Healthcare

Research

Jump to: Other

16 pages, 1001 KiB

Open AccessArticle

A SEIPS-Based Analysis to Understand Safety Culture During Postpartum Hemorrhage

by Kaitlyn L. Hale-Lopez, Madelyn M. Saenz, Neelam Verma, Shruti Chakravarthy, Rebecca Ebert-Allen, William F. Bond and Abigail R. Wooldridge

Healthcare 2025, 13(5), 499; https://doi.org/10.3390/healthcare13050499 - 26 Feb 2025

Viewed by 710

Abstract

Background/Objectives: Maternal mortality occurs at alarming rates in the United States. In 2018, there were 17 maternal deaths for every 100,000 births—double that of other high-income countries, including France and Canada. Postpartum hemorrhage (i.e., excessive blood loss during delivery or within the 24 [...] Read more.

Background/Objectives: Maternal mortality occurs at alarming rates in the United States. In 2018, there were 17 maternal deaths for every 100,000 births—double that of other high-income countries, including France and Canada. Postpartum hemorrhage (i.e., excessive blood loss during delivery or within the 24 h following) is a leading cause of maternal mortality and is a treatable condition if identified and managed in a timely manner. One aspect of work that impacts patient care during postpartum hemorrhage is the safety culture. The safety culture is the beliefs, values, and norms shared by members of the organization that influence their actions and behaviors. In this study, we use the Systems Engineering Initiative for Patient Safety (SEIPS) model to understand and describe how the sociotechnical system shapes safety culture during postpartum hemorrhage. Methods: We conducted interviews and focus groups with 29 clinicians to describe the work system and the barriers and facilitators during postpartum hemorrhage. Then, we inductively categorized the barriers and facilitators into emergent properties of sociotechnical systems related to safety culture. Results: We identified 45 barriers and 158 facilitators into five emergent properties related to the safety culture (i.e., staffing, communication, organizational management and leadership, organizational processes, and teamwork). The participants identified more positive aspects than negative, suggesting that the safety culture positively influences their actions and behaviors. Conclusions: Our results indicate that safety culture could be improved by redesigning the work system to mitigate barriers related to staffing, communication, organizational management, and teamwork that hinder the safety culture. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

► Show Figures

Figure 1

16 pages, 276 KiB

Open AccessArticle

Restorative Just Culture: An Exploration of the Enabling Conditions for Successful Implementation

by Leonie Boskeljon-Horst, Vincent Steinmetz and Sidney Dekker

Healthcare 2024, 12(20), 2046; https://doi.org/10.3390/healthcare12202046 - 15 Oct 2024

Viewed by 1857

Abstract

Background/Objectives: Restorative responses to staff involved in incidents are becoming recognized as a rigorous and constructive alternative to retributive forms of ‘just culture’. However, actually achieving restoration in mostly retributive working environments can be quite difficult. The conditions for the fair and successful [...] Read more.

Background/Objectives: Restorative responses to staff involved in incidents are becoming recognized as a rigorous and constructive alternative to retributive forms of ‘just culture’. However, actually achieving restoration in mostly retributive working environments can be quite difficult. The conditions for the fair and successful application of restorative practices have not yet been established. In this article, we explore possible commonalities in the conditions for success across multiple cases and industries. Methods: In an exploratory review we analysed published and unpublished cases to discover enabling conditions. Results: We found eight enabling conditions—leadership response, leadership expectations, perspective of leadership, ‘tough on content, soft on relationships’, public and media attention, regulatory or judicial attention to the incident, second victim acknowledgement, and possible full-disclosure setting—whose absence or presence either hampered or fostered a restorative response. Conclusions: The enabling conditions seemed to coagulate around leadership qualities, media and judicial attention resulting in leadership apprehension or unease linked to their political room for maneuver in the wake of an incident, and the engagement of the ‘second victim’. These three categories can possibly form a frame within which the application of restorative justice can have a sustainable effect. Follow-up research is needed to test this hypothesis. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

16 pages, 664 KiB

Open AccessArticle

Unpacking Perceptions on Patient Safety: A Study of Nursing Home Staff in Italy

by Ilaria Tocco Tussardi, Stefano Tardivo, Maria Angela Mazzi, Michela Rimondini, Donatella Visentin, Isolde Martina Busch, Emanuele Torri and Francesca Moretti

Healthcare 2024, 12(14), 1440; https://doi.org/10.3390/healthcare12141440 - 19 Jul 2024

Viewed by 1387

Abstract

Nursing homes (NHs) are crucial for de-hospitalization and addressing the needs of non-self-sufficient individuals with complex health issues. This study investigates the patient safety culture (PSC) in NHs within a northern Italian region, focusing on factor influencing overall safety perceptions and their contributions [...] Read more.

