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1.
Front Public Health ; 11: 1258600, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37965503

RESUMO

Background: Joint Commission International (JCI) accreditation plays a significant role in improving the quality of care and patient safety worldwide. Hospital leadership is critical in making international accreditation happen with successful implementation. Little is known about how Chinese hospital leaders experienced and perceived the impact of JCI accreditation. This paper is the first study to explore the perceptions of hospital leaders toward JCI accreditation in China. Methods: Qualitative semi-structured interviews were used to explore the perceptions of the chief operating officers, the chief medical officers, and the chief quality officers in five JCI-accredited hospitals in China. Thematic analysis was used to analyze the interview transcripts and identify the main themes. Results: Fifteen hospital leaders participated in the interviews. Three themes emerged from the analysis, namely the motivations, challenges, and benefits related to pursuing and implementing JCI accreditation. The qualitative study found that eight factors influenced hospital leadership to pursue JCI accreditation, five challenges were identified with implementing JCI standards, and eight benefits emerged from the leadership perspective. Conclusion: Pursuing JCI accreditation is a discretionary decision by the hospital leadership. Participants were motivated by prevalent perceptions that JCI requirements would be used as a management tool to improve the quality of care and patient safety in their hospitals. These same organizational leaders identified challenges associated with implementing and sustaining JCI accreditation. The significant challenges were a clear understanding of the foreign accreditation standards, making staff actively participate in JCI processes, and changing staff behaviors accordingly. The top 5 perceived benefits to JCI accreditation from the leaders' perspective were improved leadership and hospital safety, improvements in the care processes, and the quality of care and the learning culture improved. Other perceived benefits include enhanced reputation, better cost containment, and a sense of pride in the staff in JCI-accredited hospitals.


Assuntos
Acreditação , Hospitais , Humanos , Pessoal de Saúde , Internacionalidade , Segurança do Paciente
2.
Health Promot Pract ; : 15248399231193693, 2023 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-37649394

RESUMO

BACKGROUND: Faith-based organizations (FBOs) have a scant history in the literature of implementing intimate partner violence (IPV) initiatives, though many members of faith communities consider it an important issue. Furthermore, the limited studies on this topic have not explored organizational factors that are important in the implementation of such efforts. PURPOSE: To investigate factors that influence the implementation of IPV prevention and response by one Catholic organization at both diocesan and parish levels. METHODS: We conducted sixteen semi-structured interviews with members of Archdiocese of Chicago Domestic Violence Outreach (ACDVO) leadership. Using deductive content analysis, we drew on all 14 constructs and sub-constructs from the inner setting domain of the Consolidated Framework for Implementation Research (CFIR) for coding transcripts and characterizing factors influencing implementation success. RESULTS: Seven CFIR constructs were useful in identifying factors that influenced implementation success of ACDVO. At the diocesan level, the organization's leadership structure, their driven culture, and in-kind available resources propelled their work. At the level of parish ministries, successful implementation was facilitated by networking and communication among parishes. At the diocesan-level, access to knowledge and information through ACDVO's Parish Support Committee, compatibility with parish values, leadership engagement, and available resources from parishes supported implementation. CONCLUSIONS: We identified modifiable and reproducible inner setting factors that influence implementation of a Catholic IPV initiative at the diocesan-level and support parish ministries in their local activities. Future work should validate these findings in other dioceses and examine non-Catholic FBO settings.

3.
Am J Med Qual ; 37(5): 379-387, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35404306

RESUMO

Although most health care occurs in the ambulatory setting, limited research examines how providers and patients think about and enact ambulatory patient safety. This multimethod qualitative study seeks to identify perceived challenges and strategies to improve ambulatory safety from the perspectives of clinicians, staff, and patients. Data included interviews (N = 101), focus groups (N = 65), and observations of safety processes (N = 79) collected from 10 patient-centered medical homes. Key safety issues included the lack of interoperability among health information systems, clinician-patient communication failures, and challenges with medication reconciliation. Commonly cited safety strategies leveraged health information systems or involved dedicated resources (eg, providing access to social workers). Patients also identified strategies not mentioned by clinicians, emphasizing the need for their involvement in developing safety solutions. This work provides insight into safety issues of greatest concern to clinicians, staff, and patients and strategies to improve safety in the ambulatory setting.


