Patient and Staff Experience: An Exploration of Factors Contributing to Quality, Safety and Sound Governance

The new era of healthcare emphasizes the integration of nutritional care into healthcare management to improve patient outcomes. Previous studies indicated that nutritional knowledge among physicians is insufficient. Thus far, only a limited number of studies have assessed nutritional knowledge among Saudi physicians, without providing data regarding their views toward practice against malnutrition. Therefore, the aim of the present cross-sectional study was to address this knowledge gap among Saudi physicians in the hospitals of Jeddah, Saudi Arabia. A total of 117 physicians were recruited using a questionnaire to collect physician characteristics, nutritional knowledge, and knowledge and practice related to malnutrition. The mean nutritional knowledge scores were low (50%; SD: 24%). Saudi physicians scored high in questions related to the medical field; however, their knowledge related to nutrition topics was poor. The majority of Saudi physicians agreed that the nutritional management of malnourished patients was difficult at screening (79%), assessment (78%), and treatment (78%) stages. The self-assessed knowledge and interest of physicians toward malnutrition was modest, and they found the malnutrition management to be only moderately relevant to their work. Nutritional knowledge and practice against malnutrition among Saudi physicians is insufficient. Saudi physicians require proper education and training in nutrition. Full article

Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice Spotlight Organization (BPSO) Program was adopted in South Australia as a framework to systematically implement EBP in two diverse and complex healthcare settings. Methods: The study was a post-implementation, mixed-method evaluation conducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative data. Proctor’s implementation evaluation framework guided the evaluation design. Information sources included; interviews, focus groups, questionnaires, and document review. Results: Clinical and executive staff (n = 109 participants) from a broad range of stakeholder groups participated in the interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting program implementation were identified; these pertained to embedding continuity into the program’s implementation and delivery, a robust governance structure, and executive sponsorship. Barriers to implementation were also identified. These barriers pertained to organizational or workforce challenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend training, and a lack of organizational commitment to the program, especially at an executive level. As a result of successful implementation, it was observed that over three years, the BPSO program positively influenced the uptake and implementation of EBP by clinicians and the organizations into which they were introduced. Conclusions: The BPSO model can be translocated to new healthcare systems and has the potential to act as a mechanism for establishing and sustaining EBP change. This study was the first to apply an implementation evaluation framework to the BPSO program, which allowed for structured analysis of facilitating or impeding factors that affected implementation success. The findings have important implications for other health systems looking to translocate the same or similar EBP programs, as well as contributing to the growing body of implementation evaluation literature. Full article

Healthcare Organisational Culture (OC) is a major contributing factor in serious failings in healthcare delivery. Despite an increased awareness of the impact that OC is having on patient care, there is no universally accepted way to measure culture in practice. This study was undertaken to provide a snapshot as to how the English National Health Service (NHS) is currently measuring culture. Although the study is based in England, the findings have potential to influence the measurement of healthcare OC internationally. An online survey was sent to 234 NHS hospital trusts, with a response rate of 35%. Respondents who completed the online survey, on behalf of their representative organisations, were senior clinical governance leaders. The findings demonstrate that the majority of organisations, that responded, were actively measuring culture. Significantly, a wide variety of tools were in use, with variable levels of satisfaction and success. The majority of tools had a focus on patient safety, not on understanding the determining factors which impact upon healthcare OC. This paper reports the tools currently used by the respondents. It highlights that there are deficits in these tools that need to be addressed, so that organisations can interpret their own culture in a standardised, evidence-based way. Full article

Introduction: Previous research exploring the benefits of mentoring and the place of clinical governance in enhancing care delivery illustrated an unexplored synonymous relationship between mentors and mentees (students at undergraduate and postgraduate levels) and its potential impact on patient safety and quality of care. The significance of the research was in recognizing the importance the role of the mentor can play in raising awareness of patient safety and clinical governance principles and processes in the primary healthcare setting. Aims: Building on this preliminary research, this research aimed to explore primary healthcare workers and their mentor’s awareness of mentorship and clinical governance as part of a local Continuing Professional Development (CPD) program. Furthermore, it aimed to establish any relationship between the mentors, the mentee, and their awareness and application of clinical governance in the primary healthcare setting. Methodology: A quantitative research design using a survey was adopted. Data Collection Instrument: The researchers integrated previously validated questionnaires incorporating a Mentor Potential Scale, the Dimensions of Mentoring, and a Clinical Governance Awareness Questionnaire into a new questionnaire. This was called “Mentorship and Clinical Governance Awareness”. Sample: Convenience sample surveys were posted to complete and return to 480 primary healthcare workers undertaking post graduate study. Findings: A total of 112 completed questionnaires were included for the analysis amounting to a 23% response rate. A principle component factor analysis combining part 1— the characteristics of an effective mentor and part 2—the personality characteristics of an effective mentor identified four primary characteristics. These are: (1) “A Facilitatory Adviser”, (2) “Critically Enabling Facilitator”, (3) “A Change Facilitator”, and 4) “An Approachable Facilitator”. These newly identified characterizations according to the primary healthcare workers significantly impacted on their awareness and application of clinical governance in primary healthcare practice. Implications for primary healthcare practice and education: The newly devised questionnaire can be used to gauge the effectiveness of mentors and mentoring and how the characteristics of the role can impact on mentee’s awareness and application of clinical governance. Healthcare manager’s, leaders, and educators should focus their attention on how these newly established characteristics of the mentor can influence clinical governance awareness and application in healthcare the future. Full article

