The role of chief executive officers in a quality improvement initiative: a qualitative study

Objectives: To identify the critical dimensions of hospital Chief Executive Officers’ (CEOs) involvement in a quality and safety initiative and to offer practical guidance to assist CEOs to fulfil their leadership role in quality improvement (QI). Design: Qualitative interview study. Setting: 20 organisations participating in the main phase of the Safer Patients Initiative (SPI) programme across the UK. Participants: 17 CEOs overseeing 19 organisations participating in the main phase of the SPI programme and 36 staff (20 workstream leads, 10 coordinators and 6 managers) involved in SPI across all 20 participating organisations. Main outcome measure: Self-reported perceptions of CEOs on their contribution and involvement within the SPI programme, supplemented by staff peer-reports. Results: The CEOs recognised the importance of their part in the SPI programme and gave detailed accounts of the perceived value that their involvement had brought at all stages of the process. In exploring the parts played by the CEOs, five dimensions were identified: (1) resource provision; (2) staff motivation and engagement; (3) commitment and support; (4) monitoring progress and (5) embedding programme elements. Staff reports confirmed these dimensions; however, the weighting of the dimensions differed. The findings stress the importance of particular actions of support and monitoring such as constant communication through leadership walk rounds and reviewing programme progress and its related clinical outcomes at Board meetings. Conclusions: This study addressed the call for more research-informed practical guidance on the role of senior management in QI initiatives. The findings show that the CEOs provided key participation considered to significantly contribute towards the SPI programme. CEOs and staff identified a number of clear and consistent themes essential to organisation safety improvement. Queries raised include the tangible benefits of executive involvement in changing structures and embedding for sustainability and the practical steps to creating the ‘right’ environment for QI

The Role of Acute Care Managers in Quality of Care and Patient Safety

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.Open Acces

Aviation and healthcare:a comparative review with implications for patient safety

Safety in aviation has often been compared with safety in healthcare. Following a recent article in this journal, the UK government set up an Independent Patient Safety Investigation Service, to emulate a similar well-established body in aviation. On the basis of a detailed review of relevant publications that examine patient safety in the context of aviation practice, we have drawn up a table of comparative features and a conceptual framework for patient safety. Convergence and divergence of safety-related behaviours across aviation and healthcare were derived and documented. Key safety-related domains that emerged included Checklists, Training, Crew Resource Management, Sterile Cockpit, Investigation and Reporting of Incidents and Organisational Culture. We conclude that whilst healthcare has much to learn from aviation in certain key domains, the transfer of lessons from aviation to healthcare needs to be nuanced, with the specific characteristics and needs of healthcare borne in mind. On the basis of this review, it is recommended that healthcare should emulate aviation in its resourcing of staff who specialise in human factors and related psychological aspects of patient safety and staff wellbeing. Professional and post-qualification staff training could specifically include Cognitive Bias Avoidance Training, as this appears to play a key part in many errors relating to patient safety and staff wellbeing.</p

The role of chief executive officers in a quality improvement initiative: a qualitative study

Objectives: To identify the critical dimensions of hospital Chief Executive Officers’ (CEOs) involvement in a quality and safety initiative and to offer practical guidance to assist CEOs to fulfil their leadership role in quality improvement (QI). Design: Qualitative interview study. Setting: 20 organisations participating in the main phase of the Safer Patients Initiative (SPI) programme across the UK. Participants: 17 CEOs overseeing 19 organisations participating in the main phase of the SPI programme and 36 staff (20 workstream leads, 10 coordinators and 6 managers) involved in SPI across all 20 participating organisations. Main outcome measure: Self-reported perceptions of CEOs on their contribution and involvement within the SPI programme, supplemented by staff peer-reports. Results: The CEOs recognised the importance of their part in the SPI programme and gave detailed accounts of the perceived value that their involvement had brought at all stages of the process. In exploring the parts played by the CEOs, five dimensions were identified: (1) resource provision; (2) staff motivation and engagement; (3) commitment and support; (4) monitoring progress and (5) embedding programme elements. Staff reports confirmed these dimensions; however, the weighting of the dimensions differed. The findings stress the importance of particular actions of support and monitoring such as constant communication through leadership walk rounds and reviewing programme progress and its related clinical outcomes at Board meetings. Conclusions: This study addressed the call for more research-informed practical guidance on the role of senior management in QI initiatives. The findings show that the CEOs provided key participation considered to significantly contribute towards the SPI programme. CEOs and staff identified a number of clear and consistent themes essential to organisation safety improvement. Queries raised include the tangible benefits of executive involvement in changing structures and embedding for sustainability and the practical steps to creating the ‘right’ environment for QI

Expanding Healthcare Failure Mode and Effect Analysis:a composite proactive risk analysis approach

Healthcare Failure Mode and Effect Analysis (HFMEA) is a systematic risk assessment method derived from high risk industries to prospectively examine complex healthcare processes. Like most methods, HFMEA has strengths and weaknesses. In this paper we provide a review of HFMEA's limitations and we introduce an expanded version of traditional HFMEA, with the addition of two safety management techniques: Systematic Human Error Reduction and Prediction Analysis (SHERPA) and Systems-Theoretic Accident Model and Processes – Systems-Theoretic Process Analysis (STAMP-STPA). The combination of the three methodologies addresses significant HFMEA limitations. To test the viability of the proposed hybrid technique, we applied it to assess the potential failures in the process of administration of medication in the home setting. Our findings suggest that it is both a viable and effective tool to supplement the analysis of failures and their causes. We also found that the hybrid technique was effective in identifying corrective actions to address human errors and detecting failures of the constraints necessary to maintain safety

A prospective risk assessment of informal carers’ medication administration errors within the domiciliary setting

Increasingly, medication is being administered at home by family and friends of the care-recipient. This study aims to identify and analyse risks associated with potential drug administration errors made by informal carers at home. We mapped medication administration at home with a multidisciplinary team that included carers, healthcare professionals and patients. Evidence-based risk-analysis methodologies were applied: Healthcare Failure Modes and Effect Analysis (HFMEA), Systematic Human Error Reduction and Prediction Analysis (SHERPA) and Systems-Theoretic Accident Model and Processes (STAMP). The process of administration comprises seven sub-processes. Thirty four possible failure modes were identified and six of these were rated as high risk. These highlighted that medications may be given with a wrong dose, stored incorrectly, not discontinued as instructed, not recorded, or not ordered on time, and often caused by communication and support problems. Combined risk analyses contributed unique information helpful to better understand the medication administration risks and causes within homecare