Pub Date : 2025-06-12DOI: 10.1016/j.jcjq.2025.06.006
Jeffrey J. Geppert EdM, JD (is Senior Research Leader, Battelle Memorial Institute, Columbus, Ohio.), Peta M.A. Alexander MBBS, FRACP, FCICM (is Senior Associate Cardiologist, Boston Children's Hospital, and Associate Professor of Pediatrics, Harvard Medical School.), Nicole Brennan DrPH, MPH (is Director, Healthcare Quality Improvement and Population Health, Battelle Memorial Institute.), Kedar S. Mate MD (is Founder and Chief Medical Officer, Qualified Health, and Assistant Professor of Medicine, Weill Cornell Medical College.), Kathy J. Jenkins MD, MPH (is Senior Associate Cardiologist, Boston Children's Hospital, and Professor of Pediatrics, Harvard Medical School. Please address correspondence to Jeffrey J. Geppert)
{"title":"Generating Value Through Structural Investment: Rebalancing Value-Based Payment, Pay for Transformation, and Fee-for-Service","authors":"Jeffrey J. Geppert EdM, JD (is Senior Research Leader, Battelle Memorial Institute, Columbus, Ohio.), Peta M.A. Alexander MBBS, FRACP, FCICM (is Senior Associate Cardiologist, Boston Children's Hospital, and Associate Professor of Pediatrics, Harvard Medical School.), Nicole Brennan DrPH, MPH (is Director, Healthcare Quality Improvement and Population Health, Battelle Memorial Institute.), Kedar S. Mate MD (is Founder and Chief Medical Officer, Qualified Health, and Assistant Professor of Medicine, Weill Cornell Medical College.), Kathy J. Jenkins MD, MPH (is Senior Associate Cardiologist, Boston Children's Hospital, and Professor of Pediatrics, Harvard Medical School. Please address correspondence to Jeffrey J. Geppert)","doi":"10.1016/j.jcjq.2025.06.006","DOIUrl":"10.1016/j.jcjq.2025.06.006","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 673-678"},"PeriodicalIF":2.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-10DOI: 10.1016/j.jcjq.2025.06.003
Hanne Irene Jensen PhD, MHSc, CCN (is Professor, Departments of Anesthesiology and Intensive Care, Lillebaelt Hospital (Vejle and Kolding), University Hospital of Southern Denmark, and Department of Regional Health Research, University of Southern Denmark.), Hanne Andersen MPG, RN (is Nursing Director, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark.), Helen Bruun MHSc, RN (is Quality Coordinator, Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark. Please address correspondence to Hanne Irene Jensen)
Background
Do not resuscitate (DNR) orders are not always documented at transitions of care, which may lead to inappropriate resuscitation attempts. The objectives of this study were (1) to investigate the challenges in ensuring that all staff are aware of patients’ DNR orders, (2) to examine documentation of DNR orders at transitions of care, and (3) to improve knowledge about DNR orders in institutions and at transitions of care.
Methods
This intervention initiative with pre- and post-measurements (2020 and 2023) involved hospital departments and nursing homes in Denmark. The intervention consisted of a practical instruction brochure and an end-of-life presentation. The measurements included audits of resuscitation attempts and of DNR order documentation at transitions of care. Furthermore, the participating institutions completed an electronic survey on perceived challenges.
Results
Thirty nursing homes and eight hospital departments participated in pre-measurement, 20 nursing homes and seven hospital departments participated in post-measurement, and 17 to 20 sites were included in paired analyses. The number of inappropriate resuscitation attempts was identical at pre- and post-measurements (none in nursing homes and five at the hospital). Correct documentation in nursing reports at hospital discharge increased from 32% to 53% (p = 0.003). Participating units that did not perceive challenges in ensuring knowledge of DNR orders increased from 10% to 48% (p < 0.001). At post-measurement, more than 80% of participating units had worked with models to ensure awareness of DNR orders and inclusion of DNR orders at transitions of care.
Conclusion
Participants experienced a significant increased focus on DNR orders in their own departments. Likewise, a significant increase in communication of DNR orders at transitions of care was found.
{"title":"Improving Awareness and Communication of Do Not Resuscitate Orders During Transitions of Care","authors":"Hanne Irene Jensen PhD, MHSc, CCN (is Professor, Departments of Anesthesiology and Intensive Care, Lillebaelt Hospital (Vejle and Kolding), University Hospital of Southern Denmark, and Department of Regional Health Research, University of Southern Denmark.), Hanne Andersen MPG, RN (is Nursing Director, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark.), Helen Bruun MHSc, RN (is Quality Coordinator, Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark. Please address correspondence to Hanne Irene Jensen)","doi":"10.1016/j.jcjq.2025.06.003","DOIUrl":"10.1016/j.jcjq.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Do not resuscitate (DNR) orders are not always documented at transitions of care, which may lead to inappropriate resuscitation attempts. The objectives of this study were (1) to investigate the challenges in ensuring that all staff are aware of patients’ DNR orders, (2) to examine documentation of DNR orders at transitions of care, and (3) to improve knowledge about DNR orders in institutions and at transitions of care.</div></div><div><h3>Methods</h3><div>This intervention initiative with pre- and post-measurements (2020 and 2023) involved hospital departments and nursing homes in Denmark. The intervention consisted of a practical instruction brochure and an end-of-life presentation. The measurements included audits of resuscitation attempts and of DNR order documentation at transitions of care. Furthermore, the participating institutions completed an electronic survey on perceived challenges.</div></div><div><h3>Results</h3><div>Thirty nursing homes and eight hospital departments participated in pre-measurement, 20 nursing homes and seven hospital departments participated in post-measurement, and 17 to 20 sites were included in paired analyses. The number of inappropriate resuscitation attempts was identical at pre- and post-measurements (none in nursing homes and five at the hospital). Correct documentation in nursing reports at hospital discharge increased from 32% to 53% (<em>p</em> = 0.003). Participating units that did not perceive challenges in ensuring knowledge of DNR orders increased from 10% to 48% (<em>p</em> < 0.001). At post-measurement, more than 80% of participating units had worked with models to ensure awareness of DNR orders and inclusion of DNR orders at transitions of care.</div></div><div><h3>Conclusion</h3><div>Participants experienced a significant increased focus on DNR orders in their own departments. Likewise, a significant increase in communication of DNR orders at transitions of care was found.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 574-581"},"PeriodicalIF":2.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-10DOI: 10.1016/j.jcjq.2025.06.004
Nkiru Ogbuefi (is MD Candidate, Tufts University School of Medicine.), Alexandra Forauer MPH (is Director, Destination Services, Memorial Sloan Kettering Cancer Center, New York.), Maryana Kovalchuk MA (is Senior Manager, Patient Support Services, Memorial Sloan Kettering Cancer Center.), Javier Gonzalez MFA (is Language Initiatives Lead, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Catalina Gomez Luna (is Language Program Coordinator and Trainer, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Yunshan Niu MA (is Project Manager, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Francesca Gany MD, MS (is Attending Physician, and Chief, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, and Professor of Medicine and Population Health Sciences, Weill Cornell Medical College.), Lisa C. Diamond MD, MPH (is Associate Attending Physician, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Assistant Professor of Population Health Sciences, Weill Cornell Medical College. Please address correspondence to Lisa C. Diamond)
Background
Language proficiency among health care professionals is essential for delivering equitable, high-quality care to patients with a non-English language preference (NELP). This study examines how implementing a Bilingual Competency Program (BCP) for diverse clinical staff enhances patient-centered care and improves the health care experience for NELP patients.
