The Relationship between High-reliability practice and Hospital-acquired conditions among the Solutions for Patient Safety Collaborative.

Theoretically, the application of reliability principles in healthcare can improve patient safety outcomes by informing process design. As preventable harm continues to be a widespread concern in healthcare, evaluating the association between integrating high-reliability practices and patient harms will inform a patient safety strategy across the healthcare landscape. This study evaluated the association between high-reliability practices and hospital-acquired conditions. METHODS: Twenty-five pediatric organizations participating in the Children's Hospitals Solutions for patient safety collaborative participated in this nonexperimental design study. A survey utilizing the high-reliability healthcare maturity model assessed the extent of implementing high-reliability practices at each participating site. We analyzed responses for each component and a composite score of high reliability against an aggregate measure of hospital-acquired conditions. RESULTS: Of the 95 invited sites, 49 responded and 25 were included in the final results. There was a significant inverse relationship between the culture of safety component score and the Serious Harm Index (odds ratio [OR] = 0.63, 95% confidence interval [CI] 0.42-0.95, P = 0.03). There was no association between the overall high-reliability score (OR = 0.91, 95% CI 0.78-1.05, P = 0.19), the Leadership component score (OR = 0.97, 95% CI 0.70-1.33, P = 0.84), or the robust process improvement (RPI) component score (OR = 0.75, 95% CI 0.41-1.28, P = 0.26) and the Serious Harm Index. CONCLUSION: The integration of high-reliability principles within healthcare may support improved patient safety in the hospital setting. Further research is needed to articulate the breadth and magnitude of the impact of integrating high-reliability principles into healthcare.

Crafting a Team-Based, Interprofessional Undergraduate Research Honors Curriculum in the Health Professions.

Many undergraduate students in the health professions experience group work throughout their educational development, but few have the opportunity to experience teamwork in the professional disciplines. Interprofessional teamwork is necessary for successful delivery of accessible, high-quality healthcare aimed at achieving good clinical outcomes and operational efficiencies. Developing teamwork skills early in health professions education results in more successful teams in the workplace. Implementing project-based curricula that integrate undergraduate research and teamwork can lead to discipline-specific learning. The Biomedical Sciences (BMD) and Health Care Management (HCM) undergraduate majors in the UAB School of Health Professions (SHP) each focus on a distinct arm of the healthcare system. To provide these students with interprofessional training early in their education as emerging health professionals, the SHP honors curricula were revised to provide research-based experiential learning and team-building opportunities. Our approach engages BMD and HCM students in interprofessional teams in partnership with faculty mentors and community health providers to complete discipline-specific research projects that ultimately solve real-world problems, resulting in development of critical thinking, team skills, leadership, and cultural awareness of healthcare.

Patient safety culture in Peking University Cancer Hospital in China: baseline assessment and comparative analysis for quality improvement.

BACKGROUND: Limited information is available regarding the patient safety culture in Chinese hospitals. This study aims to assess the patient safety culture in Peking University Cancer Hospital and to identify opportunities for improving the organization's safety culture. METHODS: A cross-sectional study was conducted in April 2018 and 2019, respectively. Data on patient safety culture were collected from clinical and administrative staffs using the Hospital Survey on Patient Safety Culture (HSOPSC). RESULTS: Twelve composite dimension variables were hierarchically clustered. Three highest positive response dimensions include 'Organizational Learning and continuous improvement' (92.9%), 'Teamwork within units' (89.7%), and 'Hospital management support for patient safety' (83.7%), while 3 lowest positive response dimensions included 'Frequency of events reported' (43.9%), 'Non-punitive response to error' (51.1%), 'Communication openness' (52.2%), and 'Staffing' (53.7%). Compared to the average scores of the United States, the scores of the Peking University Cancer Hospital was significantly lower on 'Communication openness' and 'Frequency of events reported'. After targeted continuous improvement based on results in 2018, all 12 dimensions surprisingly increased in the safety culture conducted in 2019. CONCLUSION: Inadequate feedback and communications about error and lack of communication openness are key challenges for patient safety in the delivery of care in this hospital. Results of this baseline survey indicate the need for a modified approach and attention to context when designing interventions aimed at improving the safety culture in this organization.

Training leaders for a culture of quality and safety.

PURPOSE: The purpose of this paper is to understand the degree to which a quality and safety culture exists after healthcare workers in an academic medical center complete a quality improvement and patient safety education program focused on developing leaders to change the future of healthcare quality and safety. DESIGN/METHODOLOGY/APPROACH: The safety attitudes questionnaire (SAQ) short-form was used for measuring the culture of quality and safety among healthcare workers who were graduates of an academic medical center's healthcare quality and safety program. A 53 percent response rate from program alumni resulted in 54 usable responses. FINDINGS: This study found that 42 (78 percent) of the respondents report that they are currently working in a healthcare quality and safety culture, with 25 (59 percent) reporting promotion into a leadership role after completion of the quality improvement education program. This compares favorably to AHRQ culture of safety survey results obtained by the same academic medical center within the year prior revealing only 63 percent of all inpatient employees surveyed reported working in a quality and safety culture. RESEARCH LIMITATIONS/IMPLICATIONS: The study design precluded knowing to what degree a quality and safety culture, as measured by the SAQ, existed prior to attending the healthcare quality and safety program. ORIGINALITY/VALUE: This study has practical value for other organizations considering a quality and safety education program. For organizations seeking to build capacity in quality and safety, training future leaders through a robust curriculum is essential. This may be achieved through development of an internal training program or through attending an outside organization for education.

