Wednesday, September 8, 2010

Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes

Does any organization can implement a patient safety improvement programme?

What does it need to succeed? What results can be expected?

Quality and Safety in Health Care has published this original research outlining some answers.

UK researchers examined the perceptions of organizational readiness and its relation to the impact of the Safer Patients Initiative (SPI), a national initiative of the Health Foundation to address the patient safety improvement.

To learn about this perceptions they used a mixed-methods design, involving a survey and semistructured interviews with a sample of the improvement groups (consisting of senior executive leads, the principal SPI programme coordinator and the operational leads in each of the SPI clinical work areas) of the four organizations taking part in the first phase of SPI.

They obtained a response rate of 90% and 34 leaders participated in the interviews.

The questionnaire included items on perceptions of readiness in the following aspects:

1. Culture and attitudes toward quality and safety
2. Systems and infrastructure
3. Resource availability, measured on a scale from 1 (low preparation) to 6 (high preparation)

Further, it wondered about organizational stability, measured on a scale from 1 (stable) to 6 (turbulent).

It also asked for a specific score using a scale of 3 (significant strength) to -3 (significant weakness), of 15 factors such as financial resources, medical support, support from nurses, support from managers, etc.

The interviews contained open questions about the preconditions of the organization (culture, history of improvement, quality of information systems and measurement procedures, financial stability...) and the preparatory factors of the initiative (framework for program management, team's initial selection, clinician’s participation, communication and training before deployment...).

For the entire sample, culture and attitudes were better rated than systems and infrastructure and also than availability of resources. Everybody said that their previous history of improvement was important to take the initiative and all also experienced difficulties with the information and assessment systems’ capacity. The importance of the financial balance and the outcome was particularly important for executives.

With respect to specific factors, most were considered strengths but, while managers’ and nursing’s initial support was rated as good, medical initial support was rated worse (it was considered a weakness).

Personal interviews revealed that it is worth reflecting on the influence of the conditions at the beginning of the program. This reflection process gives the organization a valuable learning.

The highest score has the overall perception of preparation in an organization; the greatest impact presents the initiative on quality and security performance, greater sustainability of its benefits and greater success in its deployment in that organization, being leadership style an important factor in this preparation.

So this study, though preliminary, would suggest that prior to start these programmes, organizations would benefit from an assessment of their readiness with time spent in the preparation of its infrastructure, processes and culture. Furthermore, a better knowledge of these preconditions, that mark an organization as qualified to undertake the improvement work, would allow managers to set realistic expectations about the results of safety campaigns.

Burnett S, Benn J, Pinto A, Parand A, Iskander S, Vincent C. Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes. Qual Saf Health Care 2010;19:313-317

Posted by Marisa Torijano
English version by Erika C├ęspedes

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