Methods
This quality improvement initiative describes implementation of the BCP at an urban cancer center. Staff self-assessed their language skills using the adapted Interagency Language Roundtable Scale for Healthcare (ILR-H) and recorded this in the organization’s human resources platform. Those self-rating as excellent attested to their proficiency and enrolled by signing an electronic statement. Those rating themselves as very good or good took an oral proficiency test. Those who passed joined the BCP, while those self-assessing as fair or poor were not included.
Results
A total of 935 employees joined the program, representing 1,087 unique language entries across 67 languages, with Spanish, Mandarin, Russian, and Hindi being most common. Out of 1,087 unique entries, 641 (59.0%) self-assessed as excellent, 269 (24.7%) as very good (75.0% of whom [60/80] passed the proficiency test), and 130 (12.0%) as good (58.8% of whom [20/34] passed). Most participants (71.8%) were in patient-facing roles, and 68.7% held clinical positions. Of 1,087 unique entries, 721 (66.3%) were verified for language proficiency, 641 through self-assessment and 80 through formal testing.
Conclusion
The BCP enhances linguistic competency by integrating validated assessments and evidence-based methods, addressing prior program limitations, and setting a new standard for improving health equity, care quality, and outcomes for NELP patients.
{"title":"Language-Concordant Health Care: Implementation of a Bilingual Competency Program","authors":"Nkiru Ogbuefi (is MD Candidate, Tufts University School of Medicine.), Alexandra Forauer MPH (is Director, Destination Services, Memorial Sloan Kettering Cancer Center, New York.), Maryana Kovalchuk MA (is Senior Manager, Patient Support Services, Memorial Sloan Kettering Cancer Center.), Javier Gonzalez MFA (is Language Initiatives Lead, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Catalina Gomez Luna (is Language Program Coordinator and Trainer, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Yunshan Niu MA (is Project Manager, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center.), Francesca Gany MD, MS (is Attending Physician, and Chief, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, and Professor of Medicine and Population Health Sciences, Weill Cornell Medical College.), Lisa C. Diamond MD, MPH (is Associate Attending Physician, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Assistant Professor of Population Health Sciences, Weill Cornell Medical College. Please address correspondence to Lisa C. Diamond)","doi":"10.1016/j.jcjq.2025.06.004","DOIUrl":"10.1016/j.jcjq.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Language proficiency among health care professionals is essential for delivering equitable, high-quality care to patients with a non-English language preference (NELP). This study examines how implementing a Bilingual Competency Program (BCP) for diverse clinical staff enhances patient-centered care and improves the health care experience for NELP patients.</div></div><div><h3>Methods</h3><div>This quality improvement initiative describes implementation of the BCP at an urban cancer center. Staff self-assessed their language skills using the adapted Interagency Language Roundtable Scale for Healthcare (ILR-H) and recorded this in the organization’s human resources platform. Those self-rating as excellent attested to their proficiency and enrolled by signing an electronic statement. Those rating themselves as very good or good took an oral proficiency test. Those who passed joined the BCP, while those self-assessing as fair or poor were not included.</div></div><div><h3>Results</h3><div>A total of 935 employees joined the program, representing 1,087 unique language entries across 67 languages, with Spanish, Mandarin, Russian, and Hindi being most common. Out of 1,087 unique entries, 641 (59.0%) self-assessed as excellent, 269 (24.7%) as very good (75.0% of whom [60/80] passed the proficiency test), and 130 (12.0%) as good (58.8% of whom [20/34] passed). Most participants (71.8%) were in patient-facing roles, and 68.7% held clinical positions. Of 1,087 unique entries, 721 (66.3%) were verified for language proficiency, 641 through self-assessment and 80 through formal testing.</div></div><div><h3>Conclusion</h3><div>The BCP enhances linguistic competency by integrating validated assessments and evidence-based methods, addressing prior program limitations, and setting a new standard for improving health equity, care quality, and outcomes for NELP patients.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 526-533"},"PeriodicalIF":2.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-07DOI: 10.1016/j.jcjq.2025.06.001
Salome O. Chitavi PhD (is Research Scientist II, Department of Research, The Joint Commission, Oakbrook Terrace, Illinois), Michael Kohut PhD (is Qualitative Data Analyst, Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Westbrook, Maine), Barbara I. Braun PhD (is Associate Director, Department of Research, The Joint Commission), David Y. Hyun MD (is Project Director, Antibiotic Resistance Project, The Pew Charitable Trust, Washington, D.C. Please address correspondence to Salome Chitavi)
Background
Most hospitals have a basic infrastructure in place for their antimicrobial stewardship programs (ASPs). However, up to 50% of hospital-administered antimicrobials are prescribed inappropriately. To explore challenges and facilitators for effective implementation of leading practices (LPs), the authors conducted in-depth semistructured interviews with a sample of ASP leaders in Joint Commission–accredited hospitals across the United States.
Methods
In this qualitative study, the reserarchers conducted 30 in-depth interviews with a purposive sample of hospital ASP leaders from a cross section of hospitals of varied size and system membership. The framework approach was used to analyze and organize data. Factors that were critical for implementing multiple LPs across hospitals of different characteristics were termed super-facilitators.
