BMJ Quality & Safety最新文献

{"title":"Patient and caregiver priorities for quality improvement on general medical wards: a multicentre group concept mapping study.","authors":"Lauren Lapointe-Shaw, Christine Salahub, Minkyung Lee, Amol A Verma, Fahad Razak, Anshula Ambasta, Mohammad Refaei, Travis Carpenter, Brian Moses, Nabha Shetty, Ashley P Miller, Erin Spicer, Shail Rawal, Christine Soong, Kerry Kuluski, Karen Okrainec, G Ross Baker, Lucas B Chartier, Irfan A Dhalla, Radha Joseph, Walter P Wodchis, Laura Desveaux, Wendy Wu, Marisa Granieri","doi":"10.1136/bmjqs-2026-020280","DOIUrl":"https://doi.org/10.1136/bmjqs-2026-020280","url":null,"abstract":"<p><strong>Importance: </strong>Quality improvement efforts on general medical wards are often driven by organisational or clinician priorities, and little is known about patient or caregiver priorities.</p><p><strong>Objective: </strong>To understand contributors to patients' in-hospital experience and how patients and caregivers prioritise these for improvement.</p><p><strong>Methods: </strong>We recruited inpatients or their caregivers from the general medical wards of 10 hospitals across Canada from November 2023 to February 2025 to participate in a group concept mapping study. Group concept mapping is a participatory multistep mixed method used to understand how a group views a particular topic. We used a targeted recruitment strategy to ensure inclusion of individuals who identified as non-white, preferred a non-English language, were unhoused, had a history of a mental health condition or who had dementia. An open-ended prompt elicited narratives about the inpatient experience. These were iteratively summarised into statements, which subsequent participants thematically sorted and rated in response to two rating questions: (1) extent of negative impact on well-being and (2) prioritisation for quality improvement.</p><p><strong>Results: </strong>302 participants (230 patients, 72 caregivers) responded to the open-ended prompt. These were synthesised into 935 ideas, summarised into 42 unique statements, which were then rated (N=203 participants) and sorted (N=50), generating a concept map with six clusters: Environment & Facilities, Personal Support, Delays, Communication, Nutrition, Inclusivity & Engagement. There was no correlation between rating results for impact to well-being versus prioritisation for quality improvement. The 'Delays', 'Communication' and 'Inclusivity & Engagement' conceptual clusters contained many of the highest-rated improvement priorities. Prioritisation was consistent across participant subgroups, despite variation in how these groups rated items on impact to well-being.</p><p><strong>Conclusion: </strong>This study provides a ranked list of priorities, setting an agenda that is grounded in the patient experience. Overall, patients' and caregivers' own negative inpatient experiences had little bearing on overall prioritisation for quality improvement.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widening global gap in safe surgery: revisiting the surgical safety checklist at the 20th anniversary of the WHO Surgical Safety Checklist.","authors":"Karolina Kogut, Nobhojit Roy, Mary E Brindle","doi":"10.1136/bmjqs-2026-020251","DOIUrl":"10.1136/bmjqs-2026-020251","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"510-512"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining variations in the prevalence of hazardous opioid prescribing across general practices in England: a cross-sectional study.","authors":"Teng-Chou Chen, Alex M Trafford, Matthew J Carr, Neetu Bansal, Evangelos Kontopantelis, Anthony Avery, Li-Chia Chen, Darren M Ashcroft","doi":"10.1136/bmjqs-2025-018794","DOIUrl":"10.1136/bmjqs-2025-018794","url":null,"abstract":"<p><strong>Background: </strong>Prescribed opioids are potent analgesics associated with high safety risks due to their adverse effects, drug-drug and drug-disease interactions and potential for dependency. To support the implementation of prescribing indicators for further interventions, this study examined the prevalence of different types of potentially hazardous opioid prescribing (PHOP) in general practices across England and investigated underlying factors and variation between practices.