Practice or perfect? Coaching for a growth mindset to improve the quality of healthcare
Introduction Perfection in this science, or rather art [i.e. medicine] takes longer to be mastered than human life [affords]—Maimonides, philosopher and physician, Middle Ages.1 A veritable quality improvement (QI) industry has emerged that centres around initiatives to improve patient outcomes or health system performance. These initiatives often target high-risk and high-cost disease states,2 with common foci of reducing waste,3 ‘hot-spotting’4 and readmissions.5 While these initiatives can help improve health system performance across the Quintuple Aim,6 they often fall short of achieving sustained imp...
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Desveaux, L., Ivers, N. Tags: Viewpoints Source Type: research
How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study
Clinical tools for use in practice—such as medicine reconciliation charts, diagnosis support tools and track-and-trigger charts—are endemic in healthcare, but relatively little attention is given to how to optimise their design. User-centred design approaches and co-design principles offer potential for improving usability and acceptability of clinical tools, but limited practical guidance is currently available. We propose a framework (FRamework for co-dESign of Clinical practice tOols or ‘FRESCO’) offering practical guidance based on user-centred methods and co-design principles, organised in five...
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Woodward, M., Dixon-Woods, M., Randall, W., Walker, C., Hughes, C., Blackwell, S., Dewick, L., Bahl, R., Draycott, T., Winter, C., Ansari, A., Powell, A., Willars, J., Brown, I. A. F., Olsson, A., Richards, N., Leeding, J., Hinton, L., Burt, J., Maistrell Tags: Open access Research and reporting methodology Source Type: research
Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis
Conclusions
CTG monitoring is an inherently collective and sociotechnical practice. Improving it will require accounting for complex system interdependencies, rather than focusing solely on discrete factors such as individual technical proficiency in interpreting traces. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Lame, G., Liberati, E. G., Canham, A., Burt, J., Hinton, L., Draycott, T., Winter, C., Dakin, F. H., Richards, N., Miller, L., Willars, J., Dixon-Woods, M. Tags: Open access, Editor's choice Original research Source Type: research
Informing understanding of coordination of care for patients with heart failure with preserved ejection fraction: a secondary qualitative analysis
Conclusions
There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Brooman-White, R., Blakeman, T., McNab, D., Deaton, C. Tags: Original research Source Type: research
CheckPOINT: a simple tool to measure Surgical Safety Checklist implementation fidelity
Conclusions
CheckPOINT is a simple and reliable tool to assess SSC implementation fidelity and identify areas of focus for improvement efforts. Although CheckPOINT would benefit from further testing, it offers a low-resource alternative to existing research tools and captures elements of adherence and team behaviours. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Moyal-Smith, R., Etheridge, J. C., Turley, N., Lim, S. R., Sonnay, Y., Payne, S., Smid-Nanninga, H., Kothari, R., Berry, W., Havens, J., Brindle, M. E. Tags: Original research Source Type: research
Intrapartum electronic fetal monitoring: imperfect technologies and clinical uncertainties--what can a human factors and social science approach add?
For many women, fetal well-being in labour is assessed using continuous electronic fetal monitoring with cardiotocography (CTG), a technique used to monitor the fetal heartbeat and uterine contractions during pregnancy and labour.1 However, problems in the assessment of fetal well-being in labour and delays in escalation and response have been consistently highlighted in maternity care safety inquiries, both in the UK and internationally, causing untold distress to parents and families.2–6 Taking an interdisciplinary perspective, drawing on both human factors/ergonomics and social science, the study from Lamé ...
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Sandall, J. Tags: Editorials Source Type: research
Effective use of interdisciplinary approaches in healthcare quality: drawing on operations and visual management
Thinkers from the broad field of quality management, such as Edwards Deming, have influenced the more focused field of healthcare quality including international organisations such as the Institute for Healthcare Improvement and The Health Foundation. Quality management was initially established for industrial settings but has since been applied in many other sectors such as education, travel and, in this context, healthcare. Quality management encompasses quality assurance, control and improvement. Healthcare practitioners and researchers have applied aspects of these in examples such Benneyan et al1 who in their much-cit...
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Bateman, N. Tags: Editorials Source Type: research
Elusive but hopefully not illusive: coordinating care for patients with heart failure with preserved ejection fraction
Depending on your perspective, a unicorn could be either a magical horned creature or a billion-dollar start-up. Alternatively, it could represent coordinated care for patients with heart failure with preserved ejection fraction (HFpEF), as it does for Brooman-White et al.1 In their accompanying paper on coordination of care for patients with HFpEF, which included an analysis of 12 clinical guidelines and secondary analysis of qualitative interviews with patients and healthcare professionals in the UK’s National Health Service, the authors describe the apparent illusiveness of securing coordinated specialist and gene...
