Dissertations / Theses: 'Patient safety and quality in healthcare'

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Echeverri, Ana Lucia Hincapie. "Relationship between Perceived Healthcare Quality and Patient Safety." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/283602.

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The objectives of this study were to examine the association between patient perceived healthcare quality and self-reported medical, medication, and laboratory errors using cross-sectional and cross-national questionnaire data from eleven countries. In this research, quality of care was measured by a multi-faceted construct, which adopted the patient's perspectives. Five separated quality of care scales were assessed: Access to Care, Continuity of care, Communication of Care, Care Coordination, and Provider's Respect for Patients' Preferences. The findings from this investigation support a number of other published studies suggesting that Coordination of Care is an important predictor of perceived patient safety. After adjusting for potentially important confounding variables, an increase in peoples' perceptions of Coordination of Care decreased the likelihood of self-reporting medical errors (OR =0.605, 95% CI: 0.569 to 0.653), medication errors (OR =0.754, 95% CI: 0.691 to 0.830), and laboratory errors (OR =0.615, 95% CI: 0.555 to 0.681). Finally, results showed that the healthcare system type governing care processes modifies the effect of Coordination of Care on self-reported medication errors.

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Veerkamp, Celeste Goff. "Gatekeepers to healthcare quality and patient safety| Veritas Credentials." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10158999.

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The current environment of healthcare requires organizations to look at each department and each employee from an economic vantage and to consider at all viable options for cost containment. An organization’s Medical Staff Office has traditionally taken responsibility for providing the credentials and privileging function for organizations. The amount of work and time as well as seasonal fluctuations in the number of applicants proves difficult for an organization from a staffing and budgetary standpoint. For many organizations, the ability to outsource its credentialing functions to a Credentials Verification Organization may prove a cost efficient option.

Veritas Credentials seeks to remedy this difficulty for healthcare organizations by allowing the credential and privilege function to be outsourced. This business plan will show how Veritas Credentials intends to provide an array of services to ensure that healthcare organizations provide privileges to high quality providers which will ensure patient safety.

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Nadhrah, Nada Ali. "Managing workarounds in a healthcare context : a framework to improve quality and patient safety." Thesis, University of Reading, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.701961.

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The use of workarounds has been mentioned in various healthcare discipline by different approaches. However, there has been limited research thoroughly investigating the workaround phenomena and none provided a comprehensive approach that considered all stakeholders involved. The aim of this thesis is to develop a framework that can be used to enhance the understanding and knowledge of workarounds that occur in hospitals and consequently improve hospital management's ability to manage those workarounds. That is obtained by considering workarounds main elements; nature as a process, factors behind their existences, and their impact so that the level of patient safety and service quality can be improved. In order to understand the workarounds, the above can be investigated as three aspects: the process aspect of workarounds, the factors influencing professionals to use workarounds, and the impact of workarounds. First, workarounds are analysed in terms of the existing and alternative process, roles of users and the number of people involved, and time consumed to complete the process compared to the original formal work process. Data was obtained by an exploratory study conducted by semi-structured interviews at early stage of this research and six workaround cases were collected and mapped using Business Process Modelling Notation (BPMN). The exploratory study conducted, an extensive literature review, lead to the identifications of the factors influencing the use workarounds. Based on the findings a conceptual model, Workaround Motivational Model (WAMM), was formed based on the Theory of Interpersonal Behaviour (TIB) in order to investigate professional' behaviour intentions to use workarounds. A questionnaire has been developed to examine the following factors: attitude, social factors, perceived consequences (personal value), perceived consequences (patient value), perceived behavioural controls, ease of use, usefulness, facilitating conditions, and habits. Exploratory factor analysis was applied to detect the main factors followed by a linear regression analysis to identify the most significant ones. The main factors identified that have a significant influence on professionals' intention to use workaround were: social influence, habit, perceived ease of use, and perceived consequences (patient value). Finally, in order to evaluate the impact of workarounds, a Workaround Assessment Sheet (WA-AS) was developed based on the earlier findings and applied to the workaround cases. The theoretical contribution of this thesis was identifying four different types of workarounds based on their process structure. There are four types: simple workaround, process workaround, compound workaround, and consequential workaround. In addition, the workaround Motivational Model (WAMM) is a statistical model that theories professionals' intention to use workaround in healthcare context. The practical and methodological contribution was a Workaround Conceptual Knowledge Framework (WACKF) that can be applied by quality specialised and decision makers to understand workarounds used in their organisations and consequently be able to manage them. The framework has got three main components. First component is the use of process techniques to analyse workarounds and identify activities, role and number of people involved, and time consumed to complete the process and compare it to the formal work process. Second, the use of the WAMM questionnaire to identify the factors that influence professionals to use workarounds. Third, the use of the Workaround Assessment Sheet (WA-AS) to evaluate the upside and downside from workaround use in the organisation. The framework provides guidelines, underpinned by theory, that enables management level to have a holistic view of workaround in their organisation and then decide whether to adopt this workaround or strongly eliminate it. In Delphi study experts in quality and hospital management were used to assess and confirm that the components of the framework are appropriate and logically lead to better understanding of workarounds. Results of the framework validation by the decision makers also indicated that the WACKF contributes in understanding the workarounds and consequently improve the patient safety and service quality.

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Akins, Ralitsa B. "Critical processes and performance measures for patient safety systems in healthcare institutions: a Delphi study." Texas A&M University, 2004. http://hdl.handle.net/1969.1/1042.

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This dissertation study presents a conceptual framework for implementing and assessing patient safety systems in healthcare institutions. The conceptual framework consists of critical processes and performance measures identified in the context of the 2003 Malcolm Baldrige National Quality Award (MBNQA) Health Care Criteria for Performance Excellence. Methodology: The Delphi technique for gaining consensus from a group of experts and forecasting significant issues in the field of the Delphi panel expertise was used. Data collection included a series of questionnaires where the first round questionnaire was based on literature review and the MBNQA criteria for excellence in healthcare, and tested by an instrument review panel of experts. Twenty-three experts (MBNQA healthcare reviewers and senior healthcare administrators from quality award winning institutions) representing 18 states participated in the survey rounds. The study answered three research questions: (1) What are the critical processes that should be included in healthcare patient safety systems? (2) What are the performance measures that can serve as indicators of quality for the processes critical for ensuring patient safety? (3) What processes will be critical for patient safety in the future? The identified patient safety framework was further transformed into a patient safety tool with three levels: basic, intermediate, and advanced. Additionally, the panel of experts identified the major barriers to the implementation of patient safety systems in healthcare institutions. The identified "top seven" barriers were directly related to critical processes and performance measures identified as "important" or "very important" for patient safety systems in the present and in the future. This dissertation study is significant because the results are expected to assist healthcare institutions seeking to develop high quality patient safety programs, processes and services. The identified critical processes and performance measures can serve as a means of evaluating existing patient safety initiatives and guiding the strategic planning of new safety processes. The framework for patient safety systems utilizes a systems approach and will support healthcare senior administrators in achieving and sustaining improvement results. The identified patient safety framework will also assist healthcare institutions in using the MBNQA Health Care Criteria for Performance Excellence for self-assessment and quality improvement.

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Bajorek, Zofia. "The management of temporary staff in healthcare emergency departments : implications for patient safety and service quality." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/the-management-of-temporary-staff-in-healthcare-emergency-departments(9a9b3de6-8976-4344-9719-7e9a807d8aea).html.

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The use of temporary staff in healthcare presents a management challenge. There is a case for minimising their use to reduce the risks associated with their limited familiarity with the context and knowledge of protocols. However, staff shortages can negatively affect patient outcomes. Consequently, temporary staff are required but need to be carefully managed. This thesis uses the analytic framework of the psychological contract to explore the previously neglected management of the employment relationship with temporary staff. The empirical research consisted of two studies. The first explored the management of temporary staff in Emergency Departments (ED), analysing management perspectives at macro, meso and micro levels. The second studied the management of the launch of a Major Trauma Centre introducing a Consultant Resident On-Call for trauma, which required temporary contracts. The research was conducted through case studies utilising semi-structured interviews. The ED was specifically chosen because of its high use of temporary staff, and its particular challenges associated with patient care. Results indicated a conflict between the priorities of senior management to minimise staff costs, and department level management, concerned with staffing levels to maintain patient care and service delivery. Risks to patient safety, particularly when ad-hoc agency staff were recruited, were identified. Study 2 revealed a shift from relational to transactional psychological contracts when consultants were placed on temporary contracts due to the protracted management of the change process and perceived psychological contract breach. The results highlighted the distinctive characteristics of temporary staffing in healthcare, and the hierarchy of preferences between the types of temporary staff identified. The research also revealed the consequences of the competing priorities between different management levels in the hospital. Finally, the studies revealed that the psychological contracts of temporary staff were predominantly transactional, whereas a more relational contract could improve temporary staff use and patient outcomes.

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Gardner, John Wallace. "Improving Hospital Quality and Patient Safety - An Examination of Organizational Culture and Information Systems." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1348805699.

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Schmitt, Mathias. "Leadership and Healthcare Performance." Diss., Virginia Tech, 2012. http://hdl.handle.net/10919/77975.

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The U.S. health care delivery system faces serious challenges such as an increasing demand for services due to an aging population, unhealthy lifestyles, growth in the number of uninsured individuals, and an increase in chronic diseases. At the same time, the system has to cope with a limited supply of money, physicians, and nurses inferior quality of care delivered by U.S. hospitals. While the U.S. hospital industry is adapting to address these issues, not much progress in improving the quality of care delivered has been made over the last decade. However, theories exist that management systems, organizational traits, and leadership are key factors for hospitals to improve quality of care outcomes. This study takes a holistic look at these factors to identify and analyze critical drivers for better quality of care outcomes of U.S. hospitals. The study also aims to identify differences between chief executive officers' (CEOs) leadership traits among lean (mediocre performance), high (top 20th percentile), and low performing (bottom 20th percentile) U.S. hospitals in regards to their quality of care measures. Two separate online surveys were conducted. The first online survey was targeted at all 4,697 U.S. hospitals that are required to disclose quality of care measures to the Federal government. Results of this first survey revealed that two management system factors drive quality of care outcomes of U.S. hospitals. Furthermore, findings also show that critical access hospitals have a lower quality of care performance than acute care hospitals. Thus, based on the results from this survey, we concluded that management system factors are main drivers of hospital performance, whereas organizational trait and leadership factors did not significantly contribute to hospital performance. A second survey to CEOs and CEO followers in 9 selected hospitals found significant differences between CEO traits leading lean and low performing hospitals, and, to a lesser degree, significant differences among high and low performing hospitals. However, the study did not find any significant differences in CEO traits between lean and high performing hospitals. Findings also include that some management system factors differed significantly between lean and high performing hospitals, but no evidence for such differences could be found between lean and high and high and low performing hospitals, respectively. These results suggest that management systems and CEO leadership traits play an important role in determining U.S. hospital performance as measured by their quality of care.
Ph. D.