This qualitative research project aimed to gain an understanding of the experiences of managers who participated in the implementation of quality improvement projects in an assisted living facility. This study employed hermeneutic phenomenology as a research methodology, whereby managers working in an assisted living facility were invited to participate in a 60–75 min semi-structured interview. Six managers participated in the interviews. Five themes were developed from data analysis: (1) Quality improvement (QI) and resident-centered care go hand-in-hand; (2) Constant on-going commitment to continuous improvement is needed to implement QI; (3) Learning to communicate with team-members and residents/caregivers is important to implement QI; (4) Feedback is essential for the implementation of QI initiatives; and (5) Implementing new QI initiatives can be challenging. The managers emphasized the need for leadership commitment, the usage of standardized communication methods, and feedback strategies to ensure the success of QI initiatives. Additionally, the managers indicated that QI is directly related to resident-centered care and that efforts should be made to collect feedback from residents to further improve processes. Additionally, challenges surrounding the implementation of QI have been described. Since there is a scarcity of research on the implementation of QI methods in assisted living facilities, this study can provide practical tips to leaders and administrators. Full article

Hospital-acquired malnutrition is a significant issue with complex aetiology, hence nutrition interventions must be multifaceted and context-specific. This paper describes the development, implementation and process evaluation of a complex intervention for improving nutrition among medical patients in an Australian hospital. An integrated knowledge translation (iKT) approach was used for intervention development, informed by previous research. Intervention strategies targeted patients (via a nutrition intake monitoring system); staff (discipline-specific training targeting identified barriers); and the organisation (foodservice system changes). A process evaluation was conducted parallel to implementation assessing reach, dose, fidelity and staff responses to the intervention using a mixed-methods design (quantitative and qualitative approaches). Staff-level interventions had high fidelity and broad reach (61% nurses, 93% foodservice staff and all medical staff received training). Patient and organisation interventions were implemented effectively, but due to staffing issues, only reached around 60% of patients. Staff found all intervention strategies acceptable with benefits to practice. This study found an iKT approach useful for designing a nutrition intervention that was context-specific, feasible and acceptable to staff. This was likely due to engagement of multiple disciplines, identifying and targeting specific areas in need of improvement, and giving staff frequent opportunities to contribute to intervention development/implementation. Full article

Patients’ involvement in decision-making regarding their own health care is considered to be of great importance. However, their information needs are frequently reported to be unfulfilled. Few studies have investigated the knowledge, information and support needs of adolescent idiopathic scoliosis (AIS) patients and their families. Furthermore, previous studies have predominantly focussed on information needs relating to surgery. No previous studies have been conducted to specifically identify the information needs of AIS patients and their families. An online survey consisting of 18 questions was conducted to investigate the information needs of AIS patients and their families. Completed surveys of 83 participants (76 female, 7 male) from 44 differing postcode areas were analysed. The mean age of the respondents with scoliosis was 13.3 years (SD = 1.9; range = 10–18). Participants identified with feelings including worry, anxiety and being upset. The main information needs related to the cause and prognosis of the condition. Where participants had received information, there were contrasting views of the quality. The findings of this study stress the necessity for information materials to be accurate and applicable to each individual patient. Furthermore, the information should be presented in such a way as to be easily understandable, yet contain the necessary information required by AIS patients and their families. Full article

