Modifying head nurse messages during daily conversations as leverage for safety climate improvement: a randomised field experiment.

BACKGROUND: Recent literature reviews lament the paucity of high-quality intervention studies designed to test safety culture improvement in hospitals. The current study adapts an empirically supported strategy developed for manufacturing companies by focusing on patient care and safety messages head nurses communicate during daily conversations with nurses. METHODS: The study was designed as randomised control trial coupled with before-after measurement of outcome variables. We randomly assigned 445 nurses working in 27 inpatient departments in a midsize hospital in Israel to experimental and control groups. Ten randomly chosen nurses in both groups filled a brief questionnaire referring to last conversation with head nurse. One month later, head nurses in the experimental group received individual feedback, comparing individual with mean hospital scores, coupled with self-set goals for the following feedback session. Head nurses in the control group received no feedback, except for a summary report by the end of intervention. RESULTS: Patient care messages increased by 16% and professional development messages by 12%, accompanied by 17% decline in nurse-blaming messages in the experimental group, remaining unchanged in the control group. Such changes led to statistically significant increase in patient care behaviours (17%), safety climate (13%), teamwork (9%) and supervisory leadership quality (18%). Rule-compliance messages and workaround behaviours remained unchanged in experimental and control departments. CONCLUSIONS: These data support the utility of our intervention strategy for improving patient safety climate and resultant caring behaviours in healthcare organisations. The fact that our intervention used easy-to-deliver feedback requiring only two sessions minimised its organisational costs.

Perilipin expression in human adipose tissues: effects of severe obesity, gender, and depot.

OBJECTIVE: Perilipins are phosphoproteins that are localized to the surface of triacylglycerol droplets within adipocytes where they regulate the rate of lipolysis. We sought to determine the effects of severe obesity and depot [omental (Om) vs. subcutaneous (Sc)] on perilipin expression in the adipose tissue of individuals. RESEARCH METHODS AND PROCEDURES: Samples of Om and Sc adipose tissues obtained at surgery from severely obese subjects and fat aspirations from nonobese subjects were analyzed for perilipin protein and mRNA levels by Northern and Western analysis. RESULTS: Perilipin A (periA) was the major perilipin expressed in adipose tissues. periA mRNA relative abundance was significantly lower in Sc adipose tissue from severely obese compared to that from nonobese subjects. Western blotting of adipose tissue extracts showed that periA protein levels expressed relative to tissue protein or fat cell surface area were significantly lower ( approximately -40%) in abdominal Sc adipose tissue from severely obese compared to that from nonobese subjects. However, the calculated mass of perilipin per fat cell did not differ between the two groups. Perilipin mRNA levels were higher in Sc compared to Om adipose tissue from obese individuals (p < 0.025; n = 26; 17 women, 9 men); however, periA protein levels did not differ. In addition, perilipin protein, but not mRNA, levels were higher in Sc adipose tissue from obese men than from women (p < 0.025). DISCUSSION: Variations in perilipin expression may contribute to the higher basal lipolytic rates observed in obese compared to nonobese individuals and in obese women compared to obese men.