Nursing homes (NHs) are crucial for de-hospitalization and addressing the needs of non-self-sufficient individuals with complex health issues. This study investigates the patient safety culture (PSC) in NHs within a northern Italian region, focusing on factor influencing overall safety perceptions and their contributions to subjective judgements of safety. A cross-sectional study was conducted on 25 NHs in the Autonomous Province of Trento. The Nursing Home Survey on Patient Safety Culture (NHSPSC) was utilized to assess PSC among NH staff. Multilevel linear regression and post hoc dominance analyses were conducted to investigate variabilities in PSC among staff and NHs and to assess the extent to which PSC dimensions explain overall perceptions of PS. Analysis of 1080 questionnaires (44% response rate) revealed heterogeneity in PSC across dimensions and NHs, with management support, organizational learning, and supervisor expectations significantly influencing overall safety perceptions. Despite some areas of concern, overall safety perceptions were satisfactory. However, the correlation between individual dimensions and overall ratings of safety was moderate, suggesting the need to enhance the maturity level of PSCs. Promoting a shift in PSC could enhance transparency, prioritize resident safety, empower nursing staff, and increase family satisfaction with care provided in NHs. The support provided by management to PSC appears essential to influence NH staff perceptions of PS. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

► Show Figures

Figure 1

13 pages, 898 KiB

Open AccessArticle

Speaking Up and Taking Action: Psychological Safety and Joint Problem-Solving Orientation in Safety Improvement

by Hassina Bahadurzada, Michaela Kerrissey and Amy C. Edmondson

Healthcare 2024, 12(8), 812; https://doi.org/10.3390/healthcare12080812 - 10 Apr 2024

Cited by 5 | Viewed by 2833

Abstract

Healthcare organizations face stubborn challenges in ensuring patient safety and mitigating clinician turnover. This paper aims to advance theory and research on patient safety by elucidating how the role of psychological safety in patient safety can be enhanced with joint problem-solving orientation (JPS). [...] Read more.

Healthcare organizations face stubborn challenges in ensuring patient safety and mitigating clinician turnover. This paper aims to advance theory and research on patient safety by elucidating how the role of psychological safety in patient safety can be enhanced with joint problem-solving orientation (JPS). We hypothesized and tested for an interaction between JPS and psychological safety in relation to safety improvement, leveraging longitudinal survey data from a sample of 14,943 patient-facing healthcare workers. We found a moderation effect, in which psychological safety was positively associated with safety improvement, and the relationship was stronger in the presence of JPS. Psychological safety and JPS also interacted positively in predicting clinicians’ intent to stay with the organization. For theory and research, our findings point to JPS as a measurable factor that may enhance the value of psychological safety for patient safety improvement—perhaps because voiced concerns about patient safety often require joint problem-solving to produce meaningful change. For practice, our conceptual framework, viewing psychological safety and JPS as complementary factors, can help organizations adopt a more granular approach towards assessing the interpersonal aspect of their safety climate. This will enable organizations to obtain a more nuanced understanding of their safety climate and identify areas for improvement accordingly. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

► Show Figures

Figure 1

15 pages, 716 KiB

Open AccessArticle

Exploring Safety Culture in the ICU of a Large Acute Teaching Hospital through Triangulating Different Data Sources

by Ellen Liston, Enda O’Connor and Marie E. Ward

Healthcare 2023, 11(23), 3095; https://doi.org/10.3390/healthcare11233095 - 4 Dec 2023

Cited by 1 | Viewed by 1993

Abstract

Safety Culture (SC) has become a key priority for safety improvement in healthcare. Studies have identified links between positive SC and improved patient outcomes. Mixed-method measurements of SC are needed to account for diverse social, cultural, and subcultural contexts within different healthcare settings. [...] Read more.

Safety Culture (SC) has become a key priority for safety improvement in healthcare. Studies have identified links between positive SC and improved patient outcomes. Mixed-method measurements of SC are needed to account for diverse social, cultural, and subcultural contexts within different healthcare settings. The aim of the study was to triangulate data on SC from three sources in an Intensive Care Unit (ICU) in a large acute teaching hospital. A mixed-methods approach was used, including analysing the Hospital Survey for Patient Safety Culture results, retrospective chart reviews using the Global Trigger Tool (GTT) for the ICU, and staff reporting of adverse events (AE). There was a 47% (101/216) response rate for the survey. Further, 98% of respondents stated a positive patient safety rating. The GTT identified 16 AEs and 11 AEs that were reported in the same timeframe. The triangulation of the data demonstrates the complexity of understanding components of SC in particular: learning, reporting, and just culture. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

► Show Figures

Figure 1

Other

Jump to: Research

7 pages, 172 KiB

Open AccessViewpoint

Reconciling Safety and Safeguarding in Health and Social Care: Implications for Just Culture

by Siobhán E. McCarthy

Healthcare 2025, 13(7), 690; https://doi.org/10.3390/healthcare13070690 - 21 Mar 2025

Viewed by 301

Abstract

Facilitating a just response to staff involved in patient safety events is complex, with varying perceptions of safe behaviour and practice across settings. This viewpoint paper explores the challenges of developing a just culture, particularly in safeguarding situations involving peer-to-peer harm. It argues [...] Read more.