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Parkkonen, Armas. "Vietnamese Nurses’ and Nursing students’ conceptions about healthcare associated infections : An empirical research study in patient safety and quality of care." Thesis, Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-70739.

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Introduction: Healthcare associated infections (HAIs) are a global problem and lead to a large burden for the patients, healthcare systems and society. In low and middle-income countries the burden and prevalence is higher than in high-income countries. It is possible with good prevention to reduce the prevalence and burden of healthcare associated infections. Aim: Investigate Vietnamese Nurses’ and Nursing students’ conceptions about healthcare associated infections and their role in prevention of healthcare associated infections. Method: Qualitative research with a cross-sectional design and the data was collected through eight semi-structured interviews and unstructured observations. The data was analyzed by content analysis. Results: Four categories were identified in the data analysis: Understanding and conceptions about HAI, Hinders for the prevention of HAI, How to work in a preventive way for HAI, Responsibility for patient safety. Conclusion: The study showed hinders for the nurses to perform their work correctly, limitations in the environment, lack of time, and equipment and supplies. The need for improvements are more nurses, make equipment and supplies more available and more rooms for patients. The participants acknowledge about responsibility and the importance of following guidelines at the hospitals are identified in the result.

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Robbins, Julie. "Speaking Up is Hard to Do:What Can Management Do to Help When Patient Safety is on the Line?" The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1365424400.

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Moberg, Anne-May. "Från lag till handling : En fallstudie av hur lagkravet om patientsäkerhetsberättelse nyttiggjordes i Stockholms läns landsting." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-21511.

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Bakgrund: Enligt patientsäkerhetslagen 2010:659 ska vårdgivare årligen skriva en patientsäkerhetsberättelse. Granskning av 76 patientsäkerhetsberättelser i Stockholms läns landsting (SLL) visade bristande kunskap om hur den skrivs och bristfällig förståelse för patientsäkerhet, främst bland mindre vårdgivare. Hälso- och sjukvårdsadministratörer kunde inte besvara vårdgivarnas frågor om patientsäkerhetsberättelsen, varför ett förbättringsprojekt initierades för att skapa stödmaterial samt nyttiggöra patientsäkerhetsberättelsen. Syfte: Att belysa hur ett statligt styrinitiativ hanterades i praktiken i SLL och vilka erfarenheter som kunde knytas till praktikprojektet i hälso-och sjukvårdsadministrationen, hos vårdgivare och i interaktionen dem emellan samt om insatserna bidrog till ökad förståelse för patientsäkerhet. Metod: Studien var en deskriptiv fallstudie. Datainsamlingen bestod av intervjuer med vårdgivare och hälso-och sjukvårdsadministratörer och dokumentanalys. Analyserna var kvalitativ och kvantitativ innehållsanalys. Resultat: I uppföljning av vårdgivare nyttiggjordes patientsäkerhetsberättelsen med stöd av mall och manual. Interaktionen mellan vårdgivare och hälso- och sjukvårdsadministratör gick från kontroll till dialog. Lärande, och i viss mån förståelse för patientsäkerhet, ökade. Slutsats: Genom att vara proaktiv och bereda stöd för vårdgivare att fullfölja sitt åtagande avseende patientsäkerhetsberättelse kunde flera vårdgivare bli varse sitt ansvar och skyldigheter. Förbättringsprojektet genomfördes med stöd av förbättringskunskap och hög delaktighet, ett arbetssätt som rekommenderas. Fortsatt forskning av styrningens effekter föreslås.
Background: Caregivers shall according to the patient safety act 2010:659 annually write a patient safety declaration. Review of 76 patient safety declarations in Stockholm County Council (SCC), Sweden, showed a lack of knowledge about how to write and inadequate understanding of patient safety, particularly among smaller caregivers. Healthcare administrators could not answer caregivers’ questions on the patient safety declaration, why an improvement project was initiated to create support and to make the patient safety declaration useful. Aim: To illustrate how a state steering initiative was handled in practice in the SCC and the experiences associated with the improvement project in health care administration, among caregivers and the interaction between them, and whether the efforts contributed to increased understanding of patient safety. Method: The study was a descriptive case study. The data collection was interviews of caregivers and healthcare administrators and document analysis. The analysies performed were qualitative and quantitative content analysis. Results: The patient safety declaration was made useful in the follow up process of caregivers with support of a template and a manual. The interaction between caregivers and healthcare administrators went from monitoring to dialogue. Learning increased and also understanding of patient safety to some degree. Conclusion: By being proactive and prepare support for caregivers to fulfill their commitment on patient safety declarations, several caregivers became aware of their responsibilities and obligations. The improvement project was accomplished with improvement knowledge and high level of participation, an approach that is recommended. Further research on the steering effects is suggested.

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Hadziabdic, Emina. "The use of interpreter in healthcare : Perspectives of individuals, healthcare staff and families." Doctoral thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap, HV, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-14418.

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This thesis focuses on the use of interpreters in Swedish healthcare. The overall aim was to explore how individuals, healthcare professionals and family members experience and perceive the use of interpreters in healthcare. The study design was explorative and descriptive. The thesis included Serbo-Croatian(Bosnian/Croatian/Serbian)speaking individuals(n=17), healthcare professionals(n=24), official documents(n=60)and family members(n=10)of individuals using interpreters in healthcare. Individual interviews, written descriptions, review of official documents in the form of incident reports from a single case study and focus group interviews were used to collect data. Data were analyzed using phenomenography, qualitative content analysis and qualitative data analysis of focus group interviews. The overall finding from all perspectives was the wish to have a qualified interpreter whose role was as a communication aid but also as a practical and informative guide in healthcare. The perception of a qualified interpreter was someone highly skilled in medical terminology, Swedish and individuals’ native language with ability to adapt to different dialects, wearing non-provocative and neutral clothes, of the same gender, with a professional attitude and preferably in personal contact through face-to-face interaction. Besides being a communication aid, the interpreter was perceived as having an important role in helping individuals to find the right way to and within the healthcare system because foreign-born individuals were unable to understand information in healthcare. Another aspect was to have a well-developed organization with good cooperation between the parties involved in the interpretation situation, such as patients, interpreter, interpreter agency, family members and healthcare professionals to offer a good interpretation situation. In conclusion, the use of an interpreter was determined by individual and healthcare situational factors. Individualized holistic healthcare can be achieved by offering and using high-quality interpreters and cooperation within a well-developed interpreter organization. Keywords: communication, healthcare service, patient-safe quality care, qualitative data collection, qualitative data analysis, users’ perceptions/experiences, utilization of interpreters.

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Johansson, Pauline. "Mobil IKT inom omvårdnad : studier om sjuksköterskors och studenters användning av handdatorer." Doctoral thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap, HV, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-22399.

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Background: In nursing care, the steady increase of health related information implies aneed for useful Information and Communication Technology (ICT) tools that easilyprovide mobile access to accurate information. Updated information is usually available onthe Internet but personal computers are rarely available at the patients’ bedside. In Sweden,although handheld devices provide mobile access to information, they are rarely used innursing practice. Aim: This thesis aimed to explore the views of nurses and nursingstudents of using handheld devices in nursing practice. Method: Four intervention studieswere carried out during the years 2006 to 2008; a total of 30 nurses and 63 nursing studentsused handheld devices for 5-15 weeks in nursing practice, and answered questionnairesand/or participated in interviews. In 2012, a cross sectional study was undertaken with 111nurses and 287 nursing students answering a questionnaire about their views of usinghandheld devices. Quantitative data were analyzed using descriptive statistics andqualitative data were analyzed by content analysis. Results: The handheld device wasregarded to facilitate nursing practice and to be a useful tool with benefits for the patients,the nurses and for the nursing students. Independent of time and place, nurses and nursingstudents were able to access necessary information and also to make notes, plan their workand save time. The handheld device was regarded to improve patient safety and quality ofcare. The participants would not have to leave their patients to look up information,subsequently giving a more complete encounter. Additionally, the handheld device waspresumed to imply increased confidence, and support learning for nurses and nursingstudents. Conclusion: In order to continuously improve the safety and quality of healthcare,it is important to implement handheld devices in nursing practice. This issue is importantat all levels in the healthcare systems, from nurses to nursing management, policy makersand moreover for educators. Handheld devices adjusted for nursing, technical, statutory,cultural, and language country specific conditions, should be further developed,implemented, and evaluated in future research.
Omvårdnad är ett informationsintensivt område och sjuksköterskor hanterardagligen en omfattande mängd information. Kunskapsmassan växer stadigtoch behovet av tillgång till aktuell information ökar. Vanligen finns aktuellinformation tillgänglig via Internet men det är inte alltid som en dator finns tillhands vid patientens sängkant. Mobil informations- och kommunikationsteknik(IKT) såsom en handdator kan lätt ge tillgång till den information sombehövs. Trots att det finns flera fördelar med att använda mobil IKT som stödinom omvårdnad, framför allt avseende tillgång till information, såsombeslutsstöd och för lärandet, används det ännu i ringa omfattning i Sverige.Avhandlingens övergripande syfte var att undersöka sjuksköterskors ochsjuksköterskestudenters uppfattningar om att använda handdatorer inomomvårdnad.Fyra av avhandlingens fem studier genomfördes från 2006 till 2008. Sammanlagtanvände 30 sjuksköterskor och 63 sjuksköterskestudenter handdatorer5-15 veckor i arbete eller verksamhetsförlagd utbildning (VFU). Deltagarnabesvarade enkäter före och efter användningen, och intervjuades individuellteller i grupp. I den femte studien, som genomfördes 2012, besvarade 111sjuksköterskor och 287 sjuksköterskestudenter en enkät om sin uppfattning omhanddatorer. Kvantitativ data analyserades med beskrivande statistik ochkvalitativ data analyserades med innehållsanalys.Studierna visade att en handdator kan vara ett stöd i det dagliga arbetet och iVFU som informations-, antecknings- och planeringsverktyg, och kan enkeltge en översikt av patienters läkemedelsanvändning. Sjuksköterskorna ochsjuksköterskestudenterna ansåg att handdatorn kan bidra till ökad patientsäkerhetoch vårdkvalitet på grund av den snabba tillgången till aktuellinformation, oberoende av tid och plats. Patientmötet kan bli mer helt dåpatienterna inte behöver lämnas och samtalet inte behöver avbrytas;vårdrelationer kan bli vårdande relationer. Deltagarna ansåg att handdatornkan vara ett stöd avseende trygghet, minskad stress och kontinuerligt lärande. Iframtiden bör sjuksköterskor och sjuksköterskestudenter ges tillgång till mobilIKT som stöd i sitt arbete och VFU, och införandet bör därför prioriteras påalla nivåer inom vård och utbildning. IKT-kompetensen måste ökas ochslutanvändarna måste vara delaktiga i utvecklingen och införandet. Fortsattforskning behövs avseende avancerade mobila IKT-stöd; anpassade försjuksköterskans arbete.
Nurse Companion

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O'Connor, Patricia. "Looking for harm in healthcare : can Patient Safety Leadership Walk Rounds help to detect and prevent harm in NHS hospitals? : a case study of NHS Tayside." Thesis, University of St Andrews, 2012. http://hdl.handle.net/10023/2804.

