Influences of Leadership, Organizational Culture, and Hierarchy on Raising Concerns About Patient Deterioration: A Qualitative Study.

BACKGROUND: Raising concerns is essential for the early detection and appropriate response to patient deterioration. However, factors such as hierarchy, leadership, and organizational culture can impact negatively on the willingness to raise concerns. OBJECTIVES: This study aims to delve into how leadership, organizational cultures, and professional hierarchies in healthcare settings influence healthcare workers, patients, and caregivers in raising concerns about patient deterioration and their willingness to do so. METHODS: The study used a qualitative approach, conducting focus group discussions (N = 27), utilizing authentic audio-visual vignettes to prompt discussions about raising concerns. Deductive thematic analysis was employed to explore themes related to hierarchy, leadership, and organizational culture. RESULTS: Positive leadership that challenged traditional professional hierarchies by embracing multidisciplinary teamwork, valuing the input of all stakeholders, and championing person-centered practice fostered a positive working culture. This culture has the potential to empower clinical staff, patients, caregivers, and family members to confidently raise concerns. Staff development, clinical supervision, and access to feedback, all underpinned by psychological safety, were viewed as facilitating the escalation of concerns and, subsequently, have the potential to improve patient safety. CONCLUSIONS: This study offers crucial insights into the intricate dynamics of leadership, hierarchy, and organizational culture, and their profound impact on the willingness of staff and patients to voice concerns in healthcare settings. Prioritizing the recommendations of this study can contribute to reducing avoidable deaths and elevating the quality of care in healthcare settings.

Student nurses' views on shift patterns: What do they prefer and why? Results from a Tweetchat.

AIM: The main aim of the study was to understand student nurses' views around shift patterns. DESIGN: Qualitative study. METHOD: We held a Tweetchat in May 2019, where we asked questions around the frequency of 12-hr shifts working on placement; schedule flexibility while on placement; which shift patterns they preferred and why. Data from the Tweetchat were analysed using reflexive thematic analysis to generate themes from initial codes. RESULTS: Seventy-three nursing students participated in the Tweetchat. The majority reported that they work 12-hr shifts on placements, particularly when based in a hospital. We identified three themes: 'Achieving a personal equilibrium'; 'Meeting the needs of the care environment'; 'Factors affecting negotiation capacity'. Data highlighted a conflict for most students, where they preferred 12-hr shifts because of more time off for study, paid work and leisure, while acknowledging 12-hr shifts negatively affected their fatigue, exhaustion and led them to follow a poor diet and neglect exercise and sleep.