International Journal for Quality in Health Care最新文献

{"title":"Holding up the crystal ball: using regulatory intelligence insights to support quality in healthcare.","authors":"Martin Fletcher, Samantha Stark, Nikola Balvin, David Greenfield","doi":"10.1093/intqhc/mzaf001","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf001","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Holding up the crystal ball: using regulatory intelligence insights to support quality in healthcare.","authors":"Martin Fletcher, Samantha Stark, Nikola Balvin, David Greenfield","doi":"10.1093/intqhc/mzaf001","DOIUrl":"10.1093/intqhc/mzaf001","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient handoffs.","authors":"Nara Regina Spall Martins, Edson Zangiacomi Martinez, Cláudia Marquez Simões, Paul Randall Barach, Maria José Carvalho Carmona","doi":"10.1093/intqhc/mzae114","DOIUrl":"https://doi.org/10.1093/intqhc/mzae114","url":null,"abstract":"<p><p>Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room (OR) to the intensive care unit (ICU) are known to be high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the OR and the ICU can lead to flawed communication, degraded team awareness, medical errors, and increased patient harm. Data were collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes and effects analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach. We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow silos, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions, and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, the hospital, and staff, and are currently targeted for process improvement. Evidence-driven recommendations intended for reducing the risks associated with patient handoffs are presented. Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient's and clinician's needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient handoffs.","authors":"Nara Regina Spall Martins, Edson Zangiacomi Martinez, Cláudia Marquez Simões, Paul Randall Barach, Maria José Carvalho Carmona","doi":"10.1093/intqhc/mzae114","DOIUrl":"10.1093/intqhc/mzae114","url":null,"abstract":"<p><p>Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room (OR) to the intensive care unit (ICU) are known to be high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the OR and the ICU can lead to flawed communication, degraded team awareness, medical errors, and increased patient harm. Data were collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes and effects analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach. We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow silos, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions, and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, the hospital, and staff, and are currently targeted for process improvement. Evidence-driven recommendations intended for reducing the risks associated with patient handoffs are presented. Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient's and clinician's needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological safety, Job satisfaction, and the Intention to Leave among German early-career physicians.","authors":"Nicola Etti, Matthias Weigl, Nikoloz Gambashidze","doi":"10.1093/intqhc/mzaf002","DOIUrl":"https://doi.org/10.1093/intqhc/mzaf002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Healthcare systems worldwide experience shortages of healthcare professionals. Retention of physicians is becoming an increasing problem. The psychological safety among physicians affects not only performance, but also their emotional well-being and job satisfaction. This study aims to evaluate early career physicians' perception of psychological safety and its influence on job satisfaction and intention to leave.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In a cross-sectional study, early career physicians, currently in fellowship programs in Germany were invited to fill in an electronic survey. The instrument consisted of demographic variables and sections from validated and well-established questionnaires. Psychological safety was evaluated on three levels - in relation to the team leader, team as a whole, and peers. Also job satisfaction was assessed with standardized measures, and participants were asked if they were considering leaving their current employer. Participants were recruited via a nationwide learning platform - an online educational portal for medical students and early career physicians. Data analyses included descriptive, correlation analysis and regression analyses to determine univariate and multivariate associations with job satisfaction and intention to leave.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study sample consisted of 432 early career physicians. Most were fulltime employed (85.6%), female (78.2%), and in first three years of their postgraduate education (77.5%). 47.2% indicated intention to leave their current employment. On a Likert-10 agreement scale, with high scores indicating grater psychological safety, the mean scores for leader related, team related and peer related psychological safety were 6.01 (95%CI=5.81 to 6.21), 7.30 (7.11 to 7.49) and 7.95 (7.78 to 8.12), respectively. In correlation analysis, all dimensions of psychological safety showed significant associations with Job Satisfaction and the Intention to Leave. In the multiple regression analyses, female gender (B=-0.10; p=0.04) and age group (B=-0.08; p&lt;0.01) were associated with lower job satisfaction. High leader and team related psychological safety were significantly associated with higher job satisfaction (B=0.18, p&lt;0.01; B=0.10, p&lt;0.01), and negatively related to intention to leave (OR=0.53, p&lt;0.01; OR=0.77, p&lt;0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This survey enhances our understanding of the nuances of psychological safety among early career physicians. In Germany, they reported low to medium levels of psychological safety related to the leader and low job satisfaction. Almost every second participant indicated intention to leave the organisation. Leader related psychological safety had highest effect on job satisfaction and intention to leave. Our findings corroborate the eminent role of leadership, workplace and safety culture for job satisfaction and retention of early career physicians, what consequently affects qual","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting human rights-based deinstitutionalization in Lithuania by applying the World Health Organization's QualityRights Assessments.","authors":"Ugnė Grigaitė, Karilė Levickaitė, Dovilė Juodkaitė, Nijolė Goštautaitė-Midttun","doi":"10.1093/intqhc/mzae118","DOIUrl":"10.1093/intqhc/mzae118","url":null,"abstract":"<p><p>Lithuania ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2010 and started deinstitutionalization in 2014. This reform covers segregated social care institutions where persons with mental health conditions, psychosocial, and/or intellectual disabilities live. It aims to move away from institutional care and towards community-based services. Mental healthcare services are also a part of the