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Today, in 21st century healthcare at least 10% of hospitalised patients are subjected to some degree of unintended harm as a result of the treatment they receive. Despite the growing patient safety agenda there is little empirical evidence to demonstrate that patient safety is improving. Patient Safety Leadership Walk Rounds (PSLWR) were introduced to the UK, in March 2005, as a component of the Safer Patients Initiative (SPI), the first dedicated, hospital wide programme to reduce harm in hospital care. PSLWR are designed, to create a dedicated ‘conversation’ about patient safety, between frontline staff, middle level managers and senior executives. This thesis, explored the use of PSLWR, as a proactive mechanism to engage staff in patient safety discussion and detect patient harm within a Scottish healthcare system- NHS Tayside. From May 2005 to June 2006, PSLWR were held on a weekly basis within the hospital departments. A purposive sample, (n=38) of PSLWR discussions were analysed to determine: staff engagement in the process, patient safety issues disclosed; recognition of unsafe systems (latent conditions) and actions agreed for improvement. As a follow-up, 42 semi-structured interviews were undertaken to determine staff perceptions of the PSLWR system. A wide range of clinical and non-clinical staff took part (n=218) including medical staff, staff in training, porters and cleaners, nurses, ward assistants and pharmacists. Participants shared new information, not formally recorded within the hospital incident system. From the participants perspectives, PSLWR, were non threatening; were easy to take part in; demonstrated a team commitment, from the Board to the ward for patient safety and action was taken quickly as a result of the ‘conversations’. Although detecting all patient harm remains a challenge, this study demonstrates PSLWR can be a useful tool in the patient safety arsenal for NHS healthcare organisations.

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Clinco, Sandra Denise de Oliveira. "O hospital é seguro? Percepções de profissionais de saúde sobre segurança do paciente." reponame:Repositório Institucional do FGV, 2007. http://hdl.handle.net/10438/4900.

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Made available in DSpace on 2010-04-20T20:15:05Z (GMT). No. of bitstreams: 1 106674.pdf: 904594 bytes, checksum: b288b443fcee4a4b63a1ee332274a957 (MD5) Previous issue date: 2007-08-15T00:00:00Z
A segurança do paciente é um dos pilares de uma organização hospitalar. O objetivo deste estudo foi conhecer as opiniões dos profissionais de saúde, que trabalham em organizações hospitalares, quanto às dimensões de segurança do paciente. Foram abordados conceitos de acreditação, qualidade, cultura de segurança e segurança do paciente. A metodologia utilizada foi a aplicação de um questionário da Agency for Healthcare Research and Quality, traduzido para o português, às lideranças administrativas e assistenciais de hospitais acreditados (tanto pela metodologia da Organização Nacional de Acreditação quanto pela metodologia da Joint Commission International), no Estado de São Paulo. Também identificou-se a freqüência com que os erros são reportados e se as respostas aos erros cometidos são punitivas ou não.
Patient safety is one of the pillars of a healthcare organization. The aim of this study was to know the opinions of the hospital staff about the safety culture dimensions. Concepts of accreditation, quality, safety culture and patient safety are approached. The methodology consisted of a questionnaire application prepared for Agency for Healthcare Research and Quality, translated to portuguese, to the medical and nonmedical leaderships of accredited hospitals (by the methodology of the Organização Nacional de Acreditação and by the methodology of the Joint Commission International), in São Paulo state. The frequency of error reporty was also identified, as well as whether the response to error is punitive or not.

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Vizlin, Enes. "Produktivitetsmått för röntgenavdelning : En fallstudie vid Visby lasarett." Thesis, Uppsala universitet, Institutionen för samhällsbyggnad och industriell teknik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-444873.

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Den här studien görs som avslutande del av universitetsutbildning, kandidatprogram i Industriell teknik inom ämnesområdet kvalitetsteknik. Studien kan användas för vidare verksamhetsutveckling och analys av röntgenavdelningens behov av produktivitetsmått, vid Visby lasarett. På grund av restriktioner relaterade till covid-19, samt det geografiska avståndet mellan Göteborg och Visby, utfördes studien på distans genom datainsamling från intervjuer och enkätundersökning. Vidare samlades information från vetenskaplig litteratur, lagar, förordningar och dokumentanalys. I studien användes ett abduktivt arbetssätt genom att induktivt analysera insamlad data och utifrån det formulera lämplig teoretisk bakgrund som sedan på ett deduktivt sätt kunde användas för att generera ett resultat och förbättringsförslag. För att analysera och argumentera för erhållna resultat användes vetenskapliga forskningsstudier, kvantitativ data från organisationen och statistiska verktyg. Använda teorier för studien baseras på offensiv kvalitetsutveckling, processledning och Lean Healthcare. DASIAS modell användes som metod för att på ett systematiskt sätt arbeta med data från diagnostisering av problemet till implementerings- och uppföljningsförslag. Genom studien beaktades de etiska aspekter och alla inblandade subjekt informerades med hänsyn till informations-, konfidentialitets-, anonymitets-, objektivitets-, nyttjandes- och samtyckeskraven. Erhållna resultat i form av produktivitetsmått relaterar till processkartläggning, produktivitet, flödeseffektivitet, vårdbehov, kapacitetberäkning, patientsäkerhet och kötider. Analysen visar att valda indikatorer kan användas för att förbättra verksamheten men förutsättning till detta är bättre verksamhetsplanering och effektivare resursutnyttjande för att uppnå en hög flödeseffektivitet och produktivitet. Slutsatsen är att valda indikatorer kan nyttjas för förbättringsåtgärder samt att prioriteringsområden bör väljas enligt 10M analysen. Studien lämnar vissa obesvarade frågeställningar som presenteras som förslag till framtida studier.Nyckelord:
This study is conducted as a final part of the University candidate program Industrial engineering and within the field of study quality technology. This study is suitable for business development as well for the analysis of the X-ray department's needs for productivity measures, at Visby Hospital. The study was carried out at a distance by data collection from the interviews, questionnaire survey and document analysis. An abductive approach was used to generate a result and suggestions for improvement. To analyse and argue for results obtained, scientific research studies, quantitative data from the organization, statistical tools, tables and diagrams were used. The theories for this work are based on TQM, BPM and Lean Healthcare. DASIA's model was used as a method to work in a systematic way with data from diagnosing the problem to implementation and follow-up proposals. The study took into account the ethical aspects and all the subjects involved were informed regarding ethical requirements. Results obtained in the form of productivity measures relate to process mapping, productivity, flow efficiency, care needs, capacity calculation, patient safety and healthcare waiting time. The analysis shows that selected indicators can be used to improve the business, but a condition for this is better business planning and more efficient resource utilization. The conclusion is that selected indicators can be used for improvement measures and that priority areas should be selected according to the 10M analysis. The study leaves some unanswered issues that are presented as proposal for future studies in the discussion chapter.

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Clinco, Sandra Denise de Oliveira. "Participação do usuário no seu cuidado: realidade ou ficção?" reponame:Repositório Institucional do FGV, 2013. http://hdl.handle.net/10438/10675.

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A participação do paciente no cuidado é uma importante ferramenta para melhoria dos processos em uma organização hospitalar, pois aumenta a segurança do paciente. Este estudo teve como objetivo analisar se o paciente participa de seu cuidado. Esta análise foi feita por meio de entrevistas estruturadas com 243 pacientes internados em quatro hospitais com certificado de qualidade da Grande São Paulo e com a aplicação de questionário com perguntas abertas a três gestores destas organizações. Os resultados demonstram que os pacientes tem alta participação no cuidado, porém 17,3% dos pacientes referem que participaram do cuidado menos do que queriam e 43,6% não sabiam o nome do médico responsável pelo seu tratamento. Os gestores hospitalares reconhecem que a participação do paciente é importante, mas não há ações proativas efetivas nestas organizações hospitalares para identificar as necessidades dos pacientes.
The patient participation in care is an important tool for improving processes in a hospital organization, it increases patient safety. This study aimed to assess if the patient participates in their care. This analysis was done by structured interviews with 243 patients in four hospitals with quality certificate at the greater São Paulo region and with a questionnaire with open questions to three managers of these organizations. The results demonstrate that patients have high participation in care, but 17,3% of patients report that their participated care was less what they wanted and 43,6% did not know the name of the their attending physician. The hospital managers recognize that the participation of the patient is important, but no effective proactive actions were taken in these hospital organizations to identify the patients’ needs.

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Abdi, Yusuf Isse Muna. "Identifying Patient Safety and The Healthcare Environment in Puntland, Somalia." Thesis, KTH, Skolan för kemi, bioteknologi och hälsa (CBH), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-232039.