Facilitating a just response to staff involved in patient safety events is complex, with varying perceptions of safe behaviour and practice across settings. This viewpoint paper explores the challenges of developing a just culture, particularly in safeguarding situations involving peer-to-peer harm. It argues that established just culture principles, such as balancing staff and organisational accountability and using After Action Review (AAR) debriefs, need to be tailored to these contexts. In particular, organisational accountability is paramount in safeguarding situations, especially where individuals do not have the capacity to understand or intend their behaviours. Furthermore, AARs are inappropriate incident responses for serious aggression, violence, and abuse cases. To counter this, a consistent AAR practice can be valuable for preventative learning when applied to the service user care journey and comprehensive incident learning responses. The incorporation of social workers, service users, and families can help promote learning and the prevention of events. Finally, this paper emphasises the need for consistency in core safety principles across settings and the need to tailor just cultural principles to particular contexts. Future research on the role of AAR in diverse settings is recommended. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

8 pages, 164 KiB

Open AccessOpinion

What Is Truly Informed Consent in Medical Practice and What Has the Perception of Risk Got to Do with It?

by Catherine Jane Calderwood, Geir Sverre Braut and Siri Wiig

Healthcare 2025, 13(1), 8; https://doi.org/10.3390/healthcare13010008 - 24 Dec 2024

Viewed by 1358

Abstract

Making decisions about risk, describing and appropriately explaining risk in medical practice is complex for patients and professionals. In this paper, we investigate how the concept of consent is practiced differently in the UK and Norway and discuss pros and cons of the [...] Read more.

Making decisions about risk, describing and appropriately explaining risk in medical practice is complex for patients and professionals. In this paper, we investigate how the concept of consent is practiced differently in the UK and Norway and discuss pros and cons of the chosen approaches from a patient safety culture perspective. We argue that consent is a fundamental part of the safety culture and influence on health system functioning and patient and staff safety. Examples from the UK and Norway are used and discussed in terms of how risk perception influences consent processes and practices. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

5 pages, 170 KiB

Open AccessOpinion

Sailing Too Close to the Wind? How Harnessing Patient Voice Can Identify Drift towards Boundaries of Acceptable Performance

by Siri Wiig, Catherine Jane Calderwood and Jane O’Hara

Healthcare 2024, 12(15), 1532; https://doi.org/10.3390/healthcare12151532 - 1 Aug 2024

Viewed by 2494

Abstract

This opinion paper investigates how healthcare organizations identify and act upon different types of risk signals. These signals may generally be acknowledged, but we also often see with hindsight that they might not be because they have become a part of normal practice. [...] Read more.

This opinion paper investigates how healthcare organizations identify and act upon different types of risk signals. These signals may generally be acknowledged, but we also often see with hindsight that they might not be because they have become a part of normal practice. Here, we detail how risk signals from patients and families should be acknowledged as system-level safety critical information and as a way of understanding and changing safety culture in healthcare. We discuss how healthcare organizations could work more proactively with patient experience data in identifying risks and improving system safety. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

13 pages, 263 KiB

Open AccessViewpoint

Why Talking Is Not Cheap: Adverse Events and Informal Communication

by Anthony Montgomery, Olga Lainidi and Katerina Georganta

Healthcare 2024, 12(6), 635; https://doi.org/10.3390/healthcare12060635 - 12 Mar 2024

Viewed by 2714

Abstract

Healthcare management faces significant challenges related to upward communication. Sharing information in healthcare is crucial to the improvement of person-centered, safe, and effective patient care. An adverse event (AE) is an unintended or unexpected incident that causes harm to a patient and may [...] Read more.

Healthcare management faces significant challenges related to upward communication. Sharing information in healthcare is crucial to the improvement of person-centered, safe, and effective patient care. An adverse event (AE) is an unintended or unexpected incident that causes harm to a patient and may lead to temporary or permanent disability. Learning from adverse events in healthcare is crucial to the improvement of patient safety and quality of care. Informal communication channels represent an untapped resource with regard to gathering data about the development of AEs. In this viewpoint paper, we start by identifying how informal communication played a key factor in some high-profile adverse events. Then, we present three Critical Challenge points that examine the role of informal communication in adverse events by (1) understanding how the prevailing trends in healthcare will make informal communication more important, (2) explaining how informal communication is part of the group-level sensemaking process, and (3) highlighting the potential role of informal communication in “breaking the silence” around critical and adverse events. Gossip, as one of the most important sources of informal communication, was examined in depth. Delineating the role of informal communication and adverse events within the healthcare context is pivotal to understanding and improving team and upward communication in healthcare organizations. For clinical leaders, the challenge is to cultivate a climate of communication safety, whereby informal communication channels can be used to collect soft intelligence that are paths to improving the quality of care and patient safety. Full article

(This article belongs to the Special Issue Innovative Approaches for Safety Culture Improvement in Healthcare Systems)

Journal Menu

Journal Browser

Innovative Approaches for Safety Culture Improvement in Healthcare Systems

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (9 papers)

Research

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI