BACKGROUND: Health care organisations have a long history of dividing work and tasks into decentralised functions and units by forming divisions and departments with delegated power. New ways of working, such as process-oriented approaches, have been called for to address challenges such as staffing shortages and resource constraints. There is limited understanding of the interplays that will occur in health care organisations during a shift from a traditional decentralised structure to a process-oriented approach. This study aims to explore the perceptions of health care staff and leaders when introducing a process-oriented routine. METHOD: We conducted interviews and focus groups with 29 participants in specialised and primary care in order to explore their experiences of a newly introduced routine regarding on-demand consultation, aimed at enhancing communication and patient coordination in a Swedish health care region. The participants included operating managers, schedulers and physicians. Data were analysed using reflexive thematic analysis in accordance with Braun & Clark's guidance. RESULTS: The findings encompass three main themes when introducing a process-oriented routine: Creates a readiness to act, The critical role of trust for adopting on-demand consultation in everyday practice and Challenges associated with transformation. The results show that health care staff and leaders are positive about the new way of working, but the readiness to act is challenged by issues of trust, as well as cultural components and structural factors such as experienced resource constraints. CONCLUSION: Our results underscore the need to consider not only organisational aspects but also social and individual relational factors when introducing a process-oriented way of work into a decentralised and complex health care system.

Objective

This study aims to provide a deeper understanding of what persons with lived experience and professionals with experience of patient safety, suicide research, and investigations consider to be most important in investigations of healthcare before suicide to learn and improve the care of suicidal patients.

Method

This is a qualitative study based on 15 semistructured interviews with persons with lived experience of suicidality and professionals. Thematic analysis was used.

Results

The persons with lived experience and the professionals agreed that a holistic approach to the investigations is crucial. They should embrace a longer period of time, involve family and significant others, integrate the perspective and expectations of the patient, and analyze factors of significance for suicidality, suicide prevention, and safety. There is a need to improve the investigations through the involvement of all stakeholders and actors, securing competence in the investigation team and prioritizing cases to investigate.

Conclusions

Substantial changes in the approach and performance of investigations of suicide in healthcare are needed to make these investigations valuable for increasing the safety of the care of suicidal patients. A holistic perspective during the analysis is crucial for understanding the suicidal process, the interacting factors, and the care process preceding suicide. Competencies in suicidality, suicide prevention, and patient safety must be included in the analysis team to ensure high quality and relevance. To improve the value of these investigations, we suggest establishing a template based on current knowledge to ensure attention to variables of significance for a safe care of suicidal patients.

English summary:

Swedish surgical care shows high quality and patient safety. The reasons for this are several; among the most important are a generally well-educated staff and nation-wide quality registers. Areas in need of development are improved risk assessment and risk management, both for individual patients and for specific types of operations. The ability of the surgical team to synthesize information on what has been done and what should be done postoperatively and communicate this to the teams that take care of the patients after surgery needs further honing. This could result in decreased failure-to-rescue in the postoperative period. Also, strengthening of teamwork and team performance is needed. As new knowledge on the detrimental effects of rude behaviour emerges, it becomes obvious that further work to diminish this is needed. Research is under way of identifying the possibility to identify good and safe surgeons already at the start of their education.

Svensk sammanfattning:

Svensk operationssjukvård är i grunden bra och säker, även om undvikbara skador fortsatt förekommer i för hög utsträckning.

Framtida arbete behöver riktas in på bland annat preoperativ identifiering och hantering av patient- och ingreppsspecifika risker samt ett förbättrat teamarbete och arbetsklimat under hela den perioperativa perioden.

Bättre förmåga att fånga och vidta åtgärder mot avvikelser från det förväntade förloppet, det vill säga minskad »failure to rescue«, har visats vara ett effektivt sätt att reducera förekomsten av undvikbara skador.

Forskning pågår om hur man kan identifiera och träna dem med bäst förutsättningar att bli bra och säkra operatörer.

OBJECTIVE: The decline in suicide rates has leveled off in many countries during the last decade, suggesting that new interventions are needed in the work with suicide prevention. Learnings from investigations of suicide should contribute to the development of these new interventions. However, reviews of investigations have indicated that few new lessons have been learned. To be an effective tool, revisions of the current investigation methods are required. This review aimed to describe the problems with the current approaches to investigations of suicide as patient harm and to propose ways to move forward.

METHODS: Narrative literature review.

RESULTS: Several weaknesses in the current approaches to investigations were identified. These include failures in embracing patient and system perspectives, not addressing relevant factors, and insufficient competence of the investigation teams. Investigation methods need to encompass the progress of knowledge about suicidal behavior, suicide prevention, and patient safety.

CONCLUSIONS: There is a need for a paradigm shift in the approaches to investigations of suicide as potential patient harm to enable learning and insights valuable for healthcare improvement. Actions to support this paