Intensive care nurses' well-being: A systematic review

Background The study of safety culture and its relationship to patient care have been challenged by variation in definition, dimensionality and methods of assessment. This systematic review aimed to map methods to assess safety culture in hospitals, analyse the prevalence of these methods in the published research literature and examine the dimensions of safety culture captured through these processes. Methods We included studies reporting on quantitative, qualitative and mixed methods to assess safety culture in hospitals. The review was conducted using four academic databases (PubMed, CINAHL, Scopus and Web of Science) with studies from January 2008 to May 2020. A formal quality appraisal was not conducted. Study purpose, type of method and safety culture dimensions were extracted from all studies, coded thematically, and summarised narratively and using descriptive statistics where appropriate. Results A total of 694 studies were included. A third (n=244, 35.2%) had a descriptive or exploratory purpose, 225 (32.4%) tested relationships among variables, 129 (18.6%) evaluated an intervention, while 13.8% (n=96) had a methodological focus. Most studies exclusively used surveys (n=663; 95.5%), with 88 different surveys identified. Only 31 studies (4.5%) used qualitative or mixed methods. Thematic analysis identified 11 themes related to safety culture dimensions across the methods, with ‘Leadership’ being the most common. Qualitative and mixed methods approaches were more likely to identify additional dimensions of safety culture not covered by the 11 themes, including improvisation and contextual pressures. Discussion We assessed the extent to which safety culture dimensions mapped to specific quantitative and qualitative tools and methods of assessing safety culture. No single method or tool appeared to measure all 11 themes of safety culture. Risk of publication bias was high in this review. Future attempts to assess safety culture in hospitals should consider incorporating qualitative methods into survey studies to evaluate this multi-faceted construct.

https://bmjopen.bmj.com/content/bmjopen/11/7/e043982.full.pdf

Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals.

This preface was written by the Australian Commission on Safety and Quality in Health Care
(the Commission) to provide context and background to the report which follows, Safety
Culture Assessment in Health Care: A review of the literature on safety culture assessment
tools. The Commission contracted Macquarie University to prepare the literature review, as
part of the review of the Australian Health Service Safety and Quality Accreditation
(AHSSQA) Scheme.

Safety culture assessment in health care: a review of the literature on safety culture assessment modes

Adaptation as a source of safety in complex socio-technical systems: A literature review and model development

New graduate nurse wellbeing, work wellbeing and mental health: A quantitative systematic review.

Objective To assess safety culture at a public maternity hospital in Shanghai, China, using a sequential mixed methods approach. The study was part of a bigger study looking at the application of the mixed methods approach to assess safety culture in health care in different organizations and countries. Methodology A mixed methods approach was utilized by first distributing the Safety Attitudes Questionnaire measuring six safety culture dimensions and five independent items to all hospital staff (n=1482) working in 18 departments at a single hospital. Afterward, semistructured interviews were conducted using convenience sampling, where 48 hospital staff from nine departments at the same hospital were individually interviewed. Results The survey received a response rate of 96%. The survey findings show significant differences between the hospital departments in almost all safety culture dimensions and independent items. Similarly, the interview findings revealed that there were different, competing priorities between departments perceived to result in a reduced quality of collaboration and bottlenecks in care delivery. Another major finding was that staff who worked more hours per week would perceive working conditions significantly more negatively. Issues related to working conditions were also the most common concerns discussed in the interviews, especially the issue on high workload. High workload was also reflected in the fact that 91.45% of survey respondents reported that they worked 40 hours or longer per week. Finally, interview findings complemented survey findings, thus providing a more complete and accurate picture of safety culture. Conclusion Hospital leaders need to prioritize interventions focused on improving the quality of cross-department collaboration and reducing workload. A mixed methods assessment of safety culture provides more meaningful, targeted results, enabling leaders to prioritize and tailor improvement efforts to increase the impact of an intervention.

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A safety culture assessment by mixed methods at a public maternity and infant hospital in China.

Introducing Routine Measurement of Healthcare Worker's Well-being as a Leading Indicator for Proactive Safety Management Systems Based on Resilience Engineering

Although the need to improve patient safety is widely recognized, there is general agreement that ambitious targets for improvement have not been met. Resilience Engineering focuses on complex adaptive systems and provides a holistic view of interacting elements that adjust, adapt and reinforce one another in response to emerging forces. This provides a framework to understand both why organizations succeed or fail and, therefore, how to improve their reliability. One component that is often identified as a key factor in safety and reliability by complex adaptive systems and RE are the individuals within the system and their relationship to organizational performance. The goal of this paper is to identify and transfer knowledge regarding healthcare worker’s well-being from health sciences to the development of proactive safety management systems, with a specific emphasis on the RE framework as offering the most potential for this. To achieve this, the paper will: First provide a review of relevant determinants associated with a healthcare worker’s well-being that suggest both risk and contribution to the success of system performance. Next, the benefits of utilizing indicators for proactively monitoring system performance in healthcare will be reviewed. This will have a particular focus on the benefits and challenges to the routine monitoring of the healthcare worker’s well-being as a specific indicator for system performance and patient safety. Finally, further research necessary to address a number of critical key factors to investigate the utility, validity, and usability of the design and implementation of healthcare worker well-being indicators into healthcare safety management systems are identified.

6th International Conference on Applied Human Factors and Ergonomics (AHFE 2015) and the Affiliated Conferences, AHFE 2015 Introducing routine measurement of healthcare worker's well-being as a leading indicator for proactive safety management systems based on Resilience Engineering

In this short article, benefits of open access articles for industry are discussed from the point of view of the industry as both the authors and readers of open access articles. Open access articles unlock the barrier to share knowledge and experiences and building collaboration – all of which are crucial for an industry that wishes to make a global impact for a sustainable future.

/pdf/benefits-of-open-access-articles-for-industry-1ynw5oawck.pdf

Benefits of open access articles for industry

A number of hospitals around the world have allowed themselves to develop cultures of “normalized deviance,” where (below) average performance becomes the norm, people are afraid to speak out and leaders are either unaware of or deny failure. Such weaknesses have led to high-profile incidents. The patients who come to surgery are generally among the sickest and at more advanced stages of disease. The very act of treatment involves interventions that are often considerably invasive with vigorous and unpredictable physiologic responses. The level of complexity, both in task-oriented and cognitive demands on clinical team, results in a dynamic, unforgiving environment that can magnify the consequences of even small process failures, lapses and errors. Because of better-educated patients, more demanding payers, push towards transparency, more discerning regulatory agencies, safety and quality have become prominent criteria for evaluating surgical care. Providers are increasingly asked to document these areas, and patients are using this documentation to select surgeons and hospitals. Payers are using the data to direct patients to providers, and potentially to adjust reimbursement rates. Therefore, health care policy makers, health service researchers, and others are aggressively developing and implementing quality indicators for surgical practice. Given the complex interplay of structure, process, and outcomes, assessment of surgical quality presents a daunting task.

Bobbie N. Ray-Sannerud

Papers

A safety culture assessment by mixed methods at a public maternity and infant hospital in China.

Introducing Routine Measurement of Healthcare Worker's Well-being as a Leading Indicator for Proactive Safety Management Systems Based on Resilience Engineering

6th International Conference on Applied Human Factors and Ergonomics (AHFE 2015) and the Affiliated Conferences, AHFE 2015 Introducing routine measurement of healthcare worker's well-being as a leading indicator for proactive safety management systems based on Resilience Engineering

Benefits of open access articles for industry

How Regulators Assess and Accredit Safety and Quality in Surgical Services