Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. FINDINGS: Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. PRACTICE IMPLICATIONS: Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality

The Perceived Usefulness of Patient Narrative Feedback in Primary Care Settings

Research suggests that insights from patient narratives – stories about care experiences in patients\u27 own words – contain information that can be used to improve care. However, assessments of narratives reported by clinical personnel have been mixed. This is the first study, to our knowledge, to systematically measure how useful personnel in primary care perceive patient narratives to be. We surveyed 276 clinical and administrative personnel in nine primary care clinics in a large health system in the United States. We found that perceived usefulness of patient narratives is generally high, but varies by individual characteristics such as level of burnout and professional role and with organizational characteristics such as clinic\u27s learning orientation and history of using patient feedback to improve quality. These findings imply that narratives can be useful for improving primary care and that their perceived usefulness is greater when organizational practices facilitate learning from patients\u27 narrative feedback

Creating a compassion system to achieve efficiency and quality in health care delivery

Purpose: Health care delivery is experiencing a multi-faceted epidemic of suffering among patients and care providers. Compassion is defined as noticing, feeling and responding to suffering. However, compassion is typically seen as an individual rather than a more systemic response to suffering and cannot match the scale of the problem as a result. The authors develop a model of a compassion system and details its antecedents (leader behaviors and a compassionate human resource (HR) bundle), its climate or the extent that the organization values, supports and rewards expression of compassion and the behaviors and practices through which it is enacted (standardization and customization) and its effects on efficiently reducing suffering and delivering high quality care. Design/methodology/approach: This paper uses a conceptual approach that synthesizes the literature in health services, HR management, organizational behavior and service operations to develop a new conceptual model. Findings: The paper makes three key contributions. First, the authors theorize the central importance of compassion and a collective commitment to compassion (compassion system) to reducing pervasive patient and care provider suffering in health care. Second, the authors develop a model of an organizational compassion system that details its antecedents of leader behaviors and values as well as a compassionate HR bundle. Third, the authors theorize how compassion climate enhances collective employee well-being and increases standardization and customization behaviors that reduce suffering through more efficient and higher quality care, respectively. Originality/value: This paper develops a novel model of how health care organizations can simultaneously achieve efficiency and quality through a compassion system. Specific leader behaviors and practices that enable compassion climate and the processes through which it achieves efficiency and quality are detailed. Future directions for how other service organizations can replicate a compassion system are discussed

System-failing creativity in health care

Introduction: Health care professionals often generate novel solutions to solve problems during day-to-day patient care. However, less is known about generating novel and useful (i.e., creative) ideas in the face of health care system failure. System failures are high-impact and increasingly frequent events in health care organizations, and front-line professionals may have uniquely valuable expertise to address such occurrences. Methods: Our interdisciplinary team, blending expertise in health care management, economics, psychology, and clinical practice, reviewed the literature on creativity and system failures in health care to generate a conceptual model that describes this process. Drawing on appraisal theory, we iteratively refined the model by integrating various theories with key concepts of system failures, creativity, and health care worker\u27s well-being. Results: The SFC model provides a conceptualization of creativity from front-line care professionals as it emerges in situations of failure or crisis. It describes the pathways by which professionals respond proactively to a systems failure with creative ideas to effectively address the situation and affect these workers\u27 well-being. Conclusions: Our conceptual model guides health care managers and leaders to use managerial practices to shape their systems and support creativity, especially when facing system failures. It introduces a framework for examining system-failing creativity (SFC) and general creativity, aiming to improve health care quality, health care workers\u27 well-being, and organizational outcomes