Results
Of 46 hospitals invited, 30 (10 large, 10 medium, 10 small) agreed to be interviewed. Of these, 22 hospitals were general medical/surgical, 6 were critical access hospitals (CAHs), and 2 were children’s hospitals. The authors identified five super-facilitators: (1) having optimal electronic health records (EHRs), (2) dedicated staffing, (3) infectious diseases expertise, (4) hospital leadership commitment, and (5) physician champions that enhanced buy-in from clinicians.
Conclusion
Each of the five super-facilitators affect implementation of multiple leading antimicrobial stewardship practices. Given their inter-relationships, collective application of all five super-facilitators can support more effective and sustainable antimicrobial stewardship.
{"title":"Super-Facilitators for Implementation of Leading Antimicrobial Stewardship Practices in Hospitals: A Qualitative Study","authors":"Salome O. Chitavi PhD (is Research Scientist II, Department of Research, The Joint Commission, Oakbrook Terrace, Illinois), Michael Kohut PhD (is Qualitative Data Analyst, Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Westbrook, Maine), Barbara I. Braun PhD (is Associate Director, Department of Research, The Joint Commission), David Y. Hyun MD (is Project Director, Antibiotic Resistance Project, The Pew Charitable Trust, Washington, D.C. Please address correspondence to Salome Chitavi)","doi":"10.1016/j.jcjq.2025.06.001","DOIUrl":"10.1016/j.jcjq.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Most hospitals have a basic infrastructure in place for their antimicrobial stewardship programs (ASPs). However, up to 50% of hospital-administered antimicrobials are prescribed inappropriately. To explore challenges and facilitators for effective implementation of leading practices (LPs), the authors conducted in-depth semistructured interviews with a sample of ASP leaders in Joint Commission–accredited hospitals across the United States.</div></div><div><h3>Methods</h3><div>In this qualitative study, the reserarchers conducted 30 in-depth interviews with a purposive sample of hospital ASP leaders from a cross section of hospitals of varied size and system membership. The framework approach was used to analyze and organize data. Factors that were critical for implementing multiple LPs across hospitals of different characteristics were termed <em>super-facilitators</em>.</div></div><div><h3>Results</h3><div>Of 46 hospitals invited, 30 (10 large, 10 medium, 10 small) agreed to be interviewed. Of these, 22 hospitals were general medical/surgical, 6 were critical access hospitals (CAHs), and 2 were children’s hospitals. The authors identified five super-facilitators: (1) having optimal electronic health records (EHRs), (2) dedicated staffing, (3) infectious diseases expertise, (4) hospital leadership commitment, and (5) physician champions that enhanced buy-in from clinicians.</div></div><div><h3>Conclusion</h3><div>Each of the five super-facilitators affect implementation of multiple leading antimicrobial stewardship practices. Given their inter-relationships, collective application of all five super-facilitators can support more effective and sustainable antimicrobial stewardship.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 621-631"},"PeriodicalIF":2.4,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-06DOI: 10.1016/j.jcjq.2025.05.003
Bailey Russell MD (is Surgical Fellow, Department of Surgery, University of Toronto.), Arezoo Ahmadzadeh MD (is Surgical Fellow, Department of Surgery, McGill University.), Khadija Haris MD (is Resident Physician, Department of Surgery, University of Toronto.), Stephanie Jiang MD (is Resident Physician, Department of Surgery, University of Toronto.), Tyler R. Chesney MD, MSc (is Assistant Professor, Department of Surgery, University of Toronto, and Surgical Oncologist, St. Michael’s Hospital, Toronto.), Helen MacRae MD (is Professor, Department of Surgery, University of Toronto.), Marisa Louridas MD, PhD (is Assistant Professor, Department of Surgery, University of Toronto, and Colorectal Surgeon, St. Michael’s Hospital. Please address correspondence to Bailey Russell)
Background
Involvement in challenging clinical encounters can lead to significant emotional distress for physicians. Studies show that physicians prefer a supportive discussion with a peer physician over other forms of psychological support. This scoping review was conducted to identify the critical components of one-on-one peer support programs for physicians and other health care providers.
Methods
A literature search was conducted to systematically identify original studies describing the conception and implementation of and/or update to a one-on-one peer support intervention for health care providers including physicians. Studies meeting inclusion criteria were reviewed and charted to describe (1) critical components of a peer support encounter, (2) logistical considerations for program implementation, and (3) methods of evaluating a peer support program.
Results
A total of 1,028 citations were identified, and 25 were included in the final analysis. Most peer support programs were for health care providers including physicians (n = 18; 72.0%), with fewer targeting physicians only (n = 7; 28.0%). Principles of peer support identified included confidentiality, informality, and voluntary participation. Frameworks for empathetic listening were commonly included. Creation of a process for escalation to higher levels of care, such as counseling or emergent psychiatric care, was the most frequently described program component. Peer supporters were most often recruited based on peer nominations or appointment, rather than self-nomination. Training of peer supporters, identification of individuals in need of support, and program administration were approached in various ways, dependant on the setting and target population. Utilization metrics and feedback through open-ended or quantitative surveys were the most common mechanisms of program evaluation.
Conclusion
With the tools and strategies outlined in this scoping review, physicians and health care providers may be better equipped to lead change in their departments though the development of peer support initiatives.
