Patient Experience And Clinical Safety: A Literature Review

Approaches of CRM regarding healthcare

Discuss about the Patient Experience and Clinical Safety.

In this literature review, some of the major human factor models are being described as well as their applications in respect of patient safety and quality initiatives. Primarily, the aviation-based models are being discussed whose adoption has been done in respect of practices related to healthcare. The initial underpinnings regarding the models as well as their inadequacies are explained as well. Then, the macro-ergonomic models that are accounting for the intricate interactions within the environment of healthcare are also being explained.

The prevalence of aviation models to do the development of improvements relating to the safety of the patients is well recognized. Analogies have been drawn by the researchers from aviation towards healthcare and provided a strong argument to translate to the clinical realm of insights from many decades of studies relating to Human factors Engineering (HFE). HFE models in aviation were based upon the use of the methodical approach to do the identification of the shortages that are contributing to the failures or performances that are considered being sub-optimal (Wong, 2013).

There has been the application of training related to Crew Resource Management (CRM) in an extensive manner in healthcare with changeable degree of success, basically for doing the improvement of communication as well as teamwork and to do the improvement of the methods. Despite the fact that, a final decision in regard to the success of the training related to CRM cannot be made regarding healthcare, since it is still at a growing level of application  within the domain of healthcare, discussion should be made regarding certain interesting factors (West, 2014).

Primarily, it can be stated that the CRM approaches are focusing upon the behavioral safety, a methodology that is not addressing the technological, organizational as well as task-based issues that are considered being complex, and arising within the settings of healthcare. Therefore, training approaches that are based upon CRM might be considered being ineffective within the settings of healthcare. Then, in contrast to the methods that are highly engineered and are technologically reconciled, healthcare is having the requirement for major human input (West, 2014). For instance, within aviation, the human interactions occurs with an engineering process, whereas within healthcare, clinicians are interacting with the patients having significantly diverse conditions as well as sicknesses that changes in a rapid manner overtime. Such intrinsic differences within the nature of method response, amongst an engineered process as well as a natural process does the adding of an extra complexity layer making the approaches of training relating to aviation-style less flourishing (Wong, 2013).

Macro-ergonomics in respect of patient safety

            The frameworks relating to human factors to do the evaluation of patient safety as well as quality of care have been predicated through the approaches relating to macro-ergonomics. The approaches relating to macro-ergonomics take into consideration an overall process (such as, an intensive care unit). In addition, communications within the different elements regarding that process, as well as its associations with other processes (Wong 2013). The major components regarding macro-ergonomics in respect of patient safety take into consideration the following aspects,

• Approaches that are system-oriented
• Joint optimization relating to human performance as well as welfare
• Taking into consideration the organizational as well as socio-technical context
• Communications amongst the different components regarding the process.

Moreover, macro-ergonomics does the utilization of a more holistic viewpoint to account for system performance (such as, healthcare process clinicians), welfare as well as safety regarding the patients and the results (such as, safety of patients). For instance, the work process within an ICU will be taking into consideration the clinicians, the technologies that are used by them as well as their communications. There exist various external concerns such as, communication with other units, organizational practices, as well as regulatory features. While taking into consideration the design or incorporating new tools within an ICU, a macro-ergonomic approach will be taking into consideration each of these aspects (Wong, 2013). A brief description will be provided regarding the different models of macro-ergonomics that have been used to do the improvement of patient safety as well as quality within the systems of healthcare.

The Systems Engineering Initiative for Patient Safety model does the explaining of patient safety as well as healthcare quality as a functional aspect relating to work systems as well as processes. The model is based upon the structure-process-outcome model and comprising of three interacting elements, such as the work process, its impacts upon the methods relating to care as well as the results (West, 2014). The SEIPS model draws on three key human factors principles such as systems-orientation, person-centeredness as well as developments that are design-driven. The deriving of system-orientation occurs from the holistic approach in respect of studying an entire process of healthcare (Weaver, 2016). The deriving of person-centeredness occurs from taking into consideration individuals to be the core aspect relating to the work of healthcare with the supposition that there should be the designing as well as development of tools, technologies as well as systems of support with the consideration of the strengths as well as limitations of the users. Also, the improvements that are design-driven concentrates upon the improvement of work related to healthcare via the development of tools as well as activities of work that will be optimizing the human and team performance (Taylor, 2013).