</p><p><strong>Methods: </strong>We conducted a cross-sectional study focusing on adults (aged ≥18 years) at risk of triggering 17 PHOP indicators on 1 April 2021, involving 1358 general practices contributing to the Clinical Practice Research Datalink Aurum. PHOP prevalence was calculated by dividing the number of patients triggering an indicator by the total number at risk. Variation was assessed with intraclass correlation coefficients (ICCs), and multilevel mixed-effects logistic regression models identified associated factors, presented as adjusted ORs (aORs) with 95% CIs.</p><p><strong>Results: </strong>Among 3 121 852 patients observed, 361 505 (11.58%, 95% CI 11.54, 11.62) triggered at least one PHOP indicator, yielding an ICC of 0.07 (95% CI 0.06, 0.07). The prevalence of the 17 PHOP indicators ranged from 1.97% to 32.02%. Significant variability was noted across the 17 indicators, especially for persistent opioid prescriptions in patients with alcohol use issues (ICC 0.08, 95% CI 0.07, 0.09), chronic obstructive pulmonary disease or asthma (ICC 0.08, 95% CI 0.07, 0.09) and hypothyroidism (ICC 0.07, 95% CI 0.06, 0.07). Patients from the most deprived regions (aOR 1.28, 95% CI 1.22, 1.34) and the Northwest of England (aOR 1.73, 95% CI 1.66, 1.81) had a higher risk of PHOP.</p><p><strong>Conclusions and relevance: </strong>The high prevalence of PHOP, particularly among the most socioeconomically disadvantaged populations, emphasises existing prescribing risks and the need for their appropriate consideration within primary care. The high variation between practices indicates potential for improvement through targeted practice-level intervention.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"541-550"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising professional support for doctors who experience work performance issues: a realist evaluation.","authors":"Nicola Brennan, Ellie Reynolds, Tristan Price, Geoff Wong, Jennifer Cleland, Helen Lloyd, Lyndsey Withers, Thomas Gale","doi":"10.1136/bmjqs-2025-019749","DOIUrl":"10.1136/bmjqs-2025-019749","url":null,"abstract":"<p><strong>Background: </strong>The optimal performance of doctors is critical to delivering high-quality, safe healthcare. However, 6-12% of doctors may experience challenges that impact their work performance. In many countries, including the UK, there is variation in the practice and quality of professional support services between different types of organisations. The aims of our study were (1) to identify why, how, in what contexts and for whom professional support works, (2) to develop a guide for healthcare organisations to use to optimise professional support.</p><p><strong>Methods: </strong>We carried out a realist evaluation consistent with Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) II standards. 45 interviews were conducted with professional support staff and doctors who had undertaken professional support across seven sites in England. Interviews were analysed using a realist logic. To develop the guide, six workshops were held with the same groups plus a patient and public involvement group.</p><p><strong>Results: </strong>We identified six principles of effective professional support, based on 47 context-mechanism-outcome configurations. (1) Work-place culture influences support-seeking behaviour. (2) Trust and psychological safety are central to enable candid conversations and engagement. (3) Doctors can then develop self-awareness and situational awareness, reframe challenges, accept responsibility where appropriate and recognise structural factors underpinning their difficulties. (4) Doctors are more likely to feel motivated to engage through positive framing. (5) Personal and professional growth occurs when doctors are empowered to make changes to their practice. (6) Cultures that stigmatise help-seeking undermine support, while those that model vulnerability and normalise support enhance the likelihood of positive outcomes.</p><p><strong>Conclusions: </strong>Our guide provides step-by-step advice to identify key actions for those delivering professional support . Since the realist approach identifies principles and causal explanations, the findings are likely transferable to other settings/countries.