{"title":"Peer Support Programs for Physicians and Health Care Providers: A Scoping Review","authors":"Bailey Russell MD (is Surgical Fellow, Department of Surgery, University of Toronto.), Arezoo Ahmadzadeh MD (is Surgical Fellow, Department of Surgery, McGill University.), Khadija Haris MD (is Resident Physician, Department of Surgery, University of Toronto.), Stephanie Jiang MD (is Resident Physician, Department of Surgery, University of Toronto.), Tyler R. Chesney MD, MSc (is Assistant Professor, Department of Surgery, University of Toronto, and Surgical Oncologist, St. Michael’s Hospital, Toronto.), Helen MacRae MD (is Professor, Department of Surgery, University of Toronto.), Marisa Louridas MD, PhD (is Assistant Professor, Department of Surgery, University of Toronto, and Colorectal Surgeon, St. Michael’s Hospital. Please address correspondence to Bailey Russell)","doi":"10.1016/j.jcjq.2025.05.003","DOIUrl":"10.1016/j.jcjq.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Involvement in challenging clinical encounters can lead to significant emotional distress for physicians. Studies show that physicians prefer a supportive discussion with a peer physician over other forms of psychological support. This scoping review was conducted to identify the critical components of one-on-one peer support programs for physicians and other health care providers.</div></div><div><h3>Methods</h3><div>A literature search was conducted to systematically identify original studies describing the conception and implementation of and/or update to a one-on-one peer support intervention for health care providers including physicians. Studies meeting inclusion criteria were reviewed and charted to describe (1) critical components of a peer support encounter, (2) logistical considerations for program implementation, and (3) methods of evaluating a peer support program.</div></div><div><h3>Results</h3><div>A total of 1,028 citations were identified, and 25 were included in the final analysis. Most peer support programs were for health care providers including physicians (<em>n</em> = 18; 72.0%), with fewer targeting physicians only (<em>n</em> = 7; 28.0%). Principles of peer support identified included confidentiality, informality, and voluntary participation. Frameworks for empathetic listening were commonly included. Creation of a process for escalation to higher levels of care, such as counseling or emergent psychiatric care, was the most frequently described program component. Peer supporters were most often recruited based on peer nominations or appointment, rather than self-nomination. Training of peer supporters, identification of individuals in need of support, and program administration were approached in various ways, dependant on the setting and target population. Utilization metrics and feedback through open-ended or quantitative surveys were the most common mechanisms of program evaluation.</div></div><div><h3>Conclusion</h3><div>With the tools and strategies outlined in this scoping review, physicians and health care providers may be better equipped to lead change in their departments though the development of peer support initiatives.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 589-600"},"PeriodicalIF":2.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-28DOI: 10.1016/j.jcjq.2025.05.002
Elizabeth C. Kuhn MD (is Fellow, Hospital Medicine, Children’s Hospital of Philadelphia, and Instructor, Perelman School of Medicine, University of Pennsylvania.) , Katherine Pumphrey MD, MHA, MSHP (is Associate Director of Quality and Safety for Hospital Medicine, Department of Pediatrics, Boston Children’s Hospital.) , Tyler Bruinsma MD (is Resident, Department of Pediatrics, Children’s Hospital of Philadelphia.), Christopher Oskins MBA (is Enterprise Improvement Advisor, Children’s Hospital of Philadelphia.), Max Hans (is Lead Data Analyst, Children’s Hospital of Philadelphia.), Jessica Nguyen (is Care Team Assistant, Children’s Hospital of Philadelphia.), Fredrick Chang (is Care Team Assistant, Children’s Hospital of Philadelphia.), Brock Hoehn (is Care Team Assistant, Children’s Hospital of Philadelphia), Emily Kane MD, MS (is Pediatrician, Children’s Hospital of Philadelphia, and Clinical Associate Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania. Please address correspondence to Elizabeth C. Kuhn)
Introduction
Pediatric hospital capacity has decreased nationally, leaving hospitals vulnerable to capacity constraints. Approximately one fourth of pediatric patients experience discharge delays secondary to poor planning and miscommunication. As part of a hospitalwide quality improvement effort to decrease length of stay (LOS) through improved communication, an interdisciplinary team sought to increase expected discharge date (EDD) documentation for discharges on six low-performing teams from 14.2% to 50% by February 2023, inclusive of Child Opportunity Index (COI).
Methods
The team identified three primary drivers of EDD documentation: knowledge, logistics, and competing priorities. Interventions to address these drivers were implemented through eight Plan-Do-Study-Act cycles and the impact analyzed via statistical process control charts. Measures included EDD documentation (primary outcome measure), LOS (secondary outcome measure), discussion of the EDD per patient (process measure), rounding time, discharge by noon, and EDD accuracy (balancing measures).
Results
A total of 18,889 discharges were included during the baseline (July 2021 to August 2022) and intervention (September 2022 to August 2024) periods. EDD documentation demonstrated special cause variation, increasing from 14.2% to 55.7%, and was sustained for 20 months. Improvement was consistent across COI with 93.94% accuracy. LOS and rounding time were unchanged. Discussion of the EDD per patient decreased from 38.9% to 29.4%.
Conclusion
Although this effort did not decrease LOS, EDD documentation increased. This provided real-time data for more than 12,000 discharges during the intervention period. EDD documentation may serve as a valuable tool for institutional leaders to inform capacity management strategy.