Systems Engineering Initiative for Patient Safety model

The work process are consisting of individuals (such as, physicians, nurses as well as other support staff), tasks, tools as well as technologies, the physical surrounding where the performance of these tasks will occur, and also the organizational factors  that are affecting the activities related to work. Moreover, the work process is also influenced by the external factors like institutional policies as well as guidelines that are externally imposed (Sherwood. 2017). The task of a physician to enter the orders of patients gets influenced by the characteristics of the physician, the characteristics of tools utilized in respect of entering the orders as well as the practices and norms relating to the organization. The model does the assumption that the components of work process will be interacting as well as affecting the methods of care as well as workflow, which in turn, influence outcomes regarding healthcare such as safety and, in more general terms, the quality of healthcare (Phelps, 2014). The model does the incorporation of two loops relating to feedback such as, within the work process as well as care methods, and within the work process as well as results. The feedback loops does the providing of metrics in respect of probable redesign.

There has been the application of the SEIPS model regarding the study of various problems relating to safety as well as quality, which included medication safety, emergency room readmissions as well as management relating to nursing workload. For instance, the SEIPS structure is being used for categorizing the factors that contribute to the occurrence of duplicate medication orders through the use of a CPOE process (Parand, 2014). The contributing factors will be take into consideration the technological, team based as well as organizational surrounding.

This model comprises of three elements of interaction, such as performance inputs, transformational methods, performance outputs as well as feedback loops amongst the three elements. The performance inputs does the representation of the elements relating to the work system, such as the physician as well as patient, tasks, tools, organizational as well as external factors. The transformational methods do the representation of the ways by which the inputs are influencing the physical, cognitive as well as social performance regarding the healthcare professionals (Millar, 2013). For instance, the proficiency as well as skills regarding the physicians does the influencing of their capabilities for identifying as well as filtering inappropriate information regarding the case of patients. The outputs do the representation of successfully completing the tasks (such as providing the patients necessary medications or doing order entry). The three elements relating to the model are having intrinsic feedback loops within them that are acting as an input regarding other methods. The feedback loop is also serving as a mechanism of learning, acting as a guide in respect of actions that will be taken in the future regarding processes or events that are considered being similar (McFadden, 2015). The healthcare professional performance model is relying upon the key HFE principles to do the improvement of the technological aspects, practices and methods relating to healthcare via the design of tools as well as interventions that are supporting the performance of the healthcare professionals.

Application of the SEIPS model

The utilization of a holistic, methodical assessment structure assists in providing various advantages relating to patient safety as well as quality schemes. Primarily, these studies does the utilization of an approach that is regarded as multi-method, offering insights in respect of the methods regarding work system from different point of views (Hignett, 2015). Then, a holistic approach in regard to various aspects of a process is taken into consideration. Differently speaking, in respect of every clinical environment, the individual, team, organizational as well as other contextual factors relating to the environment are taken into consideration. Hence, there occurs the capturing of the work system issues from various points of views offering the capability for discerning in an effective manner potential factors that are hampering the quality as well as safety regarding patient care (Healy, 2016).

This model of human error has been particularly adapted in respect of healthcare and has been used for understanding errors related to medication a well as non-adherence of patients. In accord to the accident causation model, it can be stated that a process is having both a ‘sharp end’ as well as a ‘blunt end’.

At the sharp end, there will be the occurrence of ‘active failures’ regarding the front-line workers (Grol, 2013). These active failures are considered being acts that are considered unsafe and its classification can be done regarding slips, lapses, violations as well as mistakes. There is the occurrence of slips as well as lapses when the preparation of the correct plan is done but its execution is done in an incorrect manner (Finkelman, 2015).

