BMJ quality & safety
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BMJ quality & safety · Jan 2020
ReviewManaging risk in hazardous conditions: improvisation is not enough.
To improve overall safety and reduce harm, focus should be on reducing risk instead of eliminating harm.
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BMJ quality & safety · Sep 2019
Randomized Controlled Trial Multicenter StudyExposure to incivility hinders clinical performance in a simulated operative crisis.
Incivil behaviour by surgeons in a simulated operating room crisis undermines anaesthesia trainee performance across all domains.
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BMJ quality & safety · Dec 2020
ReviewAssociations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis.
Performance in the operating room is an important determinant of surgical safety. Flow disruptions (FDs) represent system-related performance problems that affect the efficiency of the surgical team and have been associated with a risk to patient safety. Despite the growing evidence base on FDs, a systematic synthesis has not yet been published. ⋯ Apart from the identified relationship of FDs with procedure duration, the evidence base concerning the impact of FDs on provider, surgical process and patient outcomes is limited and heterogeneous. We further provide recommendations concerning use of methods, relevant outcomes and avenues for future research on associated effects of FDs in surgery.
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BMJ quality & safety · Jan 2022
Improving the quality of self-management support in ambulatory cancer care: a mixed-method study of organisational and clinician readiness, barriers and enablers for tailoring of implementation strategies to multisites.
Improving the quality of self-management support (SMS) for treatment-related toxicities is a priority in cancer care. Successful implementation of SMS programmes depends on tailoring implementation strategies to organisational readiness factors and barriers/enablers, however, a systematic process for this is lacking. In this formative phase of our implementation-effectiveness trial, Self-Management and Activation to Reduce Treatment-Related Toxicities, we evaluated readiness based on constructs in the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT) and developed a process for mapping implementation strategies to local contexts. ⋯ The CFIR and CFIR-ERIC were valuable tools for tailoring SMS implementation to readiness and barriers/enablers, whereas NPT helped to clarify the clinical work of implementation. Our approach to tailoring of implementation strategies may have relevance for other studies.
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BMJ quality & safety · Oct 2021
Publication of inspection frameworks: a qualitative study exploring the impact on quality improvement and regulation in three healthcare settings.
The Dutch healthcare inspectorate publishes its inspection frameworks to inform both the public and healthcare providers about regulatory procedures and in the hope that publication will motivate healthcare providers to improve quality and comply with standards. This study explores the consequences of publishing these frameworks for the regulation of quality and safety in healthcare. ⋯ Publication of inspection frameworks might result in quality improvement work, and in particular contexts could be used as a regulatory strategy to target quality improvement in a healthcare sector. For this, it is important that regulators consider the capabilities and possibilities for learning and improving within a sector.