{"title":"Addressing the Inpatient Capacity Crunch: A Quality Improvement Initiative to Increase Expected Discharge Date Documentation","authors":"Elizabeth C. Kuhn MD (is Fellow, Hospital Medicine, Children’s Hospital of Philadelphia, and Instructor, Perelman School of Medicine, University of Pennsylvania.) , Katherine Pumphrey MD, MHA, MSHP (is Associate Director of Quality and Safety for Hospital Medicine, Department of Pediatrics, Boston Children’s Hospital.) , Tyler Bruinsma MD (is Resident, Department of Pediatrics, Children’s Hospital of Philadelphia.), Christopher Oskins MBA (is Enterprise Improvement Advisor, Children’s Hospital of Philadelphia.), Max Hans (is Lead Data Analyst, Children’s Hospital of Philadelphia.), Jessica Nguyen (is Care Team Assistant, Children’s Hospital of Philadelphia.), Fredrick Chang (is Care Team Assistant, Children’s Hospital of Philadelphia.), Brock Hoehn (is Care Team Assistant, Children’s Hospital of Philadelphia), Emily Kane MD, MS (is Pediatrician, Children’s Hospital of Philadelphia, and Clinical Associate Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania. Please address correspondence to Elizabeth C. Kuhn)","doi":"10.1016/j.jcjq.2025.05.002","DOIUrl":"10.1016/j.jcjq.2025.05.002","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Pediatric<span> hospital capacity has decreased nationally, leaving hospitals vulnerable to capacity constraints. Approximately one fourth of pediatric patients experience discharge delays secondary to poor planning and miscommunication. As part of a hospitalwide </span></span>quality improvement<span> effort to decrease length of stay (LOS) through improved communication, an interdisciplinary team sought to increase expected discharge date (EDD) documentation for discharges on six low-performing teams from 14.2% to 50% by February 2023, inclusive of Child Opportunity Index (COI).</span></div></div><div><h3>Methods</h3><div>The team identified three primary drivers of EDD documentation: knowledge, logistics, and competing priorities. Interventions to address these drivers were implemented through eight Plan-Do-Study-Act cycles and the impact analyzed via statistical process control charts. Measures included EDD documentation (primary outcome measure), LOS (secondary outcome measure), discussion of the EDD per patient (process measure), rounding time, discharge by noon, and EDD accuracy (balancing measures).</div></div><div><h3>Results</h3><div>A total of 18,889 discharges were included during the baseline (July 2021 to August 2022) and intervention (September 2022 to August 2024) periods. EDD documentation demonstrated special cause variation, increasing from 14.2% to 55.7%, and was sustained for 20 months. Improvement was consistent across COI with 93.94% accuracy. LOS and rounding time were unchanged. Discussion of the EDD per patient decreased from 38.9% to 29.4%.</div></div><div><h3>Conclusion</h3><div>Although this effort did not decrease LOS, EDD documentation increased. This provided real-time data for more than 12,000 discharges during the intervention period. EDD documentation may serve as a valuable tool for institutional leaders to inform capacity management strategy.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 582-588"},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-17DOI: 10.1016/j.jcjq.2025.05.001
Hojjat Salmasian MD, PhD, MPH (is Assistant Professor of Medicine, Brigham and Women’s Hospital, Boston, and Harvard Medical School.), Astrid Van Wilder PhD, MPH (is Postdoctoral Research Associate, Center for Health System Sustainability, Brown University School of Public Health, and Postdoctoral Researcher, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.), Michelle Frits (is Senior Project Manager, Information Systems, Brigham and Women’s Hospital.), Christine Iannaccone MPH (is Senior Project Manager. Brigham and Women’s Hospital.), Merranda Logan MD, MPH, FACP (is Attending Nephrologist, Massachusetts General Hospital, Boston, and Assistant Professor, Harvard Medical School.), Jonathan P. Zebrowski MD, MHQS (is Attending Psychiatrist, Massachusetts General Hospital.), David Shahian MD (is Senior Surgeon, Massachusetts General Hospital, and Professor of Surgery, Harvard Medical School.), Mitchell Rein MD (is Reproductive Endocrinologist, Salem Hospital, Salem, Massachusetts, and Associate Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School.), David Levine MD, MPH, MA (is Clinician-Investigator, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School), David W. Bates MD, MSc (is Chief, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Professor of Medicine, Harvard Medical School. Please address correspondence to Astrid Van Wilder)
Background
The past two decades have seen a surge in available patient safety metrics. However, the variability in how health care organizations choose and monitor these metrics remains unknown.
Methods
The authors cataloged the metrics organizations chose and how actively they monitored them. Factors influencing the monitoring of patient safety metrics were investigated using surveys and in-depth interviews with patient safety experts from 11 Harvard-affiliated organizations.
Results
Eighty-four individuals across 11 sites helped complete the surveys, with a mean of 2.5 representatives from each site interviewed. Significant variability in active monitoring of safety metrics was observed across different sites. Overall, 108 measures were monitored by at least 1 site. Agreement between sites about the choice of measures was weak (κ = 0.40, 95% confidence interval [CI] 0.37–0.43), ranging from κ = 0.13 (95% CI 0.07–0.20) for maternal safety measures to κ = 0.86 (95% CI 0.69–1.00) for measures of hospital-acquired infections. Although not all 23 mandatory measures were monitored across all sites, these had the highest likelihood of active monitoring. A substantial overlap existed in measures targeting the same safety event but with slight differences in definitions, limiting the comparability of rates across institutions. Key considerations for active monitoring included the perceived measure usefulness and measurement burden, although external mandates or internal institutional commitments were stronger motivators overall. Other contributors included access to analytics teams and platforms, registry participation, vendor investments, and strategic or leadership interests.
Conclusion
This study offers critical guidance to health policymakers on designing and mandating safety metrics. Despite high variability in metric selection, health care organizations share common themes when deciding what to actively measure.
背景：过去二十年来，可用的患者安全指标激增。然而，医疗机构如何选择和监控这些指标的可变性仍然未知。方法：作者编目了组织选择的度量标准以及他们如何积极地监控这些度量标准。通过对11个哈佛附属机构的患者安全专家的调查和深度访谈，研究了影响患者安全指标监测的因素。结果：来自11个站点的84个人帮助完成了调查，平均每个站点有2.5名代表接受采访。在不同地点观察到主动监测安全指标的显著差异。总体而言，至少有一个站点监测了108项措施。不同地点对措施选择的一致性较弱（κ = 0.40, 95%可信区间[CI] 0.37-0.43），范围从孕产妇安全措施的κ = 0.13 （95% CI 0.07-0.20）到医院获得性感染措施的κ = 0.86 （95% CI 0.69-1.00）。虽然并非所有地点都监测了所有23项强制性措施，但这些措施进行主动监测的可能性最高。针对同一安全事件的措施存在大量重叠，但在定义上略有不同，限制了各机构费率的可比性。积极监测的关键考虑因素包括感知到的测量有用性和测量负担，尽管外部授权或内部机构承诺总体上是更有力的激励因素。其他贡献包括访问分析团队和平台、注册参与、供应商投资以及战略或领导兴趣。结论：本研究为卫生政策制定者设计和实施安全指标提供了重要指导。尽管在度量选择上有很大的可变性，但在决定积极度量什么时，医疗保健组织有共同的主题。
