked to gender such as part-time versus working full time were reportedly influential in being overlooked for senior leadership roles. Implications of these findings are discussed in the paper.Conclusion:Social support, mentorship and role modelling are all perceived as highly important in redressing perceived gender imbalances in careers in post-graduate medical education

Patient safety culture in Italian out-ofhours primary care service: a national cross-sectional survey study

Background: Out-of-hours (OOH) services in Italy provide &gt;10 million consultations every year. To the authors' knowledge, no data on patient safety culture (PSC) have been reported. Aim: To assess PSC in the Italian OOH setting. Design &amp; setting: National cross-sectional survey using the Safety Attitudes Questionnaire — Ambulatory Version (SAQ-AV). Method: The SAQ-AV was translated into Italian and distributed in a convenience sample of OOH doctors in 2015. Answers were collected anonymously by Qualtrics. Stata (version 14) was used to estimate Cronbach's alpha, perform exploratory and confirmatory factor analysis, correlate items to doctors' characteristics, and to do item descriptive analysis. Results: Overall, 692 OOH doctors were contacted, with a 71% response rate. In the exploratory factor analysis (EFA), four factors were identified: Communication and Safety Climate (14 items); Perceptions of Management (eight items); Workload and Clinical Risk (six items); and Burnout Risk (four items). These four factors accounted for 68% of the total variance (Kaiser-Meyer-Olkin [KMO] statistic = 0.843). Cronbach's alpha ranged from 0.710-0.917. OOH doctors were often dissatisfied with their job; there is insufficient staff to provide optimal care and there is no training or supervision for new personnel and family medicine trainees. Service managers are perceived as distant, with particular issues concerning the communication between managers and OOH doctors. A large proportion of OOH doctors (56.8%) state that they do not receive adequate support. Conclusion: These findings could be useful for informing policies on how to improve PSC in Italian OOH service

Patient safety culture in Norwegian home health nursing: a cross-sectional study of healthcare provider’s perceptions of the teamwork and safety climates

Background: The threefold aim of this study was to (1) describe attitudes to patient safety among healthcare providers in home health nursing (HHN), (2) investigate differences in attitudes due to age, education level, years of healthcare work experience, and years at current workplace, and (3) compare attitudes of these HHN healthcare providers with available benchmark data from other healthcare settings. Methods: One hundred sixty HHN healthcare providers in Mid-Norway answered a survey covering the teamwork climate and safety climate in the Safety Attitudes Questionnaire (SAQ). Data were analyzed by descriptive statistics, t test, and ANOVA. Results: The overall mean score was 79.1 for teamwork climate and 72.3 for safety climate. The proportion of positive responses (i.e., scale scores ≥ 75) was 73% on teamwork climate and 53% on safety climate. For teamwork and safety climates, employees with the longest employment at the current workplace had significantly higher mean scores than those with shorter employment. No significant differences were found in mean scores for age, education level, and length of experience in healthcare. Compared to benchmark data from other studies, the mean HHN scores for both safety and teamwork climates were higher than in the vast majority of other Healthcare settings and significant differences were found for both dimensions. Conclusion: HHN has higher scores for both safety climate and teamwork climate compared to the vast majority of other healthcare settings, but there is room for improvement in the patient safety culture within the Norwegian HHN. Further research on patient safety culture in HHN is needed.publishedVersio

Elderly persons’ experiences of participation in hospital discharge process

Objective: The purpose of this study was to describe older hospital patients’ discharge experiences on participation in the discharge planning. Methods: A sample of 254 patients aged 80+ was interviewed using a questionnaire developed by the research team. Data were collected by face-to-face interviewing during the first two weeks following patients discharge from hospital. Results: In spite of their advanced age the patients in this study did express a clear preference for participation. However, there were no significant correlation between patients’ wish for participation and experienced opportunity to share decisions. Hearing ability was the only significant factor affecting the chance to participate, whereas sociodemographic factors did not significantly affect on the likelihood participation the discharge process. Conclusion: The actual practice of involving old people in the discharge process is not well developed as experienced by old patients themselves. The fact that factors like gender and education have little influence on participation in the oldest patients might be related to age; when you get old enough, old is all that is ‘visible’. Practice implications: To determine the extent of elderly patients’ desire to participate, one must actively look for it both through research and in the hands-on process of discharge

Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care

Zalika Klemenc-Ketis,1&ndash;3 Ellen Tveter Deilk&aring;s,4 Dag Hofoss,5 Gunnar Tschudi Bondevik6,7 1Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, 2Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, 3Community Health Centre Ljubljana, Ljubljana, Slovenia; 4Health Services Research Unit, Akershus University Hospital, L&oslash;renskog, 5Institute of Health and Society, University of Oslo, Oslo, 6Department of Global Public Health and Primary Care, University of Bergen, Bergen, 7National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway Purpose: To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups.Materials and methods: This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics; 37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire &ndash; Ambulatory Version (SAQ-AV). Results: The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9&plusmn;15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4&plusmn;0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8&plusmn;0.9).Conclusion: Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided. Keywords: patient care management, out-of-hours medical care, primary health care, patient safet

Informal caregivers’ participation when older adults in Norway are discharged from the hospital

This paper describes the participation of informal caregivers in the discharge process when patients aged 80 and over who were admitted from home to different hospitals in Norway were discharged to long-term community care. Data for this cross-sectional survey were collected through telephone interviews with a consecutive sample of 262 caregivers recruited between October 2007 and May 2009. The Discharge of Elderly Questionnaire was developed by the research team and was designed to elicit data concerning informal caregivers' self-reported perceptions on participation in the discharge process. A descriptive and comparative analysis of Thompson's levels of participation reported by the older generation (spouses and siblings) and the younger generation (adult children and children-in-law, nieces and grandchildren) was undertaken using bivariate cross-tabulations and chi-square tests for association and trend. Analyses showed that the younger generation of caregivers received and provided information to hospital staff to a greater degree than the older generation. Overall, 52% of the informal caregivers reported co-operating with the staff to a high or to some degree. A multivariate logistic regression analysis was used to analyse factors predicting the likelihood of informal caregivers reporting co-operation with hospital staff. The odds of younger generation caregivers reporting co-operation were more than twice as high (OR = 2.121, P = 0.045) as the odds of the older generation. Caregivers of patients with a hearing impairment had higher odds of reporting co-operation (OR = 1.722, P = 0.049) than caregivers of patients with no such impairment. The length of hospital stay, the caregiver's and patient's gender and education level were not significantly associated with caregiver's co-operation. The informal caregivers' experiences with information practices and user participation in hospitals highlight important challenges that must be taken seriously to ensure co-operation between families and hospitals when elderly patients are discharged back to the community

The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: A cross-sectional study

Background Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals. Objective To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level. Design A cross-sectional study. Setting Six of the 11 invited hospitals in South-Eastern Norway agreed to participate. Participants Inpatients ≥18 years at 88 somatic hospital wards (N = 1209). Patients in paediatric and maternity wards and day surgery patients were excluded. Methods The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels. Results The prevalence was 18.2% for pressure ulcer category I–IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level. Conclusions Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important

Modelling and prediction of weekly incidence of influenza A specimens in England and Wales

We propose a rather simple model, which fits well the weekly human influenza incidence data from England and Wales. A standard way to analyse seasonally varying time-series is to decompose them into different components. The residuals obtained after eliminating these components often do not reveal time dependency and are normally distributed. We suggest that conclusions should not be drawn only on the basis of residuals and that one should consider the analysis of squared residuals. We show that squared residuals can reveal the presence of the remaining seasonal variation, which is not exhibited by the analysis of residuals, and that the modelling of such seasonal variations undoubtedly improves model fit