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Sinnott, C., Vedanthan, R., van Olmen, J. Tags: Editorials Source Type: research
Lost in translation: does measuring 'adherence to the Surgical Safety Checklist indicate true implementation fidelity?
The use of checklists in surgery is a best practice.1 There is a plethora of evidence that suggests using the WHO Surgical Safety Checklist (SSC) reduces complications such as pneumonia,2 intraoperative blood loss,2 3 sepsis,2 unplanned intubation,2 urinary tract infections,2 wound infections,2–4 30-day readmissions and 30-day mortality.2–4 The SSC has three components, which need to be carried out for each phase of a surgical procedure, including sign-in, timeout and sign-out.5 The SSC serves as an aide memoir that includes vital information to prompt team discussions and actions that may otherwise be overlook...
Source: Quality and Safety in Health Care - March 25, 2024 Category: Health Management Authors: Gillespie, B. M., Ziemba, J. B. Tags: Editorials Source Type: research
Quality and safety in the literature: February 2024
Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals. Key points A randomised controlled trial showed that a communication coach improved cardiologists’ ability to respond to patients with empathy, elicit questions and facilitate enhanced conversation...
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Kakos, D., Houchens, N., Gupta, A. Tags: Quality & amp; safety in the literature Source Type: research
Retrospective cohort study of wrong-patient imaging order errors: how many reach the patient?
This study was conducted at a large integrated healthcare system using data from 1 January to 31 December 2019. The study used two outcome measures of wrong-patient orders: (1) wrong-patient orders that led to misadministration of radiation reported to the New York Patient Occurrence Reporting and Tracking System (NYPORTS) (misadministration events); and (2) wrong-patient orders identified by the Wrong-Patient Retract-and-Reorder (RAR) measure, a measure identifying orders placed for a patient, retracted and rapidly reordered by the same clinician on a different patient (near-miss events). All imaging orders that involved ...
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Kneifati-Hayek, J. Z., Geist, E., Applebaum, J. R., Dal Col, A. K., Salmasian, H., Schechter, C. B., Elhadad, N., Weintraub, J., Adelman, J. S. Tags: Short reports Source Type: research
Grand rounds in methodology: key considerations for implementing machine learning solutions in quality improvement initiatives
Machine learning (ML) solutions are increasingly entering healthcare. They are complex, sociotechnical systems that include data inputs, ML models, technical infrastructure and human interactions. They have promise for improving care across a wide range of clinical applications but if poorly implemented, they may disrupt clinical workflows, exacerbate inequities in care and harm patients. Many aspects of ML solutions are similar to other digital technologies, which have well-established approaches to implementation. However, ML applications present distinct implementation challenges, given that their predictions are often ...
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Verma, A. A., Trbovich, P., Mamdani, M., Shojania, K. G. Tags: Research and reporting methodology Source Type: research
Burden of serious harms from diagnostic error in the USA
Conclusion
An estimated 795 000 Americans become permanently disabled or die annually across care settings because dangerous diseases are misdiagnosed. Just 15 diseases account for about half of all serious harms, so the problem may be more tractable than previously imagined. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Newman-Toker, D. E., Nassery, N., Schaffer, A. C., Yu-Moe, C. W., Clemens, G. D., Wang, Z., Zhu, Y., Saber Tehrani, A. S., Fanai, M., Hassoon, A., Siegal, D. Tags: Editor's choice Original research Source Type: research
Development and validation of the Overall Fidelity Enactment Scale for Complex Interventions (OFES-CI)
Conclusions
The OFES-CI provides a promising novel approach for assessing fidelity enactment in QI and other complex interventions. It demonstrates good reliability against our gold standard assessment approach and addresses the practicality problem in fidelity assessment by virtue of its suitable implementation qualities. Steps for adapting the OFES-CI to other complex interventions are offered. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Ginsburg, L., Hoben, M., Berta, W., Doupe, M., Estabrooks, C. A., Norton, P. G., Reid, C., Geerts, A., Wagg, A. Tags: Open access Original research Source Type: research
Racial and ethnic disparities in common inpatient safety outcomes in a childrens hospital cohort
Conclusions
The combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Lyren, A., Haines, E., Fanta, M., Gutzeit, M., Staubach, K., Chundi, P., Ward, V., Srinivasan, L., Mackey, M., Vonderhaar, M., Sisson, P., Sheffield-Bradshaw, U., Fryzlewicz, B., Coffey, M., Cowden, J. D., PHARE Cohort Study Group, Huffman, Graham, Green, Tags: Original research Source Type: research