Assuntos
Reconciliação de Medicamentos , Segurança do Paciente , Comunicação , Humanos , Assistência Centrada no Paciente , Pesquisa Qualitativa
4.
J Patient Saf ; 18(1): e249-e256, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32740134

RESUMO

OBJECTIVES: The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture. METHODS: This was a cross-case analysis study in 25 diverse U.S. PCMHs. Data sources included interviews of a clinician and an administrator in each PCMH, surveys of clinicians and staff, and existing data on the PCMHs' characteristics. We used coincidence analysis, a novel method based on set theory and Boolean logic, to evaluate relationships between factors and the implementation outcome of patient safety culture. RESULTS: The coincidence analysis identified 5 equally parsimonious solutions (4 factors), accounting for all practices with higher safety culture. Three solutions contained the same core minimally sufficient condition: the implementation factor leadership priority for patient safety and the social network factor reciprocity in advice-seeking network ties (advice-seeking relationships). This minimally sufficient condition had the highest coverage (5/7 practices scoring higher on the outcome) and best performance across solutions; all included leadership priority for patient safety. Other key factors included self-efficacy and job satisfaction and quality improvement climate. The most common factor whose absence was associated with the outcome was a well-functioning process for behavioral health. CONCLUSIONS: Our findings suggest that PCMH safety culture is higher when clinicians and staff perceive that leadership prioritizes patient safety and when high reciprocity among staff exists. Interventions to improve patient safety should consider measuring and addressing these key factors.


Assuntos
Segurança do Paciente , Assistência Centrada no Paciente , Humanos , Liderança , Assistência Centrada no Paciente/métodos , Gestão da Segurança , Rede Social
5.
Curr Med Res Opin ; 37(11): 1991-1999, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34490810

RESUMO

Patients' perspectives on patient safety have rarely been incorporated into quality initiatives in primary care. Our objective was to understand the patient perspective on patient safety in patient-centered medical homes (PCMHs). We conducted 12 patient focus groups/interviews in nine sites with 65 patients at a geographically diverse sample of National Committee on Quality Assurance Level 3 recognized PCMHs across three states. Using a patient safety framework, we coded and analyzed interviews for overarching themes and subthemes across patient safety domains. Overarching themes focused on (1) both clear and timely communication with and between clinicians and (2) trust in the care team, including being heard, respected, and treated as a whole person. Other themes important to specific patient safety domains included sharing of and access to information, patient education and patient-centered medication reconciliation process, clear documentation for the diagnostic process, patient-centered comprehensive visits, and timeliness of care. Communication and trust are key to patient perceptions of safe primary care. Focusing on these themes across safety domains may help to make primary care both more patient-centered and safer, and should be considered in future ambulatory safety initiatives.


Assuntos
Assistência Centrada no Paciente , Atenção Primária à Saúde , Comunicação , Humanos , Percepção , Pesquisa Qualitativa
6.
Obstet Gynecol ; 126(2): 442-445, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26241436

RESUMO

The predominant mechanism by which the health care reforms of the Patient Protection and Affordable Care Act of 2010 are to be financed is through the government's simultaneous defunding of major portions of Medicare and Medicaid, including the reduction of up to 75% of federal payments to disproportionate-share hospitals. The justification for curtailment of other public programs is that after Medicaid expansion under the Affordable Care Act, the decrease in the proportion of uninsured among the U.S. population will render disproportionate-share hospital payments extraneous and unnecessary. Such justification was reiterated in the recent American College of Obstetricians and Gynecologists Committee Opinion No. 627, entitled Health Care for Unauthorized Immigrants. Herein, the soundness of the Committee Opinion's proposed policy is evaluated by reviewing available literature on the potential effect of Medicaid disproportionate-share hospital cuts with and without concomitant Medicaid expansion. Limitations of Medicaid expansion efforts before and under the Affordable Care Act, the disproportionate-share hospital payment program, and other legislation providing safety net hospitals with (some) relief of financial burdens related to uncompensated care are explicated. Findings raise concern that acceptance of cuts of up to 75% of federal disproportionate-share hospital funds on the premise that nationwide state expansion of Medicaid will offset the difference may be overly optimistic. Indeed, foregoing disproportionate-share hospital payments undercuts the otherwise laudable intent of Committee Opinion No. 627, namely to advocate for universal health care for all women, including undocumented immigrants.


