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How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study
BACKGROUND: Patient incident reporting systems have been widely used for ensuring safety and improving quality in care settings in many countries. However, little is known about the way in which incident data are used by frontline clinical staff. Furthermore, while the use of a systems perspective h...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862528/ https://www.ncbi.nlm.nih.gov/pubmed/35193562 http://dx.doi.org/10.1186/s12913-022-07631-0 |
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author | Kodate, Naonori Taneda, Ken’ichiro Yumoto, Akiyo Kawakami, Nana |
author_facet | Kodate, Naonori Taneda, Ken’ichiro Yumoto, Akiyo Kawakami, Nana |
author_sort | Kodate, Naonori |
collection | PubMed |
description | BACKGROUND: Patient incident reporting systems have been widely used for ensuring safety and improving quality in care settings in many countries. However, little is known about the way in which incident data are used by frontline clinical staff. Furthermore, while the use of a systems perspective has been reported as an effective way of learning from incident data in a multidisciplinary team, the level of adaptability of this perspective to a different cultural context has not been widely explored. The primary aim of the study, therefore, was to investigate how healthcare practitioners in Japan perceive the reporting systems and utilize a systems perspective in learning from incident data in acute care and mental health settings. METHODS: A non-experimental, descriptive and exploratory research design was adopted with the following two data-collection methods: 1) Sixty-one semi-structured interviews with frontline staff in two hospitals; and 2) Non-participatory observations of thirty-seven regular incident review meetings. The two hospitals in the Greater Tokyo area which were invited to take part were: 1) a not-for-profit, privately-run, acute care hospital with approximately 500 beds; and 2) a publicly-run mental health hospital with 200 beds. RESULTS: While the majority of staff acknowledge the positive impacts of the reporting systems on safety, the observation data found that little consideration was given to systems aspects during formal meetings. The meetings were primarily a place for the exchange of practical information, as opposed to in-depth discussions regarding causes of incidents and corrective measures. Learning from incident data was influenced by four factors: professional boundaries; dealing with a psychological burden; leadership and educational approach; and compatibility of patient safety with patient-centered care. CONCLUSIONS: Healthcare organizations are highly complex, comprising of many professional boundaries and risk perceptions, and various communication styles. In order to establish an optimum method of individual and organizational learning and effective safety management, a fine balance has to be struck between respect for professional expertise in a local team and centralized safety oversight with a strong focus on systems. Further research needs to examine culturally-sensitive organizational and professional dynamics, including leader–follower relationships and the impact of resource constraints. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-07631-0. |
format | Online Article Text |
id | pubmed-8862528 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-88625282022-02-23 How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study Kodate, Naonori Taneda, Ken’ichiro Yumoto, Akiyo Kawakami, Nana BMC Health Serv Res Research BACKGROUND: Patient incident reporting systems have been widely used for ensuring safety and improving quality in care settings in many countries. However, little is known about the way in which incident data are used by frontline clinical staff. Furthermore, while the use of a systems perspective has been reported as an effective way of learning from incident data in a multidisciplinary team, the level of adaptability of this perspective to a different cultural context has not been widely explored. The primary aim of the study, therefore, was to investigate how healthcare practitioners in Japan perceive the reporting systems and utilize a systems perspective in learning from incident data in acute care and mental health settings. METHODS: A non-experimental, descriptive and exploratory research design was adopted with the following two data-collection methods: 1) Sixty-one semi-structured interviews with frontline staff in two hospitals; and 2) Non-participatory observations of thirty-seven regular incident review meetings. The two hospitals in the Greater Tokyo area which were invited to take part were: 1) a not-for-profit, privately-run, acute care hospital with approximately 500 beds; and 2) a publicly-run mental health hospital with 200 beds. RESULTS: While the majority of staff acknowledge the positive impacts of the reporting systems on safety, the observation data found that little consideration was given to systems aspects during formal meetings. The meetings were primarily a place for the exchange of practical information, as opposed to in-depth discussions regarding causes of incidents and corrective measures. Learning from incident data was influenced by four factors: professional boundaries; dealing with a psychological burden; leadership and educational approach; and compatibility of patient safety with patient-centered care. CONCLUSIONS: Healthcare organizations are highly complex, comprising of many professional boundaries and risk perceptions, and various communication styles. In order to establish an optimum method of individual and organizational learning and effective safety management, a fine balance has to be struck between respect for professional expertise in a local team and centralized safety oversight with a strong focus on systems. Further research needs to examine culturally-sensitive organizational and professional dynamics, including leader–follower relationships and the impact of resource constraints. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-07631-0. BioMed Central 2022-02-22 /pmc/articles/PMC8862528/ /pubmed/35193562 http://dx.doi.org/10.1186/s12913-022-07631-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Kodate, Naonori Taneda, Ken’ichiro Yumoto, Akiyo Kawakami, Nana How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study |
title | How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study |
title_full | How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study |
title_fullStr | How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study |
title_full_unstemmed | How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study |
title_short | How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study |
title_sort | how do healthcare practitioners use incident data to improve patient safety in japan? a qualitative study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862528/ https://www.ncbi.nlm.nih.gov/pubmed/35193562 http://dx.doi.org/10.1186/s12913-022-07631-0 |
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