[No SPF Record] [IMPROVEDX] Culture

Tom Benzoni benzonit at GMAIL.COM
Mon Jun 11 20:41:43 UTC 2018


I wonder if the data is useful; I'm recalling Ioannidis' work; see PubMed
notations inter-located with citations.

I have worked in organizations that were extremely unsafe; so unsafe the
employees dared not say they were unsafe. I think indirect measurements are
going to be more useful.

Separate questions, takes solely from my observations (ER):

"Are you encouraged to pick up new patients until the end of your shift?"

"Are you told it is OK to turn over/hand off patients?"

"Are you an "exempt" employee?"

"As an exempt employee, do you have a regular schedule (an assigned
begin/end time and date)?"

"Do you "go off the clock" (cease to be paid) at the end of your assigned
time?"

"Are you expected to finish work after you are "off the clock?"

I assume the members of this group understand what the underlying question
is to each of the above.
Hint: you can see parallels into the burnout issue here.
This brings the questions full circle to errors; increasing burnout
increases errors.

tom





On Mon, Jun 11, 2018 at 1:32 PM Rory Jaffe <rjaffe at chpso.org> wrote:

> Here’s a few references on the relationship between culture and outcomes.
> Note this is a random selection and not a review of the literature.
>
>
>
> Farup PG. Are measurements of patient safety culture and adverse events
> valid and reliable? Results from a cross sectional study. *BMC Health
> Serv Res*. 2015;15:186. doi:10.1186/s12913-015-0852-x.
>
>
>
*Result: "There was an inverse association between the patient safety
culture and adverse events. Until the criterion validity of the tools for
measuring patient safety culture and tracking of adverse events have been
further evaluated, measurement of patient safety culture could not be used
as a proxy for the "true" safety." (PubMed)*

> "
>


> Fan CJ, Pawlik TM, Daniels T, et al. Association of Safety Culture with
> Surgical Site Infection Outcomes. *J Am Coll Surg*. 2016;222(2):122-128.
> doi:10.1016/j.jamcollsurg.2015.11.008.
>

*Result: Safety culture may decrease surgical site infections (12
indicators, "7 hospitals...with a mean survey response rate of 43%. The SSI
rates ranged from 0% to 30%, and surgical unit safety culture scores ranged
from 16 to 92 on a scale of 0 to 100."*


>
>
> Huang DT, Clermont G, Kong L, et al. Intensive care unit safety culture
> and outcomes: a US multicenter study. *Int J Qual Health Care*.
> 2010;22(3):151-161. doi:10.1093/intqhc/mzq017.
>
Mismatched reference; analysis on first article cited.

*Results: (pasted from PubMed) We achieved a 47.9% response (2103 of 4373
ICU personnel). Culture scores were mostly low to moderate and varied
across ICUs (range: 13-88, percent-positive scores). After adjustment for
patient, hospital and ICU characteristics, for every 10% decrease in ICU
perceptions of management percent-positive score, the odds ratio for
hospital mortality was 1.24 (95% CI: 1.07-1.44; P = 0.005). For every 10%
decrease in ICU safety climate percent-positive score, LOS increased 15%
(95% CI: 1-30%; P = 0.03). Sensitivity analyses for non-response bias
consistently associated safety climate with outcome, but also yielded some
counterintuitive results."*


>
> Mardon RE, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring relationships
> between hospital patient safety culture and adverse events. *J Patient
> Saf*. 2010;6(4):226-232. doi:10.1097/PTS.0b013e3181fd1a00.
>

*Result pasted from PubMed: "Nearly all of the relationships tested were in
the expected direction (negative), and 7 (47%) of the 15 relationships were
statistically significant. All significant relationships were of moderate
size, with standardized regression coefficients ranging from -0.15 to
-0.41, indicating that hospitals with a more positive patient safety
culture scores had lower rates of in-hospital complications or adverse
events as measured by PSIs."*


