Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study

Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.

Pre-analytical specimen labelling and processing errors in the ICU

Introduction: Specimen rejections have been associated with increased in-hospital stay and cost. The majority of errors occur in the pre-analytic phase. Specimen rejection can lead to high rate of recollection, delay in result availability, and high rate of test abandonment. These factors affect patient care and safety. Methods: This study conducted a retrospective review of Patient Safety Learning System (PSLS) reports for the intensive care unit (ICU) at The Ottawa Hospital General Campus (TOH) between 2010 and 2018, and a prospective review using interviews, surveys, and process mapping. Results: From 2098 PSLS reports, 52.6% were related to laboratory specimen collection and processing (pre-analytic phase). Specimen mislabelling with the wrong patient identifier accounted for 9.8% of pre-analytical error reports, while 16.4% of errors were due to non-sufficient quantity (NSQ) of specimen. 12.2 % of pre-analytical error reports involved cytology specimens. Conclusions: Pre-analytical errors are not only costly and resource draining, but may also place a burden on patients. Areas where errors were found include labels and requisitions stored in bedside cabinets, inconsistencies between specimen labels and requisitions, out-dated and difficult to access laboratory manuals, and non-sufficient quantity specimen collection. In the future we hope to start new initiatives to tackle these issues to improve patient safety and hospital efficiencies. This includes the development of a website for the laboratory manual, so that it is more easily accessible and user-friendly. With a new electronic medical record (EMR) system at TOH in 2019, we will explore the affects of pre-analytical processing of specimens.

Growing Concern on Healthcare Cyberattacks & Need for Cybersecurity

Modern healthcare systems have been dominated by virtual approaches and digital technologies. This has increased the concern for the security of healthcare devices and data due to the lack of information confidentiality and data integrity in this sector. Information category at risk and the importance of patient safety make cybersecurity unique in the field of health. Regarding the context of this problem construction of cyber resilience in healthcare organizations has become a vital task. A comprehensive solution to this problem can be obtained by the combination of human behavioral changes, technological enhancements, process modifications, and new legislations and regulations.

Implementation of Evidence-Based Patient Safety Practices: 4-Years’ Follow-up of a Nationwide Regulatory Intervention in Brazilian Hospitals

Background: Regulatory interventions are widely recommended to improve the quality of health services, but there are few studies on the possible models and their effects. The aim of this study is to describe the implementation process and analyse the results of a nationwide regulatory intervention for the implementation of patient safety practices.Methods: Four nationwide annual cross-sectional assessments were conducted in Brazilian hospitals with Intensive Care Unit beds. The participants involved all facilities operating during 2016-2019 (average N=1,989). The regulatory intervention theory aimed to increase adherence to safe evidence-based practices through national annual assessment involving a set of 21 validated structure and process indicators related to patient safety practices. At moment 1(Risk assessment), data were collected to classify hospitals according to the risk. In the sequence, the Sanitary Surveillance Centers (VISAS) carried out the analysis of the information sent by the hospitals. VISAS classified services into three groups according to compliance with the composite adherence indicator: High (67-100%); Medium (34-66%); and Low Compliance (0-33%). Moment 2 (Risk management) used responsive actions according to the hospital’s classification. Results: The intervention resulted in six annual cyclic stages and, between 2016-2019, 782 (40.1%), 980 (49.0%), 1,093 (54.3%) and 1,255 (61.8%) hospitals participated, respectively. 17 of the 20 indicators with at least two measurements had a significant improvement after national interventions (p<0.05). The overall percentage of compliance increased from 70.7 to 84.1 (p<0.001) and the percentage of hospitals with high compliance increased from 59.1 to 83.0 (p<0.001).Conclusion: The regulatory intervention used was a good tool to strengthen the information system and government actions to promote patient safety. The set of low-cost interventions seems to be useful to prioritise hospitals at higher risk and to induce responsive measures to implement patient safety practices in the evaluated context, promoting the efficiency of the regulatory process.

How will state medical boards handle cases involving disclosure and apology for medical errors?

Surveys were sent to 68 American state medical boards, including territories of the United States, inquiring how they handle—or will handle—cases involving disclosure and apology after medical errors. Surveys were not sent to specialty boards. Thirty-eight state medical boards ( n = 38, 56%) responded to the survey, with 31 completing the survey (46% completion rate) and seven boards ( n = 7) providing explanations for nonparticipation and other thoughts; 30 boards did not respond in any manner. Boards that completed the survey indicated that disclosure and apology and other positive post-event behavior by physicians are likely to be viewed favorably and disclosing physicians will not be easy targets for disciplinary measures, though boards also stressed they view each case on the merits and patient safety is their top priority. Recommendations are made for policy makers and other stakeholders.

Conceptualizing a Quantitative Measurement Suite to Evaluate Healthcare Teams

Background Current team assessment instruments in healthcare tend to involve rater-based evaluations that are susceptible to well-known biases. Recent advances in technology include portable devices to measure team-based activities. Consequently, the possibility exists to move away from rater-based assessments of team function by identifying quantitative measures to replace them. Aim This article aims to provide potential approaches to developing quantitative measurement suites involving large amounts of data to address the challenges of assessment presented by the complex nature of teamwork. Conclusion By addressing construct, measurement, and context components, we provide a practical approach to developing a suite to capture quantitative measurements that, through incorporation of social network analysis and aggregated other values, aligns with the Team Strategies & Tools to Enhance Performance and Patient SafetyTM (TeamSTEPPSTM) dimensions for fostering teamwork.