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Independent on where in the world one is, patient safety is regarded as one of the most important aspects in the healthcare industry. On the contrary, depending on where you are, the patient safety will differ and is therefore location dependent. The patient safety in a developing country will therefore be evaluated in a different way compared to a developed country. This study, therefore aimed to identify the patient safety in Puntland, Somalia and with it, its healthcare environment in the hospitals. The goal was to identify the main factors that affected the patient safety. To investigate this, a field study to the region of interest was made and subsequently interviews with staff at the site were conducted as well as observations in the concerned hospitals. The obtained results were analysed using the method of Qualitative Content Analysis. At a later stage, the results could be thematized into four categories; “Need”, “Device”, “Training” and “Knowledge”, which pinpointed the main issues. The study show that there was a common transversal issue of a inherent lack of devices, training and knowledge which in turn could severely affect the patients and their safety in ways such as misdiagnosis, delayed treatment and in worst cases death. Furthermore, it was evident that rather than the lack of actual devices, the absence of knowledge was more prevalent.
Oberoende på var än i världen man befinner sig, anses patientsäkerhet vara en av de viktigaste aspekterna i sjukvården. Å andra sidan, helt beroende på var man befinner sig kommer patientsäkerheten skilja sig och är därför lägesberoende. Patientsäkerheten i ett utvecklingsland kommer därför uppfattas på ett annat sätt i jämförelse med ett I-land. Denna studie syftar till att identifiera patientsäkerheten i Puntland, Somalia och med det dess vårdmiljö i sjukhusen. Målet var att identifiera huvudfaktorerna som påverkar patientsäkerheten. För att undersöka detta utfördes en fältstudie i den valda regionen Puntland, därefter gjordes intervjuer med personal på plats i sjukhusen och dessutom utfördes observationer. De erhållna resultaten analyserades med hjälp av metoden “Qualitative Content Analysis”. Vid ett senare skede tematiseras resultaten till fyra kategorier; “Behov”, “Apparat”, “Utbildning” och “Kunskap”, vilka visade på de huvudsakliga problemen. Studien visade slutligen på att det fanns ett gemensamt genomgående problem av brist på apparater, utbildning och kunskap, vilket i sin tur skulle kunna påverka patienter och deras säkerhet på sätt såsom feldiagnoser, försenad behandling och i värsta fall döden. Vidare fastställdes att snarare än bristen på apparater, var avsaknaden av kunskap mer påtaglig.

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D'Esmond, Lynn Berggren Knapp. "Distracted Practice and Patient Safety: The Healthcare Team Experience: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/41.

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Purpose: The purpose of this study was to explore the experiences of distracted practice across the healthcare team. Definition: Distracted practice is the diversion of a portion of available cognitive resources that may be needed to effectively perform/carry out the current activity. Background: Distracted practice is the result of individuals interacting with the healthcare team, the environment and technology in the performance of their jobs. The resultant behaviors can lead to error and affect patient safety. Methods: A qualitative descriptive (QD) approach was used that integrated observations with semi-structured interviews. The conceptual framework was based on the distracted driving model and a completed concept analysis. Results: There were 22 observation sessions and 32 interviews (12 RNs, 11 MDs, and 9 Pharmacists) completed between December, 2014 and July 2015. Results suggested that distracted practice is based on the main theme of cognitive resources which varies by the subthemes of individual differences; environmental disruptions; team awareness; and “rush mode”/time pressure. Conclusions and Implications: Distracted practice is an individual human experience that occurs when there are not enough cognitive resources available to effectively complete the task at hand. In that moment an individual shifts from thinking critically, being able to complete their current task without error, to not thinking critically and working in an automatic mode. This is when errors occur. Additional research is needed to evaluate intervention strategies to reduce and prevent distracted practice.

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Long, Jieling. "Design for patient safety : a prospective hazard analysis framework for healthcare systems." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708636.

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Åhlfeldt, Rose-Mharie. "Information Security in Distributed Healthcare : Exploring the Needs for Achieving Patient Safety and Patient Privacy." Doctoral thesis, Stockholm University, Department of Computer and Systems Sciences (together with KTH), 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-7407.

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In healthcare, patient information is a critical factor. The right information at the right time is a necessity in order to provide the best possible care for a patient. Patient information must also be protected from unauthorized access in order to protect patient privacy. It is furthermore common for patients to visit more than one healthcare provider, which implies a need for cross border healthcare and continuity in the patient process.

This thesis is focused on information security in healthcare when patient information has to be managed and communicated between various healthcare actors and organizations. The work takes a practical approach with a set of investigations from different perspectives and with different professionals involved. Problems and needs have been identified, and a set of guidelines and recommendations has been suggested and developed in order to improve patient safety as well as patient privacy.

The results show that a comprehensive view of the entire area concerning patient information management between different healthcare actors is missing. Healthcare, as well as patient processes, have to be analyzed in order to gather knowledge needed for secure patient information management.

Furthermore, the results clearly show that there are deficiencies both at the technical and the administrative level of security in all investigated healthcare organizations.

The main contribution areas are: an increased understanding of information security by elaborating on the administrative part of information security, the identification of information security problems and needs in cross border healthcare, and a set of guidelines and recommendations in order to advance information security measures in healthcare.

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Åhlfeldt, Rose-Mharie. "Information security in distributed healthcare : exploring the needs for achieving patient safety and patient privacy /." Kista : Department of Computer and Systems Sciences, Stockholm University, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-7407.

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Jun, Gyuchan Thomas. "Design for patient safety : a systematic evaluation of process modelling approaches for healthcare system safety improvement." Thesis, University of Cambridge, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.613021.

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Ntunta, Asanda. "Patient perceptions of the quality of public healthcare in South Africa." University of the Western Cape, 2019. http://hdl.handle.net/11394/7047.

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Magister Commercii - MCom
The South African democratic government is mandated by the constitution to provide quality healthcare services to the citizens of the country. Therefore, healthcare in South Africa is considered as a basic human right. The existing healthcare system exhibits extreme inequality, which translates into inequity in health outcomes across different demographic factors. Even though quality healthcare is a basic human right, problems related to the quality of healthcare remain, which poses a major challenge for the South African government. This dissertation investigates patient perceptions of the quality of public healthcare in South Africa, using General Household Survey data (2009-2016), with the objective of determining the level and trends of patient satisfaction and complaints reported when accessing public healthcare services in South Africa and identifying the correlates of these perception. This study found that patient satisfaction with public healthcare services in South Africa has increased over time while complaints have decreased over time. This study refrains from drawing conclusion on these findings at face value, since they may be other factors that explain the observed trends. The most common complaint was long waiting time at public healthcare facilities. On average, White individuals, male household heads, individuals residing in rural areas and individuals from smaller household were more likely to report to being satisfied with healthcare services received at public healthcare facilities in South Africa. Therefore, patient satisfaction survey approach should be used in conjunction with other healthcare quality measures such as direct observation, vignettes and standardised or mystery patient.

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Randmaa, Maria. "Communication and Patient Safety : Transfer of information between healthcare personnel in anaesthetic clinics." Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-278726.

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Communication errors are frequent during the perioperative period and cause clinical incidents and adverse events. The overall aim of the thesis was to study communication – the transfer of information, especially the postoperative handover – between healthcare personnel in an anaesthetic clinic and the effects of using the communication tool SBAR (Situation-Background-Assessment-Recommendation) from a patient safety perspective. The thesis is based on studies using a correlational (Paper I), quasi-experimental (Paper II and III) and descriptive (Paper IV) design. Data were collected using digitally recorded and structured observations of handovers, anaesthetic records, questionnaires, incident reports and focus group interviews. The results from baseline data showed that lack of structure and long duration of the verbal postoperative handover decreased how much the receiver of postoperative handover remembered; the item most likely not to be remembered by the receiver was anaesthetic drugs. The variation in remembered information showed that there were room for improvement (Paper I). Implementing the communication tool SBAR increased memorized information among receivers following postoperative handover. Interruptions were frequent during postoperative handover, which negatively affected memorized information (Paper III). Furthermore, after implementation of SBAR, the personnel’s perception of communication between professionals and the safety climate improved, and the proportion of incident reports related to communication errors decreased in the intervention group (Paper II). The results of the focus group interviews revealed that the nurse anaesthetists, anaesthesiologists and post-anaesthesia care unit nurses had somewhat different focuses and views of the postoperative handover, but all professional groups were uncertain about having all information needed to secure the quality of postoperative care (Paper IV). The findings indicate that using a predictable structure during postoperative handover may improve the information memorized by the receiver, perception of communication between professionals and perception of safety climate. Incidents related to communication errors may also decrease. Long duration of the handover and interruptions may negatively affect the information memorized by receiver. To ensure high quality and safe care, there is a need to achieve a shared understanding across professionals of their work in its entirety.

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Samuelsson, Emma. "Using activity theory to describe patient safety : How Region Östergötland supports patient safety development in a low and middle-income country’s healthcare system." Thesis, Linköpings universitet, Institutionen för datavetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-170095.

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Region Östergötland engages in many international collaborations as a way to exchange knowledge and insights with other organizations. The organization has had a collaboration focused on patient safety with Moi Teaching and Referral Hospital in Eldoret, Kenya, since 2015. Kenya is considered a low and middle-income country, while Sweden is considered a high-income country. The aim of this study was to describe patient safety development using activity theory, with a special focus on how Region Östergötland supports patient safety development in a low and middle-income country’s healthcare system. Data was collected by conducting interviews with six participants involved in the patient safety collaboration, by visiting Eldoret to conduct a participant observation and by analyzing relevant policy documents. The results showed that many factors are involved in patient safety development, both within an organization and in supporting the development in a low and middle-income country’s healthcare system. Healthcare organizations should strive for commitment to patient safety development from all levels of the organization, and for a safety culture where staff members are comfortable reporting errors. The management must pursue patient safety questions and put aside resources for patient safety development. As Sweden and low and middle-income countries are different in many aspects, it’s important for the supporting part, in this case Region Östergötland, to be attentive to and understanding of prevailing differences caused by available resources, cultural norms, rules and organizational structures. Many of the requirements for an organization’s patient safety development, and for a successful collaboration between Region Östergötland and Moi Teaching and Referral Hospital, were shown to be achieved or at least functioning. Even though all requirements are not fulfilled, they are all matters that can be improved by the continuation of the collaboration. Region Östergötland can learn from the collaboration by seeing how results can be achieved in an organization with few resources, how efficiently changes can be made within an organization, as well as by gaining knowledge about another culture and country. These factors create opportunities for project participants to be inspired and question current methods and norms in their own organization, which can result in improvements of Region Östergötland as on organization in the future.

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Hittle, Beverly M. "Elusive Sleep: Healthcare Workers, Shift Work, and Implications for Worker Health and Patient Safety." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1562059911010694.

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Wilson, Katherine Ann. "Does safety culture predict clinical outcomes?" Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2919.