>
>
> Chang Y, Mark B. Effects of learning climate and registered nurse staffing
> on medication errors. *Nurs Res*. 2011;60(1):32-39.
> doi:10.1097/NNR.0b013e3181ff73cc.
>

*Result pasted from PubMed: "A significant negative relationship was found
between learning climate and medication errors. It also moderated the
relationship between nurse mix and medication errors: When learning climate
was negative, having more registered nurses was associated with fewer
medication errors. However, no relationship was found between nurse mix and
medication errors at either positive or average levels of learning climate.
Learning climate did not moderate the relationship between work dynamics
and medication errors." *


>
>
> Weaver SJ, Lubomksi LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM. Promoting
> a culture of safety as a patient safety strategy: a systematic review. *Ann
> Intern Med*. 2013;158(5 Pt 2):369-374.
> doi:10.7326/0003-4819-158-5-201303051-00002.
>

*Snips from Discussion, para3: "...clear limitations must be considered.
Only studies in acute care settings using established survey measures were
included. ...qualitative studies of safety culture...were outside the scope
of this review. ...results may not generalize beyond inpatient settings.
Relevant studies may also have been inadvertently excluded despite
extensive searches. Publication bias and selective reporting of positive
findings also may limit conclusions... ...traditional criteria for
evaluating the effectiveness of clinical interventions for individual
patients are not well-suited to assessing the effectiveness of
quasi-experimental study designs conducted at the unit level of analysis.
This may have introduced systematic bias...*



>
> Rory
>
>
>
>
>
> *From:* ROBERT M BELL <
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
> *Sent:* Saturday, June 09, 2018 3:51 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [No SPF Record] [IMPROVEDX] Culture
>
>
>
> Dear all,
>
>
>
> Over the years I have often thought that a *Good Culture* in a hospital,
> medical facility reduced errors.
>
>
>
> I did a google search and there are significant posts suggesting that a
>  good culture reduces errors. However, I have no idea what is the
> scientific evidence for this.
>
>
>
> I assumed it was accurate and came up with my own list, gathered from many
> sources, of words/phrases of what kind of hospital, if given the chance, I
> would like to work in and/or be a patient.
>
>
>
> excellent standards, compassion,
>
> flexibility, compromise, transparency,
>
> courtesy, kindness, fairness, time-related goals,
>
> conflict resolution procedures, encourages creativity,
>
> good feedback mechanisms, defined mission and goals,
>
> defined strategy, team concepts, good communications,
>
> collaboration, compromise, embracing diversity.
>
>
>
> And one would ask, how meaningful are these, and what others should be
> added or removed?
>
>
>
> These are not ranked is any order and begs the question should they be?
> What are the most important to prevent error.
>
>
>
> There seem to be barriers to introducing the right culture into a hospital
> and this article discusses that.
>
>
>
>
> https://www.fiercehealthcare.com/hospitals/hospital-impact-8-cultural-barriers-to-achieving-high-reliability-healthcare
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.fiercehealthcare.com_hospitals_hospital-2Dimpact-2D8-2Dcultural-2Dbarriers-2Dto-2Dachieving-2Dhigh-2Dreliability-2Dhealthcare&d=DwMFAg&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=3-ovTI9oH9-1frmaUjjmP1WRMfm7j-oludtaCuOs7mU&s=adh1lnz3o7l3o0vMW7SyRPYlikIxPs3M38-JjDiotns&e=>
>
>
>
> Are these culture barriers meaningful? And what can anything be done about
> the obstacles to make it easier for hospitals?
>
>
>
> While we are waiting to find good ways to prevent diagnostic errors (and
> errors in general) could we support moving to good cultures for all in
> medical facilities.
>
>
>
> Would that help in any way?
>
>
>
> One fantasizes of reducing the error rate by 1 - 5%
>
>
>
> Or is this being done successfully already?
>
>
>
> Rob Bell, M.D.
>
>
>
>
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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