In particular, there is the occurrence of a ‘slip’ when a step regarding the plan will be carried out in an incorrect manner, while a ‘lapse’ will be occurring when a stage regarding the plan will get omitted. For instance, within clinical practice, the slips that are recognized are considered to be the selection of the wrong drug from a drop-down menu or having the intention to do the dispensing of one quantity of tablet while dispensing the other (Doyle, 2013). Lapses take into consideration a prescriber forgetting to strike off a drug from the drug chart or a patient not remembering when to take a dose regarding the medicine they are having. On the other hand, there is the occurrence of ‘mistakes’ as well as ‘violations’ when there occurs the formulation of an incorrect plan and then pursued (Chassin, 2013). There is the occurrence of mistakes due to the absence of, or misuse of, the pertinent rules or information. For instance, the prescribing of an inaccurate dose due to the absence of information of how the dosage of a specific medicine is given, can be considered as a example regarding mistake. There is the occurrence of violations when an individual is having the knowledge regarding the rule but decision is made by him/her of not following it – not with the mindset of causing injury but for saving time or achieving a competing precedence (Carayon, 2014).

Therefore, in accord to the accident causation model, these active failures are not occurring in seclusion, but are resulting from the ‘error-producing scenarios’ that are arising at various stages within the process. Within healthcare, this might be having relation with the patient, the task, the individual healthcare professional, the team or the surrounding.

Conclusion

From the above discussion, it can be concluded that there has been the demonstration of the concepts relating to patient safety as well as quality within healthcare. The impact of human factors regarding the context of healthcare as well as their impact on staff performance in respect of patient safety has been explained. There has also been the explanation regarding the human error theory as well as application regarding healthcare. There has also been an analysis of the association of the human factors with the quality as well as safety regarding healthcare.

Reference

Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied ergonomics, 45(1), 14-25.

Chassin, M. R. (2013). Improving the quality of health care: what’s taking so long?. Health Affairs, 32(10), 1761-1765.

Doyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ open, 3(1), e001570.

Finkelman, A. (2015). Leadership and Management in Nursing: Core Competencies for Quality Care. Pearson.

Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care. John Wiley & Sons.

Healy, J. (2016). Improving health care safety and quality: reluctant regulators. Routledge.

Hignett, S., Jones, E. L., Miller, D., Wolf, L., Modi, C., Shahzad, M. W., … & Catchpole, K. (2015). Human factors and ergonomics and quality improvement science: integrating approaches for safety in healthcare. BMJ Qual Saf, 24(4), 250-254.

McFadden, K. L., Stock, G. N., & Gowen III, C. R. (2015). Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. Health care management review, 40(1), 24-34.

Millar, R., Mannion, R., Freeman, T., & Davies, H. T. (2013). Hospital board oversight of quality and patient safety: a narrative review and synthesis of recent empirical research. The Milbank Quarterly, 91(4), 738-770.

Parand, A., Dopson, S., Renz, A., & Vincent, C. (2014). The role of hospital managers in quality and patient safety: a systematic review. BMJ open, 4(9), e005055.

Phelps, G., & Barach, P. (2014). Why has the safety and quality movement been slow to improve care?. International journal of clinical practice, 68(8), 932-935.

Sherwood, G., & Barnsteiner, J. (Eds.). (2017). Quality and safety in nursing: A competency approach to improving outcomes. John Wiley & Sons.

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2013). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Qual Saf, bmjqs-2013.

Weaver, C. A., Ball, M. J., Kim, G. R., & Kiel, J. M. (2016). Healthcare information management systems. Cham: Springer International Publishing.

West, M. A., Eckert, R., Steward, K., & Pasmore, W. A. (2014). Developing collective leadership for health care. King’s Fund.

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). Thae relationship between nursing leadership and patient outcomes: a systematic review update. Journal of nursing management, 21(5), 709-724.