Global journal on quality and safety in healthcare最新文献

Introduction: Performance improvement (PI) in healthcare is essential to improve health, patient experience, and reduce costs. PI projects became low, inconsistent and weakly-sustained in our hospital. The low number and low sustainability were scarcely in alignment with our strategic goal to become a high reliability organization (HRO). This was due to lack of standardized knowledge and ability to initiate and sustain PI projects. Therefore, a structured framework was developed, followed by the building of capacity and capability in the use of robust process improvement (RPI) amidst the COVID-19 pandemic.

Methods: A team of healthcare quality professionals collaborated with Hospital Performance Improvement-Press Ganey for hospital-wide quality improvement project. The team received training on RPI from Press Ganey and created the framework to use . This framework is based on the Institute for Healthcare Improvement Model for Improvement, Lean, Six Sigma, and FOCUS-PDSA (Find-Organize-Clarify-Understand-Select-Plan-Do-Study-Act). Thereafter, the team of internal coaches organized an RPI training course that consisted of 6 sessions, for clinical and nonclinical staff , using classroom and virtual sessions during the pandemic. This course was increased to eight sessions to avoid information overload. Process measures were collected using a survey to obtain feedback, whereas outcome measures were from the number of completed projects and their effects related to costs, access to care, waiting time, number of harms, and compliance.

Results: Participation and submission improved after three PDSA (Plan-Do-Study-Act) cycles. This resulted in an increased number of completed and sustained projects from 50 in 2019 to 94 in 2020 and continued to rise to 109 in 2021. There were 140 and 122 certified RPI coaches in 2020 and 2021, respectively. Although there was a decrease in the number of certified coaches in 2021, the number of completed projects was higher than in 2020. The overall effect of these completed projects by the third quarter of 2021 showed improvement in access to care by 39%, compliance to standards of care by 48%, satisfaction by 8%, and reduction in costs by 47,010 SAR, in waiting time of 170 hours, and in the number of harms by 89.

Conclusion: This quality improvement project led to enhanced capacity of staff as seen in the increased number of certified RPI coaches, thereby increasing the submission and completion of projects in 1 year. Its sustainability during the 2 succeeding years continued to enhance project completion and maintenance, bringing quality improvement benefits to the organization and the patients.

Introduction: This paper takes a detailed look at safety culture, different roles, and powers shared by managers, lessons from which can be applied in any form of management. It also focuses on the job of managers in enhancing safety standards in a health institution. The objective of this paper was to examine the managers' perception of patient safety culture.

Methods: This study followed a quantitative cross-sectional design. The research procedure involved all middle-level managers in Aseer Central Hospital in Abha, Saudi Arabia (N = 52). To assess the status of patient safety culture and the role of healthcare managers in the field study, the researchers constructed a study questionnaire; it included questions adapted and modified from the Safety Attitudes Questionnaire, the Hospital Survey on Patient Safety Culture questionnaire, the 10 Mintzberg managerial roles and the six types of power for healthcare managers.

Results: Most participants were Saudi nationals (73.1%) aged 31 to 40 years (44.2%). The managerial role practiced frequently was leadership (85%), but the least managerial role was the figurehead (23%). Mangers held positive attitudes toward patient safety culture with 100% positive replies. No significant association was found between sex, nationality, years of experience, and professions concerning patient safety. Additionally, the results indicated that most managers were willing to uphold a safe environment for their patients and ready to involve employees in decision-making strategies to motivate them.

Conclusion: The managerial choices in Aseer Central Hospital are based on the culture and tradition of the community, which might negatively undermine the capability of other individuals handling the same office based on their educational backgrounds and competency. Such situations also may demoralize the employees, leading to poor employee performance Suboptimal achievement was exhibited primarily by middle-level healthcare managers of all six power types: resource allocator, negotiator, liaison, spokesperson, figurehead, and entrepreneur. Therefore, there is a pressing need to improve managers' attitudes toward patient safety and activate managerial roles to ensure patients' safety is practiced unequivocally.

[This corrects the article DOI: 10.36401/JQSH-22-2.].