complex picture, undergoing its own reform since 2022. This study aims to assess the human rights conditions and standards of care in Lithuanian psychiatric and social care facilities in the context of deinstitutionalization. Data collection assessments were conducted in psychiatric hospitals and psychiatric units in general hospitals, segregated social care homes, and community-based group living homes. Independent experts collected data through documentation review, observation, and semistructured interviews with service users and staff. The study followed the World Health Organization's QualityRights Toolkit methodology. In all assessed facilities, regardless of their type, the human rights of service users are often undermined, especially the right to exercise legal capacity, personal liberty and security, freedom from seclusion and restraints, and the right to live independently and be included in the community. The study reveals shortcomings in the implementation of the UNCRPD and Lithuania's attempts at deinstitutionalization. It points to key practical gaps and areas, including the vital need for better collaboration between the social and mental healthcare systems. The Lithuanian government needs to address these issues to make reforms more effective, safeguard human rights, and ensure the quality of mental health and social care services.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting human rights-based deinstitutionalization in Lithuania by applying the World Health Organization's QualityRights Assessments.","authors":"Ugnė Grigaitė, Karilė Levickaitė, Dovilė Juodkaitė, Nijolė Goštautaitė-Midttun","doi":"10.1093/intqhc/mzae118","DOIUrl":"https://doi.org/10.1093/intqhc/mzae118","url":null,"abstract":"<p><p>Lithuania ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2010 and started deinstitutionalization in 2014. This reform covers segregated social care institutions where persons with mental health conditions, psychosocial, and/or intellectual disabilities live. It aims to move away from institutional care and towards community-based services. Mental healthcare services are also a part of the complex picture, undergoing its own reform since 2022. This study aims to assess the human rights conditions and standards of care in Lithuanian psychiatric and social care facilities in the context of deinstitutionalization. Data collection assessments were conducted in psychiatric hospitals and psychiatric units in general hospitals, segregated social care homes, and community-based group living homes. Independent experts collected data through documentation review, observation, and semistructured interviews with service users and staff. The study followed the World Health Organization's QualityRights Toolkit methodology. In all assessed facilities, regardless of their type, the human rights of service users are often undermined, especially the right to exercise legal capacity, personal liberty and security, freedom from seclusion and restraints, and the right to live independently and be included in the community. The study reveals shortcomings in the implementation of the UNCRPD and Lithuania's attempts at deinstitutionalization. It points to key practical gaps and areas, including the vital need for better collaboration between the social and mental healthcare systems. The Lithuanian government needs to address these issues to make reforms more effective, safeguard human rights, and ensure the quality of mental health and social care services.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":"37 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safeguarding quality of care in active conflict: priority issues and interventions in Sudan.","authors":"Sheila Leatherman, Aparna Ghosh Kachoria, Mohammed Idriss, Omer Ali, Christina Christopher, Ezequiel Garcia Elorrio","doi":"10.1093/intqhc/mzae112","DOIUrl":"10.1093/intqhc/mzae112","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvements to safety and quality: mastery of tools and techniques is not enough, people and culture matter.","authors":"Alessandro Laureani","doi":"10.1093/intqhc/mzae121","DOIUrl":"10.1093/intqhc/mzae121","url":null,"abstract":"","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the development of safety culture among physicians with text mining of patient safety reports: a retrospective study.","authors":"Daisuke Koike, Masahiro Ito, Akihiko Horiguchi, Hiroshi Yatsuya, Atsuhiko Ota","doi":"10.1093/intqhc/mzae108","DOIUrl":"10.1093/intqhc/mzae108","url":null,"abstract":"<p><strong>Background: </strong>Safety culture development is essential for patient safety in healthcare institution. Perceptions of patient safety and cultural changes are reflected in patient safety reports; however, they were rarely investigated. The aim of this study was to investigate the perception of physicians and to explore the development of safety culture using quantitative content analysis for patient safety reports.</p><p><strong>Methods: </strong>A retrospective analysis of free descriptions of harmful patient safety reports submitted by physicians was performed. Natural language processing and text analysis were conducted using the \"KH Coder.\" A co-occurrence analysis was performed in each period to identify and analyze the safety concepts. The study period was grouped into three for comparison.</p><p><strong>Results: </strong>The patient safety reports from physicians were collected between April 2004 and March 2020. Of these, 3351 reports were harmful: 839 reports were included in period 1, 1016 reports in period 2, and 1496 reports in period 3. Natural language processing identified 316 307 words in the free descriptions of 3351 reports. We identified seven concepts from the cluster in co-occurrence analysis as follows: \"explanation of adverse event to patients and families,\" \"central venous catheter,\" \"intraoperative procedure and injury,\" \"minimally invasive surgery,\" \"life-threatening events,\" \"blood loss,\" and \"medical emergency team and critical care.\" These seven concepts showed significant differences among the three periods, except for \"blood loss.\" The \"explanation of adverse event to patients and families\" decreased in proportion from 11.3% to 8.8% (P < .05). The \"central venous catheter\" decreased from 17.3% to 11.3% (P < .01). Meanwhile, \"minimally invasive surgeries\" and \"intraoperative procedures\" increased from 3.9% to 12.9% (P < .01) and from 10.8% to 14.6% (P < .05), respectively. Focusing on patients' events, \"life-threatening events\" decreased from 13.0% to 8.1% (P < .01); however, \"medical emergency teams and critical care\" increased from 3.3% to 10.6% (P < .01).</p><p><strong>Conclusion: </strong>Free description in patient safety reports is useful for evaluating the safety culture. Co-occurrence analysis revealed multiple concepts of physicians' perceptions. Quantitative content analysis revealed changes in perceptions and attitudes, and a disclosure policy of adverse events and the priority of patient care appeared with the development of safety culture.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}