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"517-526"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical safety checklist awareness and safety attitudes in the Eastern Mediterranean region: a cross-sectional study.","authors":"Assem Gebreal, Fatma Badr El Dine, Albaraa Abdulsalam, Doaa Hamdy Aly, Shaimaa Abdelaziz Abdelmoneim, Walid M Abd El Maksoud, Siwar Belhaj Salem, Alaa Nadir Mohamed Abdelrahim, Saja A Albanaa, Saja Alasaad, Rajiv Yussuf Ali, Ramez M Odat, Noha Taymour, Tabraiz Amin Malik, Abdelrahman Zaki Ali Mohammed, Notaila Mohammed Fayed, Khlood Saleh Mohammed Al-Ansi, Majda Attar, Ibrahim Mutwakil Gamal Ahmed, Ramy Mohamed Ghazy","doi":"10.1136/bmjqs-2025-019076","DOIUrl":"10.1136/bmjqs-2025-019076","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization Surgical Safety Checklist (WHO-SSC) is a global tool designed to enhance teamwork and safety in operating rooms (ORs). Its use remains under-reported in the Eastern Mediterranean Region (EMR). This study aimed to assess WHO-SSC awareness, adoption, satisfaction with its implementation, barriers and its impact on healthcare professionals' safety attitudes.</p><p><strong>Methods: </strong>Using a validated questionnaire, a cross-sectional survey was conducted from 11 March to 18 June 2024, in hospitals across 12 countries in the EMR through face-to-face and online distribution. Healthcare professionals' safety attitude was assessed using the modified operating-room version of the Safety Attitudes Questionnaire. A multiple logistic regression model was used for data analysis, reporting aOR with 95% CIs.</p><p><strong>Results: </strong>The study involved 3861 respondents, comprising 1348 surgeons, 1277 OR nurses and 1236 anaesthesiologists. Overall, 52.5% of respondents reported awareness of the WHO-SSC. Among those aware, adoption was highest in private and teaching hospitals and lowest in charity hospitals, with 56.2% expressing satisfaction with its implementation. Reported 'always' adherence to the checklist was 32% in elective surgeries, compared with 19% in emergency surgeries. The main barriers included a lack of training, time constraints, limited awareness and poor team communication. Overall, 61.4% of participants demonstrated a positive safety attitude. Positive attitudes were associated with older age, being from a low-income and middle-income country, and WHO-SSC awareness.</p><p><strong>Conclusion: </strong>This study emphasises inadequate awareness and adoption of the WHO-SSC in the EMR. Strengthening training, institutional support and context-specific implementation strategies is essential to enhance surgical safety culture in the region.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"527-540"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tools to engage patients and family members in diagnostic safety: we see the trees, but what about the forest?","authors":"Aubrey Samost-Williams, Sigall K Bell, Eric J Thomas","doi":"10.1136/bmjqs-2026-020127","DOIUrl":"10.1136/bmjqs-2026-020127","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"513-516"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Welcome to the jungle: collection and evaluation of quality indicators with the QUALICATOR instrument.","authors":"Jonas Backes, Justus Vogel, Alexander Geissler, Michael M Havranek, Sarah P Schladerer, David Ehlig","doi":"10.1136/bmjqs-2026-020265","DOIUrl":"10.1136/bmjqs-2026-020265","url":null,"abstract":"<p><p>The rapid growth in quality indicators (QIs) has increased complexity in selecting those that are effective for monitoring provider quality and patient outcomes. Existing selection methodologies are often insufficiently transparent or standardised and influenced by subjective opinions. To develop an instrument for evidence-based collection and evaluation of QIs that are suitable for quality monitoring, and which can be applied to various healthcare areas (HCAs; defined by care setting). The instrument was developed with HCA-specific experts, who provided feedback on its components and piloted its use in the Swiss context. We conducted a literature search with snowballing to identify prioritisation criteria and weighted these using the Analytic Hierarchy Process (AHP). We developed a template to facilitate data collection and the QI evaluation. The final QUALICATOR instrument consists of five steps: (1) definition of search scope; (2) utilisation of 12 prioritisation criteria across four dimensions (relevance, scientific soundness, usability, feasibility); (3) application of a data collection template objectifying the prioritisation criteria; (4) preselection via knockout criteria and (5) final prioritisation via weighting multicriteria