BMJ quality & safety
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BMJ quality & safety · Jul 2013
Comparative StudyStaff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England.
There is some evidence to suggest that higher job satisfaction among healthcare staff in specific settings may be linked to improved patient outcomes. This study aimed to assess the potential of staff satisfaction to be used as an indicator of institutional performance across all acute National Health Service (NHS) hospitals in England. ⋯ In the context of the continued debate about the relationship of HSMR to hospital performance, these findings of a weak correlation between staff satisfaction and HSMR are intriguing and warrant further investigation. Such measures in the future have the advantage of being intuitive for lay and specialist audiences alike, and may be useful in facilitating patient choice. Whether higher staff satisfaction drives quality or merely reflects it remains unclear.
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Tools that proactively identify factors that contribute to accidents have been developed within high-risk industries. Although patients provide feedback on their experience of care in hospitals, there is no existing measure which asks patients to comment on the factors that contribute to patient safety incidents. The aim of the current study was to determine those contributory factors from the Yorkshire Contributory Factors Framework (YCFF) that patients are able to identify in a hospital setting and to use this information to develop a patient measure of safety (PMOS). ⋯ Patients are able to identify factors which contribute to the safety of their care. The PMOS provides a way of systematically assessing these and has the potential to help health professionals and healthcare organisations understand and identify, safety concerns from the patients' perspective, and, in doing so, make appropriate service improvements.
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BMJ quality & safety · Jul 2013
Comparative StudyOn higher ground: ethical reasoning and its relationship with error disclosure.
There is broad consensus that disclosure of harmful medical errors is vital to improve safety and is ethically required. Although most physicians-in-training are taught ethics, there have been no empirical studies on whether ethical reasoning is related to disclosure. We examined whether scores on a test of ethical reasoning were associated with greater willingness to disclose errors. ⋯ Ethical reasoning scores were associated with acknowledging an error, providing more detailed explanations and taking personal responsibility. The low response rate may limit generalisability. Nevertheless, taken together with prior studies showing that ethical reasoning can be taught and measured, our findings suggest that ethical training may help to improve disclosure of medical errors.
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BMJ quality & safety · Jul 2013
TeamGAINS: a tool for structured debriefings for simulation-based team trainings.
Improving patient safety by training teams to successfully manage emergencies is a major concern in healthcare. Most current trainings use simulation of emergency situations to practice and reflect on relevant clinical and behavioural skills. We developed TeamGAINS, a hybrid, structured debriefing tool for simulation-based team trainings in healthcare that integrates three different debriefing approaches: guided team self-correction, advocacy-inquiry and systemic-constructivist techniques. ⋯ The results indicate that TeamGAINS could provide a useful debriefing tool for training anaesthesia staff on all levels of work experience. By combining state-of-the-art debriefing methods and integrating systemic-constructivist techniques, TeamGAINS has the potential to allow for a surfacing, reflecting on and changing of the dynamics of team interactions. Further research is necessary to systematically compare the effects of TeamGAINS' components on the debriefing itself and on trainees' changes in attitudes and behaviours.