Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre-Post Quasi-Experimental Quality Improvement Project.

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Military Medicine Pub Date : 2024-11-02 DOI:10.1093/milmed/usae511
Aaron M Sawyer, Sreedevi Thiyarajan, Keith Essen, Robin Pendley-Louis, Gary L Sculli, Edward E Yackel
{"title":"Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre-Post Quasi-Experimental Quality Improvement Project.","authors":"Aaron M Sawyer, Sreedevi Thiyarajan, Keith Essen, Robin Pendley-Louis, Gary L Sculli, Edward E Yackel","doi":"10.1093/milmed/usae511","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this quality improvement (QI) project was to evaluate outcomes across Veterans Health Administration (VHA) hospital facilities engaged in an enterprise-wide implementation of a high-reliability organization (HRO) framework.</p><p><strong>Materials and methods: </strong>This QI project relied on primary data drawn from 139 facilities nationwide from 2019 to 2023. Data sources included the All Employee Survey Patient Safety Culture (PSC) Module and patient safety reporting data derived from the Joint Patient Safety Reporting system. The project design applied a pre-post quasi-experimental design that examined within-cohort changes at pre-intervention, intervention, and 2 post-intervention follow-up timepoints. HRO interventions included a combination of training, leadership coaching, site assessments, and experiential learning. HRO interventions were initiated at 18 facilities beginning in 2019 (Cohort 1), 54 facilities in 2020 (Cohort 2), and 67 facilities in 2021 (Cohort 3). For between-cohort analyses, the relative degree of change within Cohort 1 sites was compared with all other sites.</p><p><strong>Results: </strong>There were broad positive within-group trends for PSC scores across all sites, and domain-specific between-group differences in PSC Dimension 2-Risk Identification and Just Culture-and Dimension 4-Error Transparency and Risk Mitigation. For patient safety reporting, total events reported, and close calls increased for Cohort 1. The ratio of close calls to adverse events also increased for both Cohort 1 and all other VHA sites at post-intervention year 2.</p><p><strong>Conclusions: </strong>The results of this QI project will inform further refinements to VHA's efforts to implement HRO principles and practices in the nation's largest integrated health system. In addition, the implementation practices may inform other large-scale, multi-level efforts to improve quality and patient safety.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Military Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/milmed/usae511","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: The purpose of this quality improvement (QI) project was to evaluate outcomes across Veterans Health Administration (VHA) hospital facilities engaged in an enterprise-wide implementation of a high-reliability organization (HRO) framework.

Materials and methods: This QI project relied on primary data drawn from 139 facilities nationwide from 2019 to 2023. Data sources included the All Employee Survey Patient Safety Culture (PSC) Module and patient safety reporting data derived from the Joint Patient Safety Reporting system. The project design applied a pre-post quasi-experimental design that examined within-cohort changes at pre-intervention, intervention, and 2 post-intervention follow-up timepoints. HRO interventions included a combination of training, leadership coaching, site assessments, and experiential learning. HRO interventions were initiated at 18 facilities beginning in 2019 (Cohort 1), 54 facilities in 2020 (Cohort 2), and 67 facilities in 2021 (Cohort 3). For between-cohort analyses, the relative degree of change within Cohort 1 sites was compared with all other sites.

Results: There were broad positive within-group trends for PSC scores across all sites, and domain-specific between-group differences in PSC Dimension 2-Risk Identification and Just Culture-and Dimension 4-Error Transparency and Risk Mitigation. For patient safety reporting, total events reported, and close calls increased for Cohort 1. The ratio of close calls to adverse events also increased for both Cohort 1 and all other VHA sites at post-intervention year 2.

Conclusions: The results of this QI project will inform further refinements to VHA's efforts to implement HRO principles and practices in the nation's largest integrated health system. In addition, the implementation practices may inform other large-scale, multi-level efforts to improve quality and patient safety.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
在大型综合医疗系统中实施高可靠性组织框架:前后期准实验性质量改进项目。
简介:本质量改进(QI)项目的目的是评估退伍军人健康管理局(VHA)医院设施在全企业范围内实施高可靠性组织框架的成果:本质量改进(QI)项目旨在评估退伍军人健康管理局(VHA)医院设施在全企业范围内实施高可靠性组织(HRO)框架的成果:该 QI 项目依靠的是 2019 年至 2023 年期间从全国 139 家机构获得的原始数据。数据来源包括全体员工调查患者安全文化(PSC)模块和来自患者安全联合报告系统的患者安全报告数据。项目设计采用了前-后准实验设计,考察了干预前、干预和干预后两个随访时间点的队内变化。HRO 干预措施包括培训、领导力辅导、现场评估和体验式学习。HRO 干预措施于 2019 年在 18 家机构启动(队列 1),2020 年在 54 家机构启动(队列 2),2021 年在 67 家机构启动(队列 3)。在队列间分析中,比较了队列 1 机构与所有其他机构的相对变化程度:结果:所有医疗机构的 PSC 分数在组内呈广泛的正向趋势,而在 PSC 维度 2--风险识别与公正文化和维度 4--差错透明度与风险缓解方面则存在特定领域的组间差异。在患者安全报告方面,组群 1 报告的总事件数和险情报告数均有所增加。在干预后的第 2 年,群组 1 和所有其他退伍军人医疗服务机构的密切呼叫与不良事件的比率也有所上升:本 QI 项目的结果将为进一步完善 VHA 在全国最大的综合医疗系统中实施 HRO 原则和实践的工作提供参考。此外,实施实践还可为其他大规模、多层次的提高质量和患者安全的工作提供参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
期刊最新文献
Fatigue and Sleep-related Impairment as Predictors of the Effect of Nonpharmacological Therapies for Active duty Service Members With Chronic Pain: A Secondary Analysis of a Pragmatic Randomized Clinical Trial. Challenges to School Success Among Children in U.S. Military Families. Combat-Relevant Anesthesia Fellowships Help Sustain the Army's Multidomain Medical Force. Preparing Military Interprofessional Health Care Teams for Effective Collaboration. Synopsis of the 2023 U.S. Department of VA and U.S. DoD Clinical Practice Guideline for the Management of Pregnancy.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1