decision analysis. Final criteria weights derived via the AHP varied substantially across HCAs (eg, relevance: 19.16%-57.10%; scientific soundness: 5.50%-39.50%; usability: 13.17%-33.75%; feasibility: 11.78%-45.57%), reflecting HCA-specific priorities. A web-based prototype is available to support a user-friendly application. This QUALICATOR instrument provides a transparent, scalable approach to navigate through a growing body of QIs with further validation needed. It provides a methodological framework and proof of concept, rather than a ready-to-use solution. It shows policymakers, providers and payers a path to make informed decisions about which QIs to prioritise, monitor, invest in and act on.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"565-575"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping review of patient and family engagement interventions in diagnosis: a paradox of too much, yet so little.","authors":"Mary A Hill, Helen Haskell, Katie N Dainty, Kerry Kuluski, Christine Shea, Layla Heimlich, Sharifa Kazi, Mark Sochaniwskyj, Alessia Priore, Taylor Leslie Marie Mason, Tess Coppinger, Simran Isani, Nicole Scala, Sara Shearkhani, Sadaf Kazi, Traber D Giardina, Kristen E Miller, Kelly M Smith","doi":"10.1136/bmjqs-2025-019145","DOIUrl":"10.1136/bmjqs-2025-019145","url":null,"abstract":"<p><strong>Introduction: </strong>Actively engaging patients is essential for diagnostic excellence and patient safety.</p><p><strong>Objectives: </strong>To (1) identify and synthesise interventions facilitating patient and family engagement (PFE) across the diagnostic process, and (2a) assess patient involvement and (2b) equity considerations in their design or implementation.</p><p><strong>Design: </strong>This scoping review followed Arksey and O'Malley's framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review) guidelines. An advisory panel guided the review. We searched Medline, Embase, CINAHL, PsycInfo and Northern Light for peer-reviewed literature and conducted grey literature searches using DuckDuckGo and targeted websites. Search terms focused on PFE and diagnostic error. Eligible interventions were published in English between January 1999 and July 2024 and supported PFE in at least one step of the National Academies of Sciences, Engineering, and Medicine (NASEM) diagnostic process. Narrative reviews, case studies and editorials were excluded. Interventions were mapped to the NASEM steps; data were extracted on patient involvement and equity.</p><p><strong>Results: </strong>Of the 11 630 studies screened, 250 were included, representing 260 interventions. Most (n=213; 85.2%) were from the grey literature, and patients were primary users (n=166; 63.8%). Interventions spanned all diagnostic process steps but were most common in treatment (n=122; 46.9%) and history taking (n=100; 38.5%), with few in referrals (n=10, 3.8%) and physical examinations (n=6, 2.3%). The evidence base was weak: grey literature interventions lacked high-quality studies, and among the 37 peer-reviewed studies, three were randomised controlled trials, each limited by small samples or high attrition. Only 63 interventions (24.2%) were designed with patients, and 48 (18.5%) incorporated equity.</p><p><strong>Conclusion: </strong>PFE interventions exist across the diagnostic process, but few target referrals and physical examinations. The evidence remains weak, and current interventions cannot be considered effective. Future research should prioritise equity, patient involvement and rigorous evaluation.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"552-564"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145817564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional support is an important lifeboat, but let's also stop people falling into the water.","authors":"Alison Pearson, Kathryn Bamforth, Alice Miller","doi":"10.1136/bmjqs-2026-020086","DOIUrl":"10.1136/bmjqs-2026-020086","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"507-509"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widening of the 'technical/practical' divide: New advances in statistical process control bring new capabilities and new challenges.","authors":"Brant J Oliver","doi":"10.1136/bmjqs-2026-020143","DOIUrl":"10.1136/bmjqs-2026-020143","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"503-506"},"PeriodicalIF":6.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}