Abstract:
INTRODUCTION:Individual effort and practice systems contribute to quality performance, but the nature of their contributions remains unclear. METHODS:This study assessed the roles of individual attributes and behaviours versus practice attributes in quality performance by assessing general internists' perceptions of factors that drive their engagement in quality improvement (QI). The authors interviewed 20 physicians in two distinct categories from diverse practice settings who had the greatest discordance between their ranked scores on standardised measures of individual quality performance and practice 'systems' performance. RESULTS:Findings suggest that there are subtle but important differences between high-scoring physicians practising in low-scoring practice systems, and low-scoring physicians practising in high-scoring practice systems with regards to quality performance and improvement. Physicians with high individual and low systems scores contributed a greater individual effort in quality improvement (QI), exhibited greater internal drivers to change, and reported a greater number and broader list of QI activities than physicians with low individual scores and high systems scores. Physicians with high individual scores also tended to be more reflective. There was a lack of consensus between categories on the relative usefulness of different systems resources, including electronic information systems. Our findings also suggest that physicians practice in isolation and autonomously, and highly independent of each other, and perceive a tension between pursuing technical quality and patient satisfaction at the same time. Both categories were skeptical of performance measurement more generally. CONCLUSION:QI efforts may be more effective if they foster both specific individual attitudes and capabilities, as well as improve practice-level systems.
journal_name
BMJ Qual Safjournal_title
BMJ quality & safetyauthors
Pham HH,Bernabeo EC,Chesluk BJ,Holmboe ESdoi
10.1136/bmjqs.2010.048991subject
Has Abstractpub_date
2011-08-01 00:00:00pages
704-10issue
8eissn
2044-5415issn
2044-5423pii
bmjqs.2010.048991journal_volume
20pub_type
杂志文章abstract:AIM:To evaluate the effectiveness of a 'Do not interrupt' bundled intervention to reduce non-medication-related interruptions to nurses during medication administration. METHODS:A parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were rando...
journal_title:BMJ quality & safety
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjqs-2016-006123
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:Errors in clinical reasoning occur in most cases in which the diagnosis is missed, delayed or wrong. The goal of this review was to identify interventions that might reduce the likelihood of these cognitive errors. DESIGN:We searched PubMed and other medical and non-medical databases and identified addition...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2011-000149
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:Patient and family engagement (PFE) in healthcare is an important element of the transforming healthcare system; however, the prevalence of various PFE practices in the USA is not known. OBJECTIVE:We report on a survey of hospitals in the USA regarding their PFE practices during 2013-2014. RESULTS:The resp...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004006
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:Patient safety studies have identified older adults as a high-risk group for adverse events (AEs). As frequent users of the emergency department (ED), they are vulnerable to the negative consequences of ED crowding. The study objective was to determine whether a prolonged ED stay is associated with an increas...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2009.034926
更新日期:2011-07-01 00:00:00
abstract:INTRODUCTION:Trauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs). In situ simulation (ISS) provides a novel prospective approach to recreate clinical s...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2020-011363
更新日期:2020-10-23 00:00:00
abstract:OBJECTIVE:Paediatric cardiac surgery has a low error tolerance and demands high levels of cognitive and technical performance. Growing evidence suggests that further improvements in patient outcomes depend on system factors, in particular, effective team skills. The hypotheses that small intraoperative non-routine even...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.048983
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Quality of care is considered to be of central importance in healthcare, disability services and rehabilitation. People experiencing disability often access a range of health and social care services; for some, these services are integral parts of daily life. Little research has explored perspe...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.042812
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Recent research suggests that hospital rates of postoperative venous thromboembolism (VTE) are subject to surveillance bias: the more hospitals 'look for' VTE, the more VTE they find. However, little is known about what drives variation in hospital VTE imaging rates. We conducted an observational study to ex...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003150
更新日期:2014-11-01 00:00:00
abstract:OBJECTIVE:To assess the psychometric properties of the French-language version of the Hospital Survey on Patient Safety Culture (HSOPSC). METHODS:Data were obtained from a staff survey at a Swiss multisite hospital. We computed descriptive statistics and internal consistency coefficients, then conducted a confirmatory...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2013-002024
更新日期:2014-05-01 00:00:00
abstract::In a high-reliability organisation (HRO), safety and quality (SQ) is an organisational priority, and all workforce members are engaged, continuously learning and improving their work. To build organisational capacity for SQ work, we have developed a role-tailored capacity-building framework that we are currently emplo...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2016-006240
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVES:To provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England. METHODS:We used UK-based prevalence of medication errors (in prescribing, dispensing, administration and monitoring) in primary care, secondary care and care hom...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010206
更新日期:2021-02-01 00:00:00