Assuntos
Economia Hospitalar/legislação & jurisprudência , Administração Financeira de Hospitais/métodos , Medicaid , Medicare , Patient Protection and Affordable Care Act , Assistência Perinatal , Feminino , Humanos , Medicaid/economia , Medicaid/legislação & jurisprudência , Pessoas sem Cobertura de Seguro de Saúde , Medicare/economia , Medicare/legislação & jurisprudência , Assistência Perinatal/economia , Assistência Perinatal/legislação & jurisprudência , Cuidados de Saúde não Remunerados/legislação & jurisprudência , Estados Unidos
10.
Jt Comm J Qual Patient Saf ; 35(10): 519-25, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19886091

RESUMO

BACKGROUND: Monitoring hand hygiene guideline compliance in an ambulatory environment can be challenging. For example, direct observation by independent observers is impractical because the sink and hand sanitizer dispensers are most often located inside the examination room. At Johns Hopkins Outpatient Center, an ambulatory care facility located on the campus of The Johns Hopkins Hospital in Baltimore, patients were engaged as an observer in monitoring hand hygiene compliance. METHODS: The Johns Hopkins Hospital's ambulatory quality and patient safety (AQPS) task force, after assessing common methods of monitoring hand hygiene compliance including direct observation, self-reporting, and product usage, evaluated using the patient as an observer. RESULTS: Of 50 patients interviewed, 43 (86%) indicated a willingness to monitor and report providers' compliance with hand hygiene guidelines. In collaboration with providers, a patient-as-observer hand hygiene monitoring process was developed and piloted. Qualitative feedback postimplementation did not indicate that the process would inhibit the patient-provider relationship. The cost of the program to implement and maintain averages $0.17 per patient encounter. The overall patient response rate was 21.6% (range, 12%-77%), based on completed observation cards to total appointments completed. Hand hygiene compliance as measured by the patient-as-observer process averaged 88% (range, 74%-100%). Independent observation revealed 100% concurrence between the patient's recorded observation and the independent observer. DISCUSSION: Engaging the patient to report on hand hygiene compliance was found to be efficient and acceptable to patients and providers, and the results of the observations were representative of actual provider behavior.


Assuntos
Assistência Ambulatorial/normas , Fidelidade a Diretrizes , Desinfecção das Mãos/normas , Controle de Infecções/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Observação , Participação do Paciente , Projetos Piloto
11.
Jt Comm J Qual Patient Saf ; 33(1): 25-33, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17283939

RESUMO

BACKGROUND: Proper patient identification is a major factor affecting patient safety in any health care organization. METHODS: An interdisciplinary team, using three Plan-Do-Study-Act (PDSA) cycles, reviewed the incidence of patient misidentifications resulting from registration process errors. Retrospective and prospective data were collected to determine the incidence among inpatients and outpatients. RESULTS: Registration-associated patient misidentification errors occurred 7 to 15 times per month. Information systems deficiencies, inadequate training, and the lack of a single master patient index were among the root causes identified. After three PDSA cycles, the incidence rate for registration-associated patient misidentification errors declined for inpatients (80.5%) but increased for outpatients (30.2%). DISCUSSION: Through an iterative process as implied in the PDSA cycle, registration-associated patient misidentification errors for established Johns Hopkins Hospital patients were dramatically reduced. A checklist is provided for other organizations to assess their vulnerability to registration-associated patient misidentification errors. The checklist suggests, for example, that organizations strive to develop a single master patient index and limit access to registration systems to staff with proper training and performance expectations.


Assuntos
Sistemas de Identificação de Pacientes/organização & administração , Avaliação de Processos em Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Centros Médicos Acadêmicos , Humanos , Comunicação Interdisciplinar , Erros Médicos/prevenção & controle , Estudos Prospectivos
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