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Patient safety in healthcare has become a national objective. Healthcare organizations are striving to improve patient safety and have turned to high reliability organizations as those in which to model. One initiative taken on by healthcare is improving patient safety culture--shifting from one of a 'no harm, no foul' to a culture of learning that encourages the reporting of errors, even those in which patient harm does not occur. Lacking from the literature, however, is an understanding of how safety culture impacts outcomes. While there has been some research done in this area, and safety culture is argued to have an impact, the findings are not very diagnostic. In other words, safety culture has been studied such that an overall safety culture rating is provided and it is shown that a positive safety culture improves outcomes. However, this method does little to tell an organization what aspects of safety culture impact outcomes. Therefore, this dissertation sought to answer that question but analyzing safety culture from multiple dimensions. The results found as a part of this effort support previous work in other domains suggesting that hospital management and supervisor support does lead to improved perceptions of safety. The link between this support and outcomes, such as incidents and incident reporting, is more difficult to determine. The data suggests that employees are willing to report errors when they occur, but the low occurrence of such reportable events in healthcare precludes them from doing so. When a closer look was taken at the type of incidents that were reported, a positive relationship was found between support for patient safety and medication incidents. These results initially seem counterintuitive. To suggest a positive relationship between safety culture and medication incidents on the surface detracts from the research in other domains suggesting the opposite. It could be the case that an increase in incidents leads an organization to implement additional patient safety efforts, and therefore employees perceive a more positive safety culture. Clearly more research is needed in this area. Suggestions for future research and practical implications of this study are provided.
Ph.D.
Department of Psychology
Sciences
Psychology PhD

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Namana, Subhadra, and Sanar Al-Dori. "Healthcare Management : Measuring patient satisfaction of service quality in Swedish dental clinics." Thesis, Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-37082.

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ABSTRACT:Healthcare management is a field that is related to management, leadership, and service of anorganization. Due to high competition and change in the environment of healthcare organizations,managers need to embrace the innovation to respond to those changes and make the organizationsuccessful by improving the process, structure, and culture of the organization as well as to provideefficient and effective care that will lead to achieve patient satisfaction. Service quality is one ofthe key factor among the service innovations that contribute to business development and leadingposition in the business world with high competition. Patient satisfaction is important for anyhealthcare organization. Patient satisfaction improves hospital/clinic image, which changes into anincrease in the use of services provided by the healthcare systems and increases market share.Patient satisfaction is dependent on the service quality which is the main factor in healthcareinnovations.Purpose: The purpose of this study is to understand experience levels of the patient satisfaction ofservice quality in Swedish dental clinics, based on the factors affecting dental service quality.Data Sources: Interviews with staff from six clinics in Sweden, 240 patient surveys from twopublic and two private Swedish dental clinic, group interviews with three Swedish dental clinics,Science-Direct, Research Gate, ABI Inform, Google Scholar, Academia.edu.Method: This study is based on the quantitative and qualitative analysis (i.e., mixed methodapproach) and abductive approaches to measure patient satisfaction in Swedish dental clinicsthrough service quality. The problem is analyzed through interviews with the staff in private andpublic dental clinics. The factors affecting the dental service quality are analyzed throughtheoretical and empirical analysis. The patient’s satisfaction was measured by SERVQUAL toolthrough using patients’ survey that consists of 12 questions based on the four factors (tangibility,empathy, responsiveness, and Assurance). Patient survey is conducted in four dental clinics. SPSSwas used to calculate mean and standard deviation for the survey’s result. After analyzing the result,group interviews with clinic 1, clinic 3 and clinic 5 was conducted to understand different valuesin the tool i.e., the value created, value destroyed, and value missed based on the customerperception to analyze the service quality of the dental clinics.Findings: The result from the surveys showed that the factor empathy has highest positive affectand responsiveness has the lowest effect in four dental clinics. The lowest effect in the factorresponsiveness is based on the waiting time to meet a dentist. The group interviews gave us thedifferent values which are based on the idea of the value mapping tool in customer perspective.The value that the clinics gained trust from their patients. The value missed\destroyed is the waitingtime to meet a dentist. The new opportunities are to improve the services by installing newtechnology products and changing the appearance of the clinic.

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Maneejiraprakarn, Phattharamanat. "Effects of patient delivery models on nurse job satisfaction, quality of care and patient safety." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/404586/.

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Background; a patient care delivery model describes a method of allocating work at hospital ward level. Four classical models are articulated which involve different work allocation paradigms. Research findings are varied in regard to the association between these models of care and outcomes. This study aimed to (1) describe current approaches to the delivery of nursing care to hospital based patients and (2) examine the association between patient care delivery models and nurse job-satisfaction, quality of care and patient safety. Method: a cross-sectional survey was conducted in two phases: (1) a pilot study and a preliminary survey; and, (2) the main study. Data were collected from general medical and surgical wards in 11 regional hospitals in Thailand from July 2013 to October 2014. Findings: The pilot study (9 wards, 1 hospital) demonstrated that the chosen data collection procedures are feasible and confirmed the reliability of the instruments. The preliminary survey (42 wards, 6 hospitals) suggested that there was a degree of incongruence between the models of care reported by the ward managers and the actual patterns of care delivery as well as dissonance with the classical model‘s characteristics derived from the literature. A revised classification, using the ward managers‘ reported current methods of care delivery was made. The majority of the wards (62%) can be classified as team nursing. However, all characteristics of the classical task allocation, and the patient allocation model existed in wards classified as following the team nursing paradigm. The main study (1,193 staff nurses and their 76 ward managers; 83% and 95% response rate) confirmed that current approaches to care delivery are not based on any single classical model; instead, the approaches observed are eclectic, combining the classical team nursing model with a hybrid assignment of tasks as well as patients, and the duration of responsibility lasting for one shift. Hierarchical modelling was performed. After controlling for nurse-to-patient ratio, skill mix ratio and work environment, it was demonstrated that work allocation patterns derived from the team nursing and patient allocation models were found to be independently significant associated with a likelihood of nurse reported good quality of care (odds ratio 3.1 and 1.5, 95% confidence interval: 1.4-6.7 and 1.1-2.1). No supportive evidence for any benefits of implementing work allocation patterns derived from the primary nursing and task allocation models has been found. Conclusion: The results provided both more accurate knowledge and a better understanding of work allocation mechanisms, at the micro level, within the nursing team. Shifting the emphasis from an evaluation of the patient care delivery model to the components of work allocation is suggested, as the pure classical model no longer exists. However, work allocation patterns that emphasise the formation of explicit nursing sub-teams with the ward compliment (elements of ?team nursing‘) and explicit assignment of nurses to individual patients (elements of ?patient allocation‘) based on nurses skills and patient need appear to be associated with better outcomes than patterns that involve task allocation or those which emphasise continuity of nurse to patient assignment.

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Baxter, Ruth Mary. "Learning from positive deviants to improve the quality and safety of healthcare." Thesis, University of Leeds, 2016. http://etheses.whiterose.ac.uk/16776/.

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Every day around the globe, patients are harmed within healthcare organisations. Attempts to improve the quality and safety of healthcare traditionally focus on past errors and harm, yet there is little evidence of widespread improvement. In contrast, the positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance despite facing the same constraints as others. Bradley et al. (2009) have proposed a four stage process to apply positive deviance within healthcare organisations: 1) positive deviants are identified using routinely collected data; 2) hypotheses are generated about how they succeed; 3) these are tested within representative samples; and 4)the successful strategies are disseminated. Despite this, limited guidance exists to support applications. This thesis sought to test a robust and pragmatic method for applying the positive deviance approach within multidisciplinary healthcare teams. Study 1 systematically reviewed the methods used to apply positive deviance within healthcare. Previous applications identified positively deviant organisations or individuals and focused on narrow outcomes or processes of care. Applications lacked quality and used extensive resources. Study 2 analysed NHS Safety Thermometer data to identify five positively deviant and five matched comparison elderly medical wards. In the main, staff and patient perceptions of safety on these wards supported their identification. During study 3, multidisciplinary staff focus groups were conducted to explore how these wards delivered exceptionally safe care. In total, 14 behaviours and cultures were hypothesised to facilitate positive deviance at ward level. Study 4 assessed the feasibility of applying positive deviance within a general practice setting. Findings highlighted challenges of selecting data to identify positive deviants, recruiting general practices to participate, and generating hypotheses about success strategies that were unique to positive deviants yet common among them. In combination, these studies generated guidance to support rigorous applications of the positive deviance approach within healthcare organisations. The evidence suggested that, in the future, it may be possible to improve the quality and safety of care by focusing on those that demonstrate exceptional rather than poor outcomes of care.

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Tuite, Helena. "The culture of a Middle Eastern, multicultural healthcare institution and how it facilitates patient safety." Thesis, University of Ulster, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.592888.

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A movement to promote patient safety as a priority has gained momentum globally over the past 12 years. 2004 witnessed the World Health Organisation launching the World Alliance for Patient Safety and from its inception included representation from the Arab Gulf States. World Health Organisation's priorities for patient safety research puts identification, development and testing of locally effective solutions as a number one priority for the developing countries, as little epidemiology exists. Reporting of medical errors is a key mechanism of patient safety. To identify local solutions to the global problem of gross underreporting of medical errors and near misses, the culture of an organization needs to be understood first. The uniqueness of the Middle Eastern healthcare institution and the richness of its cultural diversity with less than 6% of its healthcare providers from the indigenous workforce, add complexity to the promotion of patient safety. This thesis presents and discusses findings of a study exploring how the culture of a multicultural Middle Eastern healthcare institution facilitates patient safety. The aim of the study is to determine how the culture facilitates patient safety and its objectives are to: use an ethnographic approach to gain a greater understanding of how registered nursing staff makes sense of patient safety; use of discourse analysis approach to make sense of power within this organization. The conceptual framework is based on an adaptation of Schein's organizational culture assessment model informed by discourse analysis influenced by the French philosopher Michel Foucault's approach to governmentality, to provide for a micro and macro level analysis of the study. Underpinning Schein's model is the theory that culture can be analysed at three different levels and by separating these levels, i.e. artefact, espoused values and basic assumptions, or at the taken for granted level, one can assess the 'essence of culture'. Governmentality is about how we think about guiding ourselves or others in any number of situations. Foucault's main interest in this regard lies in using history, i.e. genealogy, to show how things have become taken for granted, in the present, illuminating the fragility of the perceived perfect order, focused on power relations. This thesis is presented in 8 chapters. Data were generated from 622 hours of non-participant observation, detailed and highly descriptive field notes, reflexive diaries, transcripts, documents, archival search and open ended, semi-structured interview and informal conversations. Data were analysed under the three levels of the conceptual framework and a separate analysis was conducted by using a topography approach and a simple theoretical framework, with the same database, to provide for the history of the present. The findings provide a story of the lived culture through a description of the artefacts and espoused values and an interpretation of the basic assumptions in their attempt to characterise the essence of the culture of this organization that allows those expressed values that have become normalised. Exploring the global, regional and local discourses of patient safety provides us with an historical gaze that sees how the winds of change swept through this developing country in early 2000. The two key findings include: The routine non-conformity with set standards and patient safety related policies originate from the interconnectedness between the organization's adaptation to its external environment and the internal relationship among its group members. The unintended consequences of the subsequent strategiC position of changing the vision focus, to becoming internationally recognised for healthcare excellence through accreditation, has led to internal and external regulatory and disciplinary technologies and the subsequent inherent resistive actions. The discussion focuses on these key findings and brings together and reflects upon the various other findings of the study. The findings are discussed and interpreted in relation to the currently available literature. Implications for further research for these findings are proposed in conclusion.

