Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management最新文献

Despite significant progress in patient safety, human error continues to occur at high rates in surgical settings. The Human Factors Analysis and Classification System (HFACS) offers a proactive lens to understand how and where errors emerge. This study examines HFACS's utility and reliability in categorizing and comparing human error in cardiovascular, orthopedic, trauma care, and neurosurgery. Observational data from cardiovascular, orthopedic, trauma, and neurosurgery cases were coded using HFACS by trained analysts applying unanimous, majority, and reconciled consensus strategies to assess interrater reliability. Across specialties, 98.25% of disruptions occurred at the “preconditions for unsafe acts,” indicating latent failures. In cardiovascular surgery, 49.20% were linked to adverse mental states (e.g., cognitive overload, stress), 26.95% to physical environment issues, and 12.69% to crew resource management. Orthopedic surgery showed 68.75% of crew resource management failures, 19.47% personal readiness issues, and 5.87% environment stressors. Trauma care involved 61.38% crew resource management, 26.71% adverse mental states, and 10.33% team availability. Neurosurgery disruptions stemmed 59.42% from technological environment/layout and 35.92% from communication, coordination, and planning. HFACS is a reliable tool for categorizing human factors in diverse surgical environments. Findings highlight distinct latent failure profiles across specialties and underscore the importance of data driven specialty-specific safety interventions.

Personas have gained significant recognition in healthcare for their impact on improving patient needs and resources. Patient personas are detailed profiles of patients with similar common needs, preferences, goals, and behaviors. This review examined patient personas, explored current methodologies in persona creation, and identified gaps in existing methods. Then, we proposed future directions incorporating advanced techniques such as predictive analytics to enhance persona creation. We applied PRISMA guidelines, searched databases such as PubMed, Web of Science, and ScienceDirect for related articles, and found 1893 articles. After screening the articles using the inclusion and exclusion criteria, 24 articles published between 2013 onwards were selected for this review. Several studies have used either qualitative, quantitative, or mixed methods to create personas. Researchers have implied that the reliance on qualitative data can introduce bias that affects persona accuracy. This review highlights the crucial role of patient personas in improving healthcare delivery, and personas have been proven effective in reforming healthcare services to meet patient needs. Although patient personas have been utilized for over a decade, post-implementation evaluations are seldom addressed. Evidence suggests that there is a need for continuous improvement to improve patient outcomes and healthcare services.

Patient safety culture is a critical component of health care quality in nursing homes. Surveys on patient safety culture can be helpful tools to evaluate care. The aims of the study were to translate a survey on patient safety culture, namely, the Nursing Home Survey on Patient Safety Culture (NHSOPS 1.0) from English into Swedish and to adapt it to Swedish conditions and to validate the translation. The survey was translated into Swedish following the TRAPD translation process —translate, review, adjudicate, pre-test, and document, as suggested by the provider of the original survey. The validity of the items was measured by Cronbach's alpha. Some changes in wording were made according to Swedish conditions. A pre-test with staff working in nursing homes showed adequate results for the translation. In this pilot study, all items and questions were considered valuable for measuring patient safety and were therefore retained in the Swedish version. The translated survey may be a helpful tool for measuring patient safety in nursing homes and prompting staff to reflect on their workplaces.

This paper examines the legal complexities surrounding hospital liability for malpractice committed by independent-contractor physicians, particularly within high-risk emergency care contexts. Through rigorous doctrinal analysis of landmark US decisions including Stelzer v. Northwest Community Hospital (2023), Popovich v. Allina Health System (2020), and Estate of Essex v. Grant County Public Hospital District No. 1 (2024) alongside seminal Commonwealth judgments such as Woodland v. Swimming Teachers Association (UK, 2013) and Kondis v. State Transport Authority (Australia, 1984), the study evaluates how courts apply the doctrines of vicarious liability, nondelegable duty, and apparent authority in cases involving explicit consent disclaimers. Findings reveal significant judicial inconsistencies regarding whether clear contractual disclaimers fully absolve hospitals of institutional liability. To address this doctrinal ambiguity, the paper proposes a novel hybrid liability model that maintains the protective legal force of explicit disclaimers when patients genuinely comprehend their scope, while preserving hospitals’ overarching nondelegable obligations to patient safety, particularly in emergency care. By aligning doctrinal reform and policy recommendations, such as multilayered consent strategies, rigorous contractor oversight, integrated communication protocols, and comprehensive governance-level audits with the aims of SDG3, this study offers an actionable framework to enhance healthcare transparency, accountability, and patient safety across contemporary health systems.

This letter to the editor responds to Bailey and Delchamps’ recent article on integrating enterprise risk management (ERM) in fall-related injury prevention. We extend their framework to emergency departments (EDs), emphasizing the strategic advantage of initiating individualized fall risk assessment at the point of triage. Many high-risk indicators—such as anticoagulant use and cognitive impairment—are already accessible in ED settings and can be embedded into machine learning–supported tools like the Rothman index or fall triage score. We also highlight the financial implications of fall-related injuries originating in or near the ED, noting their potential to increase hospital length of stay and trigger non-reimbursable costs. The authors’ inclusion of risk matrices and heat maps presents scalable opportunities for safety prioritization in dynamic ED environments. We conclude by recommending prospective validation of ERM-based approaches within level 1 trauma centers and invite collaboration to test the framework's effectiveness in real-world emergency settings.

The consistent promotion of a culture of respect and accountability in the workplace is vital to the success of healthcare organizations. However, the existing literature on practical strategies for addressing misconduct, particularly with respect to physician behavior, is relatively sparse. The aim of this review was to thus devise an evidence-based, empirical framework for the management and remediation of disruptive physician actions. Core themes on which to center the framework were initially identified based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. A MEDLINE search was undertaken to identify original peer-reviewed works using terms associated with unprofessionalism with the goal of building a foundational basis. Articles published from January 2014 to March 2025 and restricted to the English language were included. Among the 1123 original articles that entered the final selection process, 1112 were excluded because they were focused solely on the characterization of disruptive behavior (n = 429); limited to trainees (n = 277), limited to ancillary staff (n = 150); concentrated on prevention (n = 148); and described consequences (n = 108). A total of 11 original publications thus met criteria for inclusion and differed in their design, methods, and endpoints. The core themes that emerged for framework construction were expectation setting (four studies); climate/organizational analysis (three studies); peer involvement (two studies); and professional training (two studies). The feasibility of developing an evidence-based framework to address disruptive physician behavior was demonstrated. The management implications specific to risk are discussed.