abstract:OBJECTIVE:Hospital care comprises nearly a third of US healthcare expenditures. Fifteen to 20 per cent of this spending is considered to be potentially preventable. Risk prediction models have suboptimal accuracy and typically exclude patient experience data. No studies have explored patient perceptions of the likeliho...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-007184
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:We sought to investigate the formal and informal ways preregistration students from medicine, nursing, pharmacy and the allied healthcare professions learn about patient safety. METHODS:We drew on Eraut's framework on formal and informal acquisition of professional knowledge to undertake a series of phased ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2013-001905
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:To examine the association of mortality by day of the week for emergency and elective patients. DESIGN:Retrospective observational study using the international dataset from the Global Comparators (GC) project consisting of hospital administrative data. SETTING:28 hospitals from England, Australia, USA and ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003467
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:To assess the quality of guidelines, consensus statements and systematic reviews on flu and pneumococcal immunisations in HIV-infected children. METHOD:The authors screened PubMed and Embase databases until the year 2009 for guidelines, consensus statements and systematic reviews on flu and pneumococcal immu...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs.2010.047316
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. OBJECTIVE:The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process. METHODS:A qualitative study using purposive s...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs-2012-001165
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:Neonates are at high risk for significant morbidity and mortality from medication prescribing errors. Despite general awareness of these risks, mistakes continue to happen. Alerts in computerised physician order entry intended to help prescribers avoid errors have not been effective enough. This improvement p...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001089
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Existing evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered nurses (RNs). However, no previous studies have described the relationship between nu...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-008948
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-006599
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVE:This article is an exploration of views and experiences of Patient Safety Walkrounds, a widely recommended strategy for identifying patient safety problems and improving safety culture. DESIGN AND SETTING:Qualitative analysis of semistructured, in-depth interviews with 11 senior leaders and 33 front-line sta...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001706
更新日期:2014-10-01 00:00:00
abstract::This paper aims to draw attention to the social and micropolitical dimensions of attempting to implement improvements within healthcare organisations. It is argued that quality improvement initiatives, like other forms of organisational innovation, will fail unless they are conceived and implemented in such a way as t...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.046482
更新日期:2011-04-01 00:00:00
abstract::Current methods used to evaluate the effects of healthcare improvement efforts have limitations. Designs with strong causal inference-such as individual patient or cluster randomisation-can be inappropriate and infeasible to use in single-centre settings. Simpler designs-such as prepost studies-are unable to infer cau...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-009734
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Patient and public involvement (PPI) is often an essential requirement for research funding. Distinctions can be drawn between clinical research, which generally focuses on patients, and implementation research, which generally focuses on health professional behaviour. There is uncertainty about the role of ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-006954
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness of dischar...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000074
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Free-text directions generated by prescribers in electronic prescriptions can be difficult for patients to understand due to their variability, complexity and ambiguity. Pharmacy staff are responsible for transcribing these directions so that patients can take their medication as prescribed. However, little ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010405
更新日期:2020-05-25 00:00:00
abstract:OBJECTIVE:To determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls. DESIGN:Prospective observational study. SETTING:Three National Health Service acute hospitals in England. PARTICIPANTS:Adult patients sustaining an in-hospital cardiac arrest (CA) or medical emergency (ME) which...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000319
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:In this study, we aim to develop a set of quality indicators for optimal perioperative diabetes care throughout the hospital care pathway and to gain insight into the feasibility of the indicator set in daily clinical practice by assessing the clinimetric properties of the indicators in a practice test. MET...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004112
更新日期:2016-07-01 00:00:00
abstract::Cystic fibrosis (CF) is a chronic disease requiring patients to have frequent specialty healthcare visits to delay progression of lung disease, prevent and treat failure to thrive and initiate early interventions to prevent acute illness and complications. The CF Foundation recommends that patients have visits with th...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2013-002345
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Our goal was to compare hospital scores from the most widely used commercial website in the USA to hospital scores from more systematic measures of patient experience and outcomes, and to assess what drives variation in the commercial website scores. METHODS:For a national sample of US hospitals, we compare...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001360
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. DESIGN:Literature review, expert panel and focus group. SETTING:Primary care with access to e-prescribing systems. PARTIC...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.049635
更新日期:2011-10-01 00:00:00