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Tukay, Remeliza Navarrete. "Diabetes Mellitus Type 2: A Quality Improvement and Patient Safety Initiative." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3213.

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The purpose of the quality improvement (QI) project was to examine the relationship between amended nursing education concerning diabetes mellitus (DM) Type 2 self-care management incorporating Tune in, Explore, Assist, Communicate, and Honor (TEACH) and Motivational Interviewing (MI) strategies and techniques and the Glycosylated hemoglobin (HgbA1C) of veteran patients with uncontrolled diabetes. The target sample included the 2 licensed practical nurses and 2 registered nurses assigned to 2 primary care teams, and the 10 purposively sampled patients with uncontrolled DM Type 2 from each team. The nurses' competencies were measured through descriptive comparison before and after nursing education implementation using the instrument Patient Education: TEACH for Success Self-Assessment Questionnaire. The nurses' confidence and their perceived importance of the TEACH and MI skills application and skill assessment for promoting health behavior change were tested inferentially with a paired t test before and after nursing education implementation using the instrument Clinician Importance and Confidence Regarding Health Behavior Counseling Questionnaire. The primary care team developed their skills tailored to each patient's needs, considering the guiding principles and premises of the health belief model (HBM). Patients' self-care management knowledge, skills and confidence were improved. The project decreased the elevated HgbA1C of patients measured after the project initiative. The QI project leads to positive social change by decreasing the number of patients with uncontrolled diabetes among the veteran population. The patients and their providers can develop individualized plans of care for diabetes management by educating, redirecting, and evoking behavioral changes in the veteran patients by using a team approach.

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Canham, Aneurin. "Examining the application of STAMP in the analysis of patient safety incidents." Thesis, Loughborough University, 2018. https://dspace.lboro.ac.uk/2134/36150.

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This thesis examines the application of Systems-Theoretic Accident Model and Processes (STAMP) in healthcare and the analysis of patient safety incidents. Healthcare organisations have a responsibility for the safety of the patients they are treating. This includes the avoidance of unintended or unexpected harm to people during the provision of care. Patient safety incidents, that is adverse events where patients are harmed, are investigated and analysed as accidents are in other safety-critical industries, to gain an understanding of failure and to generate recommendations to prevent similar incidents occurring in the future. However, there is some dissatisfaction with the current quality of incident analysis in healthcare. There is dissatisfaction with the recommendations that are generated from healthcare incident analysis which are felt to produce weak and ineffective remedial actions, often including retraining of individuals and small policy change. Issues with current practice have been linked to the use of Root Cause Analysis (RCA), an analysis method that often results in the understanding of an accident as being the result of a linear chain of events. This type of simple linear approach has been the target of criticism in safety science research and is not felt to be effective in the analysis of incidents in complex systems, such as healthcare. Research in accident analysis methods has developed from a focus on technical failure and individual human actions to consideration of the interactions between people, technology and the organisation. Accident analysis methods have been developed that guide investigations to consideration of the whole system and interactions between system components. These system approaches are judged to be superior to simple linear approaches by the research community, however, they are not currently used in healthcare incident investigation practice. The systems approach of STAMP is felt to be a promising method for the improvement of healthcare incident analysis. STAMP strongly embodies the concepts of systems theory and analyses human decision-making. The application of STAMP in healthcare was investigated through three case studies, which applied STAMP in: 1. The analysis of the large-scale organisational failure at Mid-Staffordshire NHS Trust between 2005-2009. 2. The analysis of a common small-scale hospital-based medication prescription error. 3. The analysis of patient suicide in the community-based services of a Mental Health Trust. The effectiveness of the STAMP applications was evaluated with feedback from healthcare stakeholders on the usability and utility of STAMP and discussion of the STAMP applications against criteria for accident analysis models and methods. Healthcare stakeholders were generally positive about the utility of STAMP, finding it to provide a system view and guide consideration of interactions between system components. They also felt it would help them generate recommendations and were positive about the future application of STAMP in healthcare. However, many felt it to be a complicated method that would need specialist expertise to apply. The STAMP applications demonstrated the ability of STAMP to consider the whole system and guide an analysis to the generation of recommendations for system measures to prevent future incidents. From the findings of the research, recommendations are made to improve STAMP and to assist future applications of STAMP in healthcare. The research also discusses the other factors that influence incident analysis beyond that of the analytical approach used and how these need to be considered to maximise the effectiveness of STAMP.

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Kyrkander, Sara. "Traceability of Single-Use Medical Devices through the Hospital Supply Chain. Reflections and Recommendations for Implementation of Single-Use Medical Devices Traceability." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279140.

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There is an increased need for complete medical device traceability in the healthcare industry. The two main reasons are the healthcare industry's global supply chain and decentralised adverse events reporting, where different laws apply for each country and where each country has their own database for incidents without international governance. The idea of improving traceability procedures in the surgical department at Karolinska University Hospital was formed in the light of a near miss event where guidelines regarding incident management of a Single-Use Medical Device (SUMD) were not followed properly. Hence, this thesis project will investigate the issue of finding an effective way to trace SUMDs at Karolinska University Hospital, in order to improve the incident management process and suggest improvements of patient safety at other Swedish hospitals as well. The collection of data consisted of different data sources; observations at the research site and interviews with relevant participants. By employing multiple sources to this study, a more holistic approach could be achieved. In addition to observing the current situation of device registration, it was of importance to ask individuals with competence and different perspectives on the issue of traceability of SUMDs. To answer the research questions, the acquired data was categorized into the different identified cornerstones of traceability of SUMDs. These were registration process, perioperative supply chain and incidents management. Each section was divided into an investigation of the current process, issues and suggested improvements, in order to clearly answer to the research questions. Furthermore, these acquired answers and insights, from observations and interviews, were translated and summarized to form a basis for the results. Based on the data acquisition and compilation from the different perspectives, key findings and themes are presented in the results. The thesis proposal include a visual representation that show the physical flow of a SUMD from the point of being delivered to the hospital by the distributor, through different entities where registration occur, until it is either discarded or saved for incidents reporting. In order to avoid many of the current issues and to realize the acquired suggestions from this thesis, interoperability between the systems within the healthcare organization as well as between the different entities throughout the entire supply chain is an essential part of the solution, which should be further studied.

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Meier, Jens. "Structured patient information management for efficient treatment and healthcare quality assurance in oncology." Doctoral thesis, Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-192590.

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Die Behandlung von Patienten mit Tumoren im Kopf-Hals-Bereich gestaltet sich als komplexer und herausfordernder Prozess sowohl für den Patienten als auch für die behandelnden Ärzte und Chirurgen. Zur Gewährleistung der bestmöglichen individuellen Therapie werden vor Beginn der Behandlung zahlreiche diagnostische Verfahren durchgeführt. Hierzu zählen unter anderem medizinische bildgebende Verfahren wie z.B. Computertomographie (CT) oder Magnetresonanztomographie (MRT) sowie die Entnahme von tumorverdächtigem Gewebe während einer Panendoskopie zur exakten Bestimmung der Tumorart (Histologie, Grading, TNM-Klassifikation nach UICC, genaue Lokalisation des Primärtumors, der lokoregionären Metastasen und ggf. Fernmetastasen). Die gewonnenen Informationen bilden anschließend die Grundlage für die Entscheidung über die durchzuführende Therapie und stehen in unterschiedlichen klinischen Informationssystemen sowie auf Papierakten zur Verfügung. Leider werden die Daten im klinischen Alltag häufig nur unstrukturiert und schwer auffindbar präsentiert, da die führenden Informationssysteme nur unzureichend in den klinischen Arbeitsprozess integriert und untereinander schlecht vernetzt sind. Die präzise und erschöpfende Darstellung der jeweiligen individuellen Situation und die darauf aufbauende Therapieentscheidung sind aber entscheidend für die Prognose des Patienten, da der erste, gut geplante \"Schuss\" entscheidend für den weiteren Verlauf ist und nicht mehr korrigiert werden kann. In dieser Arbeit werden neue Konzepte zur Verbesserung des Informationsmanagements im Bereich der Kopf-Hals-Tumorbehandlung entwickelt, als prototypische Software implementiert und im klinischen Alltag in verschiedenen Studien wissenschaftlich evaluiert. Die Erlangung eines tiefgreifenden Verständnisses über die klinischen Abläufe sowie über beteiligte Informationssysteme und Datenflüsse stellte den ersten Teil der Arbeit dar. Aufbauend auf den Erkenntnissen wurde ein klinisches Informationssystem oncoflow entwickelt. Oncoflow importiert vollautomatisch relevante Patientendaten von verschiedenen klinischen Informationssystemen, restrukturiert die Daten und unterstützt Ärzte und Chirurgen im gesamten Therapieprozess. Das System wurde anschließend in unterschiedlichen Studien evaluiert und der klinische Nutzen in Bezug auf effizientere Arbeitsabläufe und eine verbesserte Informationsqualität gezeigt. Im folgenden Teil der Arbeit wurden Machine Learning Methoden genutzt um von Daten in der elektronischen Patientenakte auf den aktuellen Prozessschritt im Therapieprozess zu schließen. Der letzte Teil der Arbeit zeigt Möglichkeiten zur Erweiterung des Systems zur Nutzung in weiteren klinischen Fachdisziplinen auf.

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Silva, Lúcia de Fátima Neves da. "Reorientação do gerenciamento de risco hospitalar do Instituto Nacional de Traumatologia e Ortopedia." reponame:Repositório Institucional da FIOCRUZ, 2009. https://www.arca.fiocruz.br/handle/icict/2351.