(1) Background: A patient safety incident reporting system was introduced in Indonesian hospitals in 2006; however, under-reporting of patient safety incidents is evident. The government plays a vital role in the implementation of a national system. Therefore, this study focuses on how the Indonesian government has been undertaking its role in patient safety at provincial and city/district levels, including incident reporting according to the National Guideline for Hospital Patient Safety. (2) Methods: This study employed a qualitative approach with interviews of 16 participants from seven organizations. The data were managed using NVivo and thematically analyzed. (3) Results: The findings revealed several problems at the macro-, meso-, and micro-level as the government was weak in monitoring and evaluation. The District Health Office (DHO) and Provincial Health Office (PHO) were not involved in incident reporting, and there was a lack of government support for the hospitals. (4) Conclusions: The DHO and PHO have not carried out their roles related to patient safety as mentioned in the national guidelines. Lack of commitment to and priority of patient safety, the complexity of the bureaucratic structure, and a lack of systematic partnership and collaboration are problems that need to be addressed by systematic improvement. To ensure effective and efficient national outcomes, the three levels of government need to work more closely. Full article

Background: Between October 2017 and March 2018, the Trust experienced significant winter pressures and an increase in category 2 and 3 hospital-acquired avoidable pressure ulcers. This review aimed to investigate the causal factors of this increase. Methods: A ‘Deep Dive’ review of 37 cases was undertaken in three stages: (i) assurance; ensure the increase was not due to insufficient equipment; (ii) collation of relevant data, including age, length of time in A&E, bed surface, number of internal moves; (iii) analysis identifying factors that might account for the observed increase. Findings: Age combined with prolonged length of time in A&E, being nursed on a trolley followed by three or four internal moves were observed in patients who developed pressure ulcers. Patient age was observed as a key factor, with those over 80 years experiencing pressure ulcers more frequently. Conclusion: The small size of this data suggests a need for the greater awareness of frailty issues in older people, timely assessment and intervention to prevent a chain of detrimental factors might be key to reduce and prevent hospital-acquired avoidable pressure ulcers. Recommendations for immediate action, education and future research have been made to the Trust Quality and Safety Committee. Full article

Background: The attitudes of doctors and nurses toward patient safety representa significant contributing factor to hospital safety climates and medical error rates. Yet, there are very few studies of patient safety attitudes in Saudi hospitals and none conducted in hospital emergency departments. Aims: The current study aims to investigate and compare the patient safety attitudes of doctors and nurses in a Saudi hospital emergency department. Materials and Method: The study employed a qualitative research design via semi-structured interviews with Saudi and non-Saudi doctors and nurses working in a Saudi hospital emergency department to determine their attitudes and experiences about the patient safety climate. Results: Findings revealed doctors and nurses held some similar safety attitudes; however, nurses reported issues with doctors with respect to their teamwork, communication, and patient safety attitudes. Moreover, several barriers to the patient safety climate were identified, including limits to resources, teamwork, communication, and incident reporting. Conclusion: The findings provide one of the few research contributions to knowledge regarding the patient safety attitudes of Saudi and non-Saudi doctors and nurses and suggest the application of such knowledge would enhance positive patient outcomes in emergency departments. Full article

Quality within all areas of healthcare should be systemically monitored and ensured. However, the definition of quality is complex and diverse. In the ambulance service (AS), quality has traditionally been defined as response time, but this measurement eliminates the possibility of addressing other characteristics of quality, such as the care provided. This study aimed to explore what constitutes quality in the context of the ambulance service as experienced by ambulance clinicians, physicians, and managers. A focus group study was conducted with 18 participants. The three focus groups were analyzed with the focus group method developed by Kreuger and Casey. The participants highlighted patient involvement, information and care, as well as adherence to policies, regulations, and their own standards as representing quality in the AS. This study demonstrates that quality is in the eye of the beholder. As quality seems to be viewed similarly by patients and ambulance clinicians, physicians, and managers, stakeholders should aim for a paradigm shift where patients’ experience of the care is just as important as various time measures. Full article

Behaviors that undermine a culture of safety within hospitals threaten overall wellbeing of healthcare workers as well as patient outcomes. Existing evidence suggests negative behaviors adversely influence patient outcomes, employee satisfaction, retention, productivity, absenteeism, and employee engagement. Our objective was to examine the presence of negative behaviors within a healthcare system and the influence of negative behaviors among healthcare workers on perceptions of patient safety culture. Using a cross-sectional design, the negative behaviors in healthcare survey (NBHC) and selected composites of the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS) were combined within an electronic survey which was administered to physicians, clinical and managerial staff. Exposure to contributing factors of negative behaviors was moderately correlated with elements of HSOPS, including perceptions of teamwork within units, management response to error, and overall patient safety grade. Use of aggression and fear of retaliation were moderately correlated with HSOPS management response to error. Reducing healthcare worker exposure to contributing factors of negative behavior may result in increased perceptions of teamwork within a hospital unit, while addressing use of staff aggression and fear of retaliation potentially positively influences management response to error. Full article