{"title":"Patient Safety Metrics Monitoring Across Harvard-Affiliated Hospitals: A Mixed Methods Study","authors":"Hojjat Salmasian MD, PhD, MPH (is Assistant Professor of Medicine, Brigham and Women’s Hospital, Boston, and Harvard Medical School.), Astrid Van Wilder PhD, MPH (is Postdoctoral Research Associate, Center for Health System Sustainability, Brown University School of Public Health, and Postdoctoral Researcher, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.), Michelle Frits (is Senior Project Manager, Information Systems, Brigham and Women’s Hospital.), Christine Iannaccone MPH (is Senior Project Manager. Brigham and Women’s Hospital.), Merranda Logan MD, MPH, FACP (is Attending Nephrologist, Massachusetts General Hospital, Boston, and Assistant Professor, Harvard Medical School.), Jonathan P. Zebrowski MD, MHQS (is Attending Psychiatrist, Massachusetts General Hospital.), David Shahian MD (is Senior Surgeon, Massachusetts General Hospital, and Professor of Surgery, Harvard Medical School.), Mitchell Rein MD (is Reproductive Endocrinologist, Salem Hospital, Salem, Massachusetts, and Associate Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School.), David Levine MD, MPH, MA (is Clinician-Investigator, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School), David W. Bates MD, MSc (is Chief, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Professor of Medicine, Harvard Medical School. Please address correspondence to Astrid Van Wilder)","doi":"10.1016/j.jcjq.2025.05.001","DOIUrl":"10.1016/j.jcjq.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div><span>The past two decades have seen a surge in available patient safety metrics. However, the variability in how </span>health care organizations choose and monitor these metrics remains unknown.</div></div><div><h3>Methods</h3><div>The authors cataloged the metrics organizations chose and how actively they monitored them. Factors influencing the monitoring of patient<span> safety metrics were investigated using surveys and in-depth interviews with patient safety experts from 11 Harvard-affiliated organizations.</span></div></div><div><h3>Results</h3><div>Eighty-four individuals across 11 sites helped complete the surveys, with a mean of 2.5 representatives from each site interviewed. Significant variability in active monitoring of safety metrics was observed across different sites. Overall, 108 measures were monitored by at least 1 site. Agreement between sites about the choice of measures was weak (κ = 0.40, 95% confidence interval [CI] 0.37–0.43), ranging from κ = 0.13 (95% CI 0.07–0.20) for maternal safety measures to κ = 0.86 (95% CI 0.69–1.00) for measures of hospital-acquired infections. Although not all 23 mandatory measures were monitored across all sites, these had the highest likelihood of active monitoring. A substantial overlap existed in measures targeting the same safety event but with slight differences in definitions, limiting the comparability of rates across institutions. Key considerations for active monitoring included the perceived measure usefulness and measurement burden, although external mandates or internal institutional commitments were stronger motivators overall. Other contributors included access to analytics teams and platforms, registry participation, vendor investments, and strategic or leadership interests.</div></div><div><h3>Conclusion</h3><div>This study offers critical guidance to health policymakers on designing and mandating safety metrics. Despite high variability in metric selection, health care organizations share common themes when deciding what to actively measure.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 558-565"},"PeriodicalIF":2.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-06DOI: 10.1016/j.jcjq.2025.04.008
Nicholas A. Giordano PhD, RN, FAAN (is an Assistant Professor at the Nell Hodgson Woodruff School of Nursing, Emory University.), Ingrid M. Duva PhD, MN, RN (is an Assistant Clinical Professor, at the Nell Hodgson Woodruff School of Nursing, Emory University.), Beth Ann Swan PhD, RN, CHSE, FAAN, ANEF (is a Professor at the Nell Hodgson Woodruff School of Nursing, Emory University.), Theodore M. Johnson II MD, MPH (is a Professor in the Department of Medicine and in the Department of Family and Preventive Medicine, Emory University School of Medicine. He is also an Investigator with the Birmingham/Atlanta VA Geriatrics Rehabilitation, Education, and Clinical Center and the Atlanta Veterans Affairs Healthcare System.), Jeannie P. Cimiotti PhD, RN, FAAN (is an Associate Professor at the Nell Hodgson Woodruff School of Nursing, Emory University with a Secondary Appointment in the Department of Health Policy and Management, Rollins School of Public Health, Emory University.), Dorian A. Lamis PhD, ABPP (is an Associate Professor in the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.), JoAnna Hillman MPH (is the Owner of and Principal Evaluator at Hillman Associates, LLC, Pittsburgh.), Janelle Gowgiel MPH (is a Business Consultant–Patient Access at Southeast Permanente Medical Group, Atlanta.), Kristin Giordano MPH (is an Evaluation Specialist at the Emory Centers for Public Health Training and Technical Assistance, Rollins School of Public Health, Emory University.), Nikki Rider ScD, MPP (is a Director in the Center for Program Evaluation and Quality Improvement, Emory Centers for Public Health Training and Technical Assistance, Rollins School of Public Health, Emory University.), Lisa Muirhead DNP, APRN-BC, ANP, FAANP, FAAN (is a Professor at the Nell Hodgson Woodruff School of Nursing, Emory University.), Michelle Wallace DNP, RN, TCRN, NEA-BC, FACHE (is the Chief Nursing Officer at Grady Memorial Hospital, Atlanta.), Tim Cunningham DrPH, RN, MSN, FAAN (is the former Co-Chief Well-Being Officer at Emory Healthcare, Atlanta), Maureen Shelton MDiv, ACPE (is the System Director of Education, Spiritual Health at Emory Healthcare, Emory University.), Timothy Harrison MS (is the Associate Director for Cognitively-Based Compassion Training, Center for Contemplative Science and Compassion-Based Ethics, Emory University.), LaTanya Holland MBA (is the Project Coordinator/Executive Assistant, Nell Hodgson Woodruff School of Nursing, Emory University.), Ammar A. Rashied MS (is a Biostatistician, Biostatistics Collaboration Core, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University.), Jennifer S. Mascaro PhD (is an Associate Professor in the Department of Family and Preventive Medicine, Emory University School of Medicine. Please address correspondence to Nicholas A. Giordano)
Background
A healthy, competent, and compassionate health care workforce is critical to ensure that health systems can deliver high-quality, safe patient care. Therefore, health care personnel need access to scalable, recurring, evidence-based training opportunities to bolster compassion, mitigate burnout, and enhance resiliency, ultimately improving their professional quality of life. This evaluation examined the reach, effectiveness, adoption, implementation, and maintenance of workplace-based well-being training opportunities offered by Atlanta’s Resiliency Resource for frontline Workers (ARROW) program across two health systems.
Methods
ARROW formed through an academic practice partnership designed to introduce health care personnel to evidence-based mindfulness and compassion-based training opportunities: the Community Resiliency Model (CRM) and Cognitively-Based Compassion Training (CBCT). Trainees provided evaluation feedback immediately before, two weeks after, and three months after attending a CRM or CBCT event. The Short Professional Quality of Life Scale assessed compassion fatigue, burnout, and compassion satisfaction; the Connor-Davidson Resilience Scale assessed resiliency.