Self-Reported Adherence to High Reliability Practices Among Participants in the Children's Hospitals' Solutions for Patient Safety Collaborative.

BACKGROUND: Application of high reliability principles has the potential to transform the health care industry to perform with a higher level of safety than is present today. The purpose of this study was to quantitatively assess and describe the extent and variability of integration of high reliability practices among a collaborative of children's hospitals using the High Reliability Health Care Maturity (HRHCM) model. METHODS: A survey instrument based on the HRHCM model was developed to determine the extent of integration of high reliability practices across hospitals participating in the Children's Hospitals' Solutions for Patient Safety (CHSPS) network. The survey was distributed with instructions for completion to obtain a single organizational response, which was then used to quantify the extent to which high reliability attributes were implemented at each organization. RESULTS: Of the 95 institutions in the CHSPS at the time of the study, 46 provided a complete response to the survey (48.4% response rate). The overall mean score for high reliability was 42.3 (range: 28-53), which places the cohort in the stage of approaching high reliability. Of the responding organizations, none fell into the beginning stage, while 15.2% landed in the developing, 4.3% in the advancing, and 80.4% in the approaching high reliability stages. CONCLUSION: Understanding high reliability attributes and assessing the location of individual and collaborative-wide sites along the high reliability continuum using this maturity model identify opportunities for organizations as they progress on their high reliability journey. Our results suggest opportunity in all domains of the high reliability maturity model for the majority of participating children's hospitals.

Global mHealth policy arena: status check and future directions.

In this review, we examine an important piece of the mHealth puzzle that has received scant attention-health policy. The question is whether health policy ultimately will serve to unite nations in advancing global mHealth or, as Mars and Scott suggested in 2010, keep nations isolated and ultimately making their policy decisions in "eHealth silos". Such a non-collaborative approach seriously hampers the potential for using mobile health technologies to deliver health care across borders, assuring individuals access to affordable, convenient, and quality healthcare in underserved regions. From a global perspective, mHealth policy review is difficult as some important policies may be subsumed in comprehensive planning and strategy documents. Political, environmental, economic, organizational, and technology disparities across nations represent a significant impediment to developing mHealth products and services that can be deployed globally. To date, there is modest evidence that such challenges are being addressed. Even though payers can encourage adoption of mHealth with financial incentives for use, it appears that payment or reimbursement tends to be a roadblock for almost all nations, whether they are emerging or developed. If payment for mHealth services is not guaranteed, business models will not be sustainable and providers will have fewer opportunities for scalability. Furthermore, because mHealth policies typically are subject to some type of government scrutiny and oversight, many product developers and entrepreneurs may turn elsewhere for their investments. Global resource scarcity also challenges optimal mHealth deployment, and governments seek to ensure improved population health outcomes as return on their mHealth investments. Unfortunately, such justification is difficult as evaluation methods simply have not kept pace with mHealth technology capability. Requisite measurement tools are sorely lacking when it comes to evaluating efficacy of mHealth interventions, due in part to insufficient research to inform development of needed measurement tools. Because most robust mHealth research trials have been conducted in the developed world with its impressive technology infrastructure and not in developing nations where the health needs are greatest, evaluation of mobile technology intervention from a global perspective tends to be insufficient to inform policy decisions.

A model for mHealth skills training for clinicians: meeting the future now.

We describe the current state of mHealth skills acquisition, education, and training available to clinical professionals in educational programs. We discuss how telemedicine experienced exponential growth due in large part to the ubiquity of the mobile phone. An outcome of this unprecedented growth has been the emergence of the need for technology skills training programs for clinicians that address extant curricula gaps. We propose a model to guide the development of future training programs that incorporate effective training strategies across five domains: (I) digital communication skills; (II) technology literacy and usage skills; (III) deploying telehealth products and services; (VI) regulatory and compliance issues; and (V) telehealth business case. These domains are discussed within the context of interprofessional teams and broader organizational factors.

Preparing for diversity management strategies: teaching tactics for an undergraduate healthcare management program.

This paper reports the processes used by faculty in the Bachelor of Science in Health Sciences (BSHS) Program at the University of Alabama at Birmingham to increase diversity knowledge for the faculty and to incorporate diversity management issues and skills development into the program curriculum using a structured plan.

Evaluating stakeholder management performance using a stakeholder report card: the next step in theory and practice.

In the highly competitive health care environment, the survival of an organization may depend on how well powerful stakeholders are managed. Yet, the existing strategic stakeholder management process does not include evaluation of stakeholder management performance. To address this critical gap, this paper proposes a systematic method for evaluation using a stakeholder report card. An example of a physician report card based on this methodology is presented.