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Made available in DSpace on 2011-05-04T12:36:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2009
As instituições de saúde são organizações com um alto potencial de risco tanto para pacientes, quanto para profissionais de saúde. Nessas instituições ocorrem diversos tipos de risco, o que torna muito complexo o gerenciamento dos mesmos por uma única estrutura organizacional, que no caso das instituições de saúde do Brasil é a Gerência de Risco Sanitário. Os riscos são tratados nas instituições de saúde de forma isolada por diversas estruturas organizacionais, o que não permite uma avaliação e um tratamento sistêmico dos mesmos. Diante desse problema consideramos necessária a execução de um estudo de revisão da literatura sobre gerenciamento de risco hospitalar objetivando contribuir para a ampliação da abrangência das ações desenvolvidas na Gerência de Risco do Instituto Nacional de Traumatologia e Ortopedia. Com base no conhecimento adquirido através da revisão da literatura, formulamos uma proposta para criação de um Comitê de Risco no Instituto Nacional de Traumatologia e Ortopedia que terá como o objetivo fazer uma gestão integrada dos diversos tipos de risco encontrados na instituição, identificando-os e tratando-os de forma proativa, bem como propondo açõespara redução ou mitigação dos mesmos.
Health institutions are organizations with a high potential risk for patients and for health professionals. In these institutions occur different kinds of risk, which makes very complex to manage them by a single organization structure, which, in the case of health institutions in Brazil, is the Sanitary Risk Management. Risks are treated in health institutions in isolation by several organization structures, which does not allow an evaluation neither a systemic treatment of these. In face of this problem we consider necessary to implement a study to review the literature about hospital risk management aiming to contribute to expand the scope of the actions developed in Risk Management from the National Institute of Traumatology and Orthopedy. Based on knowledge acquired through literature review, we formulate a proposal for creation a Risk Committee in the National Institute of Traumatology and Orthopedy that will aim to make an integrated management of various types of risk found in the institution, identifying them and treating them proactively, and proposing actions to reduce or mitigate them.

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Pukk, Härenstam Karin. "Learning from patient injury claims : an assessment of the potential of patient injury claims to a safety information system in healthcare /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-153-1/.

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Brüggemann, Jelmer, Barbro Wijma, and Katarina Swahnberg. "Patients’ silence following healthcare staff’s ethical transgressions." Linköpings universitet, Genus och medicin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-77147.

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The aim of this study was to examine to what extent patients remained silent to the health care system after they experienced abusive or wrongful incidents in health care. Female patients visiting a women’s clinic in Sweden (n = 530) answered the Transgressions of Ethical Principles in Health Care Questionnaire (TEP), which was constructed to measure patients’ abusive experiences in the form of staff’s transgressions of ethical principles in health care. Of all the patients, 63.6% had, at some point, experienced staff’s transgressions of ethical principles, and many perceived these events as abusive and wrongful. Of these patients, 70.3% had remained silent to the health care system about at least one transgression. This silence is a loss of essential feedback for the health care system and should not automatically be interpreted as though patients are satisfied.

funding agencies|Nordic Council of Ministers||Swedish Research Council|2009-2380|

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39

Choi, Young-Seon. "The physical environment and patient safety: an investigation of physical environmental factors associated with patient falls." Diss., Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/45974.

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Patient falls are the most commonly reported "adverse events" in hospitals, according to studies conducted in the U.S. and elsewhere. The rate of falls is not high (2.3 to 7 falls per 1,000 patient days), but about a third of falls result in injuries or even death, and these preventable events drive up the cost of healthcare and, clearly, are harmful outcomes for the patients involved. This study of a private hospital, Dublin Methodist Hospital, in Dublin, Ohio analyzes data about patient falls and the facility's floor plans and design features and makes direct connections between hospital design and patient falls. This particular hospital, which was relatively recently constructed, offered particular advantages in investigating unit-layout-related environmental factors because of the very uniform configuration of its rooms, which greatly narrowed down the variables under study. This thesis investigated data about patients who had suffered falls as well as patients with similar characteristics (e.g., age, gender, and diagnosis) who did not suffer falls. This case-control study design helps limit differences between patients. Then patient data was correlated to the location of the fall and environmental characteristics of the locations, analyzed in terms of their layout and floor plan. A key part of this analysis was the development of tools to measure the visibility of the patient's head and body to nurses, the relative accessibility of the patient, the distance from the patient's room to the medication area, and the location of the bathroom in patient rooms (many falls apparently occur during travel to and from these areas). From the analysis of all this data there emerged a snapshot of the specific rooms in the hospital being analyzed where there was an elevated risk of a patient falling. While this finding is useful for the administrators of that particular facility, the study also developed a number of generally applicable conclusions. The most striking conclusion was that, for a number of reasons, patients whose heads were not visible from caregivers working from their seats in nurses' stations and/or from corridors had a higher risk of falling, in part because staff were unable to intervene in situations where a fall appeared likely to occur. This was also the case with accessibility; patients less accessible within a unit had a higher risk of falling. The implications for hospital design are clear: design inpatient floors to maximize a visible access to patients (especially their heads) from seats in nurses' stations and corridors.

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Bien, Elizabeth A. "Occupational Exposure Assessment of Home Healthcare Workers: Development, Content Validity, and Piloting the Use of an Observation Tool." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin159584568462432.

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Kreckler, Simon Michael. "Improving patient safety on a surgical ward using a quality improvement approach." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610295.

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Kahn, Julie. "Biomechanics of Patient Handling Slings Associated with Spinal Cord Injuries." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4702.

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Pressure ulcers and related skin integrity threats are a significant problem in current transfer/transport systems used for spinal cord injury patients. To understand this problem twenty-three different slings with varying type, material, and features were analyzed in hopes to identify at-risk areas for skin integrity threats such as pressure ulcers. Population samples included non-disabled (otherwise referred to as "healthy") volunteers as well as SCI patients from the James A. Haley Veterans Hospital. High resolution pressure interface mapping was utilized to directly measure the interface pressures between the patient and sling interface. Overall results provide relevant feedback on the systems used and to suggest a particular type of sling that might reduce and possibly minimize skin integrity threats as well as extend safe patient handling guidelines with sling use. It was found that the highest interface pressures convened along the seams of the sling, regardless of manufacturer or type.

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ALORBI, GENEVIEVE AKU. "ESSAYS ON HOSPITAL REIMBURSEMENT AND QUALITY OF HEALTHCARE PROVISION." OpenSIUC, 2017. https://opensiuc.lib.siu.edu/dissertations/1333.

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This dissertation seeks to investigate how hospital reimbursement policy affects the quality of care provided to patients when providers compete for healthcare labor that is limited in supply. Cost payment systems fully reimburse a provider’s the total cost of healthcare provided, fixed reimbursements are predetermined at a fixed amount and mixed reimbursements have a cost and fixed component. The first chapter investigates how government reimbursement schemes that induce quality competition among health providers affects the choice of quality of care provided to patients and how these choices depend on the labor supply constraints in the healthcare labor market. We build a theoretical model that explicitly incorporates the healthcare labor supply into a framework of a hospital cournot competition, to show how a hospitals' choice of quality of patient care will be directly influenced when there is a shortage of health personnel in a regulated reimbursement system. We find that multiple equilibria can arise in healthcare markets depending on the consumers’ sensitivity to quality and hospitals’ share of cost when investing in quality. Contrary to existing findings, we are able to show that the effects of reimbursement schemes can vary in different equilibria and in different labor market situations. For instance, in high patient quality sensitivity hospital markets under a high hospital quality equilibrium, we can show that a cost payment scheme decreases a provider’s quality of care while a fixed reimbursement scheme increases quality. More importantly we find that the labor market constraint increases or decreases the effect of the reimbursement system on quality of care. Consequently, the labor constraint changes the quality choice of the provider as compared to the quality level that would have been induced by a particular reimbursement’s policy incentive for quality. In the second chapter, we carry out some of the testable implications of the theoretical finding from the first chapter. This paper investigates how higher Medicare payments brought about by geographical reclassification affects a provider’s quality of care as captured by registered nurses (RN) and licensed practical nurses (LPN) staffing, as well as patient outcomes (mortality, urinary tract infections, pneumonia, peptic ulcer deep vein thrombosis) and length of stay when hospitals compete for nurses. In contrast with past literature, we specifically allow for asymmetry in the hospital’s choice of quality, by permitting coefficients to differ across reclassified hospitals in response to the higher Medicare payments. This asymmetry is based on the relativity of the labor cost faced by the hospital due to competition for nurses in the healthcare labor market. Using Healthcare Cost and Utilization Project (HCUP) and the Center for Medicare and Medicaid (CMS) data from the period 2001 to 2011, we find that hospitals who face relatively higher labor costs will post reclassification increase their RN to LPN staffing ratio as compared to hospitals in their post geographical reclassification areas. A higher RN staffing by these hospitals will result in an improvement of quality of care as the incidence of patient complications due to Pneumonia, Peptic Ulcer and Deep Vein Thrombosis reduces for hospitals that were reclassified after allowing for asymmetry in response to the higher Medicare payment due to differences in labor costs (Pneumonia and Peptic Ulcer complications improve as compared to pre re-class area hospitals and DVT in both pre/post re-class area hospitals). Length of stay also increases for hospitals that faced a higher labor cost while mortality and UTI complications remain unchanged post reclassification. Finally, in the third chapter, we examine how the for profit (FP) or not for profit (NFP) status of hospitals impact the choice of nurse staffing and patient outcomes when there is an increase in provider reimbursement due geographical reclassification. Most of the past studies focus on mortality and length of stay in FPs and NFPs, we extend these studies by investigating the impact of geographical reclassification on patient outcomes that have been established as outcomes sensitive to nursing care. From our regression results, with reference to the ratio of RN to LPN staffing, we find evidence that an increase in Medicare payments will have a greater impact in FPs than in NFPs as compared to their pre re-class geographical area control hospitals. We also find that in hospitals that face a relatively higher labor cost as compared to their controls; (1) There is no difference in the impact of reclassification between FPs and NFPs (2) There is a better response from FPs than NFPs to geographical reclassification when the outcome considered is DVT as evidenced by a decreases in cases of DVT (3) NFPs decrease length of stay whiles FPs increase length of stay as compared to their post re-class geographical area hospitals.

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Urban, Rachel L. "Medicines Reconciliation: Roles and Process. An examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/7288.

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Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture.

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Devkaran, Subashnie. "International healthcare accreditation : an analysis of clinical quality and patient experience in the UAE." Thesis, Heriot-Watt University, 2014. http://hdl.handle.net/10399/2796.