Results
ARROW hosted 59 training events that directly trained 761 health care personnel. Trainees’ compassion fatigue scores, a key component of professional quality of life, decreased up to three months after engaging in programming by 0.32 points (p = 0.005, d = -0.14). Trainees who attended CBCT events were observed to have additional declines in compassion fatigue scores, by 0.45 points (p = 0.016, d = -0.215). No differences in burnout, compassion satisfaction, or resiliency were observed. ARROW mentored 68 health care personnel to become either CRM– or CBCT–certified instructors using a train-the-trainer approach. New trainers continued to offer well-being training opportunities and reached an additional 772 colleagues.
Conclusion
The findings from this evaluation indicate the broad reach and sustained impact ARROW had across health systems, engaging health care personnel in workplace well-being programming to bolster professional quality of life. Specifically, improvements in compassion fatigue scores following program participation corresponded to a small effect size; however, no changes in burnout, compassion satisfaction, or resiliency were seen after engaging in ARROW programming.
背景：一支健康、称职和富有同情心的卫生保健队伍对于确保卫生系统能够提供高质量、安全的患者护理至关重要。因此，卫生保健人员需要获得可扩展的、经常性的、以证据为基础的培训机会，以增强同情心，减轻倦怠，增强弹性，最终提高他们的职业生活质量。该评估检查了亚特兰大一线工作者弹性资源（ARROW）项目在两个卫生系统中提供的基于工作场所的福祉培训机会的范围、有效性、采用、实施和维护。方法：ARROW通过学术实践合作伙伴关系成立，旨在向卫生保健人员介绍基于证据的正念和同情心培训机会：社区弹性模型（CRM）和基于认知的同情心培训（CBCT）。学员在参加CRM或CBCT活动前、两周后和三个月后立即提供评估反馈。短期职业生活质量量表评估同情疲劳、倦怠和同情满意度；康纳-戴维森复原力量表评估复原力。结果：ARROW举办了59场培训活动，直接培训了761名卫生保健人员。作为职业生活质量的关键组成部分，受训人员的同情疲劳得分在参与编程三个月后下降了0.32分（p = 0.005, d = -0.14）。参加CBCT活动的受训者在同情疲劳得分上又下降了0.45分（p = 0.016, d = -0.215）。在倦怠、同情满意度或恢复力方面没有观察到差异。ARROW采用培训培训师的方法指导了68名医疗保健人员成为CRM或cbct认证的讲师。新的培训师继续提供福利培训机会，并培训了另外772名同事。结论：本次评估的结果表明，ARROW在整个卫生系统中具有广泛的影响和持续的影响，使卫生保健人员参与工作场所福祉规划，以提高职业生活质量。具体而言，参与项目后同情疲劳得分的改善对应于一个小的效应量；然而，参与ARROW编程后，倦怠、同情满意度和弹性没有变化。
{"title":"Effects of a Workplace Well-Being Program on Professional Quality of Life Among Health Care Personnel","authors":"Nicholas A. Giordano PhD, RN, FAAN (is an Assistant Professor at the Nell Hodgson Woodruff School of Nursing, Emory University.), Ingrid M. Duva PhD, MN, RN (is an Assistant Clinical Professor, at the Nell Hodgson Woodruff School of Nursing, Emory University.), Beth Ann Swan PhD, RN, CHSE, FAAN, ANEF (is a Professor at the Nell Hodgson Woodruff School of Nursing, Emory University.), Theodore M. Johnson II MD, MPH (is a Professor in the Department of Medicine and in the Department of Family and Preventive Medicine, Emory University School of Medicine. He is also an Investigator with the Birmingham/Atlanta VA Geriatrics Rehabilitation, Education, and Clinical Center and the Atlanta Veterans Affairs Healthcare System.), Jeannie P. Cimiotti PhD, RN, FAAN (is an Associate Professor at the Nell Hodgson Woodruff School of Nursing, Emory University with a Secondary Appointment in the Department of Health Policy and Management, Rollins School of Public Health, Emory University.), Dorian A. Lamis PhD, ABPP (is an Associate Professor in the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.), JoAnna Hillman MPH (is the Owner of and Principal Evaluator at Hillman Associates, LLC, Pittsburgh.), Janelle Gowgiel MPH (is a Business Consultant–Patient Access at Southeast Permanente Medical Group, Atlanta.), Kristin Giordano MPH (is an Evaluation Specialist at the Emory Centers for Public Health Training and Technical Assistance, Rollins School of Public Health, Emory University.), Nikki Rider ScD, MPP (is a Director in the Center for Program Evaluation and Quality Improvement, Emory Centers for Public Health Training and Technical Assistance, Rollins School of Public Health, Emory University.), Lisa Muirhead DNP, APRN-BC, ANP, FAANP, FAAN (is a Professor at the Nell Hodgson Woodruff School of Nursing, Emory University.), Michelle Wallace DNP, RN, TCRN, NEA-BC, FACHE (is the Chief Nursing Officer at Grady Memorial Hospital, Atlanta.), Tim Cunningham DrPH, RN, MSN, FAAN (is the former Co-Chief Well-Being Officer at Emory Healthcare, Atlanta), Maureen Shelton MDiv, ACPE (is the System Director of Education, Spiritual Health at Emory Healthcare, Emory University.), Timothy Harrison MS (is the Associate Director for Cognitively-Based Compassion Training, Center for Contemplative Science and Compassion-Based Ethics, Emory University.), LaTanya Holland MBA (is the Project Coordinator/Executive Assistant, Nell Hodgson Woodruff School of Nursing, Emory University.), Ammar A. Rashied MS (is a Biostatistician, Biostatistics Collaboration Core, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University.), Jennifer S. Mascaro PhD (is an Associate Professor in the Department of Family and Preventive Medicine, Emory University School of Medicine. Please address correspondence to Nicholas A. Giordano)","doi":"10.1016/j.jcjq.2025.04.008","DOIUrl":"10.1016/j.jcjq.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div><span>A healthy, competent, and compassionate health care workforce is critical to ensure that </span>health systems<span><span><span> can deliver high-quality, safe patient care. Therefore, health care personnel need access to scalable, recurring, evidence-based training opportunities to bolster compassion, mitigate burnout, and enhance </span>resiliency, ultimately improving their professional </span>quality of life. This evaluation examined the reach, effectiveness, adoption, implementation, and maintenance of workplace-based well-being training opportunities offered by Atlanta’s Resiliency Resource for frontline Workers (ARROW) program across two health systems.</span></div></div><div><h3>Methods</h3><div>ARROW formed through an academic practice partnership designed to introduce health care personnel to evidence-based mindfulness<span> and compassion-based training opportunities: the Community Resiliency Model (CRM) and Cognitively-Based Compassion Training (CBCT). Trainees provided evaluation feedback immediately before, two weeks after, and three months after attending a CRM or CBCT event. The Short Professional Quality of Life Scale assessed compassion fatigue, burnout, and compassion satisfaction; the Connor-Davidson Resilience Scale assessed resiliency.</span></div></div><div><h3>Results</h3><div><span><span>ARROW hosted 59 training events that directly trained 761 health care personnel. Trainees’ compassion fatigue scores, a key component of professional </span>quality of life, decreased up to three months after engaging in programming by 0.32 points (</span><em>p</em> = 0.005, <em>d</em> = -0.14). Trainees who attended CBCT events were observed to have additional declines in compassion fatigue scores, by 0.45 points (<em>p</em> = 0.016, <em>d</em> = -0.215). No differences in burnout, compassion satisfaction, or resiliency were observed. ARROW mentored 68 health care personnel to become either CRM– or CBCT–certified instructors using a train-the-trainer approach. New trainers continued to offer well-being training opportunities and reached an additional 772 colleagues.</div></div><div><h3>Conclusion</h3><div>The findings from this evaluation indicate the broad reach and sustained impact ARROW had across health systems, engaging health care personnel in workplace well-being programming to bolster professional quality of life. Specifically, improvements in compassion fatigue scores following program participation corresponded to a small effect size; however, no changes in burnout, compassion satisfaction, or resiliency were seen after engaging in ARROW programming.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 548-557"},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-06DOI: 10.1016/j.jcjq.2025.04.009