The assessment of healthcare facility quality using business excellence models provides valuable information about performance gaps, which can be used to improve performance. Within the excellence framework, the "result" domain presents more challenges in terms of improvement over time. Using European and American business excellence-based models (EFQM and Balridge, respectively), this review aims to highlight the impact of quality assessment on the improvement of healthcare performance results. A literature search was performed using PubMed, SCOPUS, and CINAHL databases. PRISMA guidelines were followed. All the articles were evaluated using the Critical Appraisal Skills Programme (CASP) Tool. Thematic analysis was conducted following Thomas and Harden's approach, and confidence levels were determined using the GRADE-CERQual method. Nine studies were included. Two main themes emerged: 1) the assessment highlighted improvement in some results; and 2) the assessment highlighted areas that need improvement. The assessments focused mostly on customer-based results and least on society-based results. Six out of nine included studies did not show improvement in the desired results after a one-time assessment; however, no recommendations to improve quality were given to the facility after the assessments. Unless there is continuity in the assessment process, the desired results may not improve.

Introduction: Access to ionizing radiation has become widely available for diagnosis and treatment. The increased use of ionizing radiation has been associated with radiation exposure hazards for patients and radiation workers. Raising the level of radiation protection awareness is important to maintain the safety of healthcare settings.

Methods: Online questionnaires were distributed to 755 healthcare workers and students at King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. The questionnaire consisted of 14 multiple-choice questions divided into two sections (questions related to radiation protection and common radiologic examination doses).

Results: In total, 443 participants completed the questionnaire, including 142 (32%) medical students, 107 (24%) radiology technologists, 105 (24%) radiography students, and 89 (20%) physicians. Of the participants, 245 (55%) were men. A total of 74 (84%) physicians and 51 (47%) radiology technologists had more than 5 years of experience. Eleven (12%) physicians and 44 (41%) radiology technologists had 1-4 years of experience, whereas the rest had less than 1 year of experience. Only 16% of participants attended training courses on a regular basis. However, 15% of the participants thought that they had excellent knowledge of radiation protection, whereas 18% admitted that they did not have sufficient knowledge. Sixty-two percent of the questions related to radiation protection awareness were answered correctly. Forty-five percent of the participants correctly answered questions related to doses from common radiologic examinations. Only 23% and 16% of participants were aware of the noncontrast chest CT and lumbar x-ray doses, respectively. Moreover, 35% and 24% of participants did not know that pelvic MRI and abdominal ultrasound do not contribute any radiation dose, respectively.

Conclusion: The results showed a knowledge gap regarding radiation protection and dose levels; therefore, periodic refresher courses are recommended for healthcare workers in order to increase the level of awareness.

Introduction: The objective of this quality improvement, interventional study regarding patients with diabetes undergoing diabetic ophthalmology outpatient surgery aimed to develop, implement, and evaluate a new diabetic algorithm to improve safety, operating room efficiency, and decrease supply cost.

Methods: A multidisciplinary study team was assembled, including ophthalmologists, endocrinologists, anesthesiologists, management, and nurses to review the current diabetic protocol. From August 2016 to July 2017, 13 patient safety concerns or incident reports were reviewed that identified two serious cases of hypoglycemia. Using the concerns data, frontline perspectives, and reviewing best practice guidelines, a new diabetic algorithm was developed and trialed for 24 months. The new algorithm limited the use of an existing preoperative insulin protocol and reduced the number of nurses required. The number of adverse events, nursing setup process steps, setup time, and preoperative insulin infusion protocols used were collected. An evaluation of the supply costs was performed.

Results: After implementing the new diabetic algorithm, zero safety incidents were reported, and a 97.5% reduction in the use of preoperative insulin protocol resulted. Nursing staff perceived that the new diabetic algorithm was easier to configure, 23 minutes faster to set up, and required one nursing staff member. Supply cost was reduced by $30.63 (Canadian Dollars, CAD) per patient.

Conclusion: Perioperative glucose irregularities may threaten patient safety and surgical outcomes. Healthcare professionals must improve patient safety, decrease healthcare expenditure, and prevent unnecessary delays. Multidisciplinary frontline staff experiential knowledge aided in the recognition of potential problems and comprehensive solutions to optimize patient care.