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A mixed method research design was used to answer the question; ‘does accreditation have an impact on hospital quality, clinical measures and patient experience?’ The thesis contains three study components: 1) A case study determining the predictors of patient experience; 2) a cross-sectional study examining the relationship of hospital accreditation and patient experience and 3) A four year time series analysis of the impact of accreditation on hospital quality using 27 quality measures. A case study analysis of patient experience, using a piloted, validated and reliable survey tool, was conducted in Al Noor Hospital. The survey was administered via face-to-face interviews to 391 patients. Patient demographic variables, stay characteristics and patient experience constructs were tested against five patient experience outcome measures using regression analysis. The predictors of positive patient experience were the patient demographics (age, nationality, and health status), hospital stay characteristics (length of stay and hospital treatment outcome) and patient experience constructs (care from nurses, care from doctors, cleanliness, pain management and quality of food). Recommendations were made on how hospital managers can improve patient experience using these modifiable factors. The cross-sectional study found that accredited hospitals had significantly higher inpatient experience scores than non-accredited hospitals. The hospital level variables, other than patient volume, had no correlations with patient experience. The interrupted time series analysis demonstrated that although accreditation improved the quality performance of the hospital with a residual benefit of 20 percentage points above the baseline level, this improvement was not sustained over the 3-year accreditation cycle. The accreditation life cycle theory was developed as an explanatory framework for the pattern of performance during the accreditation cycle. This theory was consequently supported by empirical evidence. Recommendations were made for improvement of the accreditation process. The Life Cycle Model and time series analysis were proposed as strategic tools for healthcare managers to recognise and prevent the negative trends of the accreditation life cycle in order to sustain improvements gained from accreditation. The findings of the three research components were triangulated to form a theory on the impact of accreditation on clinical quality measures and patient experience. This thesis is important from a research perspective, as healthcare accreditation, although commonly used to improve quality, is still under researched and under theorised. This is the first investigation of accreditation to use interrupted time series analysis, the first analysis on patient experience and hospital accreditation and also the first study on patient experience in the Middle East. Thus it adds to the evidence base of accreditation and patient experience but also has policy and management implications.

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Urban, Rachel Louise. "Medicines reconciliation : roles and process : an examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/7288.

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Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture.

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Willis, Cameron David. "Measuring quality outcomes in patient care: the example of trauma services." Monash University. Faculty of Medicine, Nursing and Health Sciences. Department of Epidemiology and Preventive Medicine, 2008. http://arrow.monash.edu.au/hdl/1959.1/62206.

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As healthcare and health systems become increasingly complex, expectations of what constitutes high quality care continue to evolve. Stakeholders now require contemporary and meaningful measures of system performance. As such, valid healthcare quality metrics are rapidly becoming essential for those providing and receiving healthcare to assess performance and motivate change. This thesis investigates the utility of quality indicators in trauma care. Multiple in-hospital indicators have been promulgated by various bodies for assessing quality of trauma care. The properties of ideal indicators have been widely documented however few published data have reported these properties for many trauma measures. The emphasis on trauma process measures (eg. time to interventions) highlights the need for indicators with known links to patient outcomes. This process-outcome link may be viewed as a measure of an indicator’s construct validity. As this property is unknown for many trauma indicators, this thesis focuses on the construct validity of a number of routinely utilised trauma indicators. In this thesis, the available in-hospital indicators proposed by The American College of Surgeons Committee on Trauma and additional indicators used in the Victorian State Trauma System were investigated for their relationships with patient outcomes. A small number of indicators were found to have statistically significant relationships with patient outcomes, however many indicators demonstrated counter-intuitive relationships, whereby high quality care was linked with poorer patient outcomes. These results suggested that links between indicators and outcomes may not be best measured using individual indicators for individual patients. Rather, a strategy for measuring patient outcomes at the hospital level may be needed. To combine multiple indicators into a single measure of hospital level performance, a number of composite methods were explored using two trauma registries. Three composite weighting schemes were employed. As composite measures are often used for provider ranking or benchmarking, the stability of hospital ranks between providers and over time was investigated. The composites were found to have moderate to strong correlations (0.76-0.99) however variability in composite hospital rankings existed, particularly for middle ranking facilities. The construct validity of each available indicator and composite score was investigated through the relationship with hospital level risk-adjusted mortality using Poisson regression models, risk adjusting for expected deaths using the TRISS formulation. Each composite measure demonstrated a significant association with mortality, with the mortality decrease across the middle 50% of each composite score ranging from 12.06% – 16.13%. These findings suggest that complex measures such as trauma composite indices may be better able to measure the interactions between processes within complex systems that influence quality of care. This thesis adds valuable insight into the use of indicators for assessing quality of care in trauma systems. The combination of individual indicators into composite forms appears to strengthen the construct validity of these measures. By demonstrating the process-outcome link for trauma composite indices, this thesis has identified a means of utilising process measures to assess hospital level performance that may become important for future public reporting and hospital funding schemes.

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Parand, Anam. "The role of acute care managers in quality of care and patient safety." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/11677.

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Healthcare managers have a responsibility for the standard of their services and patient care delivered. Their work is thought to be essential in achieving and improving high quality care and patient safety. However, little is empirically known about their role in this. This thesis investigates acute care managerial work and impact in the context of quality of care and patient safety. It draws upon power and work-activity group theories and literature from other industries to guide investigation and elucidate findings. The introductory Chapters (Chapters 1-3) provide the background context of quality of care and patient safety, relevant management theory, and literature on the role of acute care managers in quality and safety. A systematic literature review in Chapter 4 illustrates a case for empirical research on this topic and suggests areas for further investigation. Chapters 5 and 6 report a case study investigation of the senior manager’s dimensions of involvement in a quality and safety improvement collaborative. These Chapters present self-reports of 17 Chief Executive Officers and 18 Medical Directors across 20 NHS hospitals on their actions and contributions to the UK Safer Patients Initiative (SPI). From this, a model of five principle dimensions of involvement emerged. Corroborating this model, Chapter 7 reports the staff perspective of their senior managements’ role in SPI, comprising interviews with 36 staff also involved in the SPI programme across the 20 hospitals. To explore the work of the acute care middle manager in quality and patient safety, 36 interviews with general managers, service and divisional managers across two NHS Trusts and two specialities reveal their relevant training/learning, demands, choices and constraints (Chapter 8). This informed two follow up surveys that further quantified the interview findings and explored theoretical power and role constructs. The first survey presents the views of 100 middle managers from 10 NHS Trusts on their quality and safety-related time, learning, activities, power and impact (Chapter 9). The second survey reports 60 clinical staff views on the same items, illustrating some divergence on critical constructs (Chapter 10). The thesis closes with a final Chapter (Chapter 11) comprising a summary of the key findings per Chapter and the overarching themes from the thesis. Methodological limitations/strengths, wider implications for managers and policy makers, and future research are considered. The Chapter ends with concluding remarks on the critical work performed by acute care managers across organisational levels for the daily preservation of quality and patient safety and its improvement.

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Ford, Paul Leslie. "Patient Care Provider Safety: Examining one intervention to reduce hospital violence." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4042.

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Abstract In the summer of 2009, Tampa General care providers met with Hospital Administration to express concern that violence on care units was a growing problem and making it difficult to provide quality care. Nurses stated that such violence was one important reason many of their peers choose to retire. Administration took this situation seriously and formed a committee to gather information and submit suggestions to reduce the violence. The committee consisted of representatives from several nursing units, human resources, risk management, security, and administration. Duties assigned included investigation of the actual number of reports on all units and trends. The committee was also charged with the production of a report regarding reviewing other hospital data, literature review, and developing recommendations. Internal reports indicated that the total prevalence of reported violence as well as the incidence per patient had increased annually since 2005. The hospital reports contradicted the national literature regarding the emergency department (ED) and psychiatric unit (Psych) being the two hospital units with the highest number of violent events. One possible reason for the difference is that these departments require all care providers to attend de-escalation and self-defense classes annually. Based on these findings, the researcher developed and adapted training similar to that of the ED for other units reporting aggressive, abusive, and violent patients. The committee approved a draft plan for implementation. Following presentation to Nursing Administration, some modifications were made, and the Internal Review Boards of the hospital and University of South Florida (USF) approved the project. The hypothesis tested in this study was whether training in de-escalation and self-defense modifies providers' behaviors to prevent or reduce aggressive, abusive, or violent behavior by patients and visitors. The independent variable was training. The dependent variable was requests for assistance with unruly, angry, or violent patients or visitors. Event reports of the year prior were used for historical comparison. Event reports for the experimental period were assembled subsequent to the training for comparison. Nursing Administration selected two units to receive the training intervention. The two units selected were neither the worst nor the best in numbers, but rather the middle. Nursing required that all training be scheduled in normal department meetings and that Nurse Managers of the units agree to participate. The research design presumed that at least 85% of care providers on a unit would attend the training. Schedules were developed to accommodate all care providers. The training was presented during June of 2010. Experimental and comparison units were monitored each month for the number of reported violent events (Code Grays) on each unit. During the fourth months of monitoring, there was a data spike in the Cardiac Care unit. No action was taken until another spike occurred during the sixth month. It was determined that an error had occurred that partially invalidated the data from the Cardiac Care unit: the 85% participation rate among staff had not been reached. Monitoring continued for 12 months after the training. The Eldercare unit showed reduced requests for assistance. Overall, the Cardiac Care unit increased requests for assistance from the year before. Results were adjusted for patient census. Wilcoxon Signed Ranks Testing was performed and displayed using box plots to show how far the median changed during the research from one group to the next. The analysis compared prior year with the year following the interventions, and indicated that there was a movement toward a reduction of Code Grays. To determine if there was a difference between comparison units and experimental units 12 months after the training, Poisson Regression Analysis was utilized. When the comparison units were set as the reference, Poisson analysis indicated the events were decreasing on both units. The Cardiac Care unit did not have a statistically significant p value. The Eldercare unit had a p value of .019. In conclusion, the results are mixed and statistically inconclusive. From the care providers' perspective, any reduction in violence is significant. The data regarding the training interventions indicates that there was an empirical, albeit not a statistically significant, change in Code Gray reports. Training may have reduced the violence on the Eldercare unit by nearly half.

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Gustafsson, Maria. "Patient experience surrounding service failure in Swedish public healthcare: a qualitative study of patient perceptions." Thesis, Internationella Handelshögskolan, Högskolan i Jönköping, IHH, Företagsekonomi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-45198.

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Background: Swedish healthcare is frequently claimed to be top class. A view not only communicated by politicians and the media, but also shared by an average citizen - for decades. Certain statistical indicators seem to support this: Sweden historically scores very high in life expectancy, stroke and cancer survival and infant mortality. At the same time, it is being reported that Swedish healthcare is suffering from a number of problems. While statistics looks reassuring, it focuses on results rather than processes, and does not take patient perceptions into account. Patient perspective seems to be somewhat overlooked in general in favour of more operations-focused research. Purpose: The purpose of this study is to address the shortage of relevant literature and describe patient experience surrounding service failure in the fairly unique institutional context of Swedish public healthcare. Patient experience will include patient perceptions on service failure and recovery, as well as patient expectations and post-failure responses. Method: The study employed a qualitative approach with 13 semi-structured interviews. Conclusion: The study located reasons for service failure, which are fairly consistent with both previous research on this matter and the reported struggles of Swedish healthcare. It was also found that service recovery is not a common occurrence. Determinants for patient expectations and variability in patient post-failure responses were also uncovered.

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Dissertations / Theses on the topic 'Patient safety and quality in healthcare'

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