Stephanie A. Zajac PhD, MS (is an Organizational Psychologist and Senior Leadership Practitioner, University of Texas MD Anderson Cancer Center, Houston.), Kimberly N. Williams PhD (is an Instructor of Record, Embry-Riddle Aeronautical University, Daytona Beach, Florida.), Sabina M. Patel MS (is a PhD Candidate, Embry-Riddle Aeronautical University.), Elizabeth H. Lazzara PhD, MA (is an Associate Professor, Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University.), Joe R. Keebler PhD, MA (is a Professor, Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University.), Mark W. Clemens MD, MBA, FACS (is a Surgeon and Professor, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.), Courtney L. Holladay PhD, MA (is the Associate Vice President, Leadership Institute, University of Texas MD Anderson Cancer Center. Please address correspondence to Courtney L. Holladay)
Background
Psychological safety is a critical teamwork competency that promotes effective communication, teamwork, patient safety, and the well-being of health care professionals. However, previous research on barriers and facilitators to promotion of psychological safety has focused mainly on clinical staff, omitting other health care disciplines that contribute to patient safety and high-quality care.
Methods
The authors conducted a qualitative study in one health system to identify barriers and facilitators to psychological safety in the workplace. Participants in a quality improvement (QI) initiative were invited through automated e-mails sent via the Qualtrics platform to participate in this survey. Employees self-selected whether to respond, as participation was not required as part of the QI initiative engagement.
Results
A total of 429 participants across 19 departments spanning administration, education, research, and clinical areas were invited. The average survey response rate across departments was 52.2%. Participants answered two open-ended questions: (1) “What are situations where it can be difficult to take an interpersonal risk and speak up [on this team]?” and (2) “What are the challenges to creating psychological safety within your current team?” Three psychological safety subject matter experts coded the data to extract factors and subthemes. Thematic factors at the individual, team, and organization level were uncovered. Sixteen subcategories of factors that affect psychological safety emerged, uncovering two implications.
Conclusion
Psychological safety as defined here includes not just team level but the individual and organization levels. Interventions must align with the factors at all three levels for a personalized and comprehensive approach.
{"title":"Understanding Psychological Safety in Health Care: A Qualitative Investigation and Practical Guidance","authors":"Stephanie A. Zajac PhD, MS (is an Organizational Psychologist and Senior Leadership Practitioner, University of Texas MD Anderson Cancer Center, Houston.), Kimberly N. Williams PhD (is an Instructor of Record, Embry-Riddle Aeronautical University, Daytona Beach, Florida.), Sabina M. Patel MS (is a PhD Candidate, Embry-Riddle Aeronautical University.), Elizabeth H. Lazzara PhD, MA (is an Associate Professor, Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University.), Joe R. Keebler PhD, MA (is a Professor, Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University.), Mark W. Clemens MD, MBA, FACS (is a Surgeon and Professor, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.), Courtney L. Holladay PhD, MA (is the Associate Vice President, Leadership Institute, University of Texas MD Anderson Cancer Center. Please address correspondence to Courtney L. Holladay)","doi":"10.1016/j.jcjq.2025.04.009","DOIUrl":"10.1016/j.jcjq.2025.04.009","url":null,"abstract":"<div><h3>Background</h3><div>Psychological safety is a critical teamwork competency that promotes effective communication, teamwork, patient safety, and the well-being of health care professionals. However, previous research on barriers and facilitators to promotion of psychological safety has focused mainly on clinical staff, omitting other health care disciplines that contribute to patient safety and high-quality care.</div></div><div><h3>Methods</h3><div>The authors conducted a qualitative study in one health system to identify barriers and facilitators to psychological safety in the workplace. Participants in a quality improvement (QI) initiative were invited through automated e-mails sent via the Qualtrics platform to participate in this survey. Employees self-selected whether to respond, as participation was not required as part of the QI initiative engagement.</div></div><div><h3>Results</h3><div>A total of 429 participants across 19 departments spanning administration, education, research, and clinical areas were invited. The average survey response rate across departments was 52.2%. Participants answered two open-ended questions: (1) “What are situations where it can be difficult to take an interpersonal risk and speak up [on this team]?” and (2) “What are the challenges to creating psychological safety within your current team?” Three psychological safety subject matter experts coded the data to extract factors and subthemes. Thematic factors at the individual, team, and organization level were uncovered. Sixteen subcategories of factors that affect psychological safety emerged, uncovering two implications.</div></div><div><h3>Conclusion</h3><div>Psychological safety as defined here includes not just team level but the individual and organization levels. Interventions must align with the factors at all three levels for a personalized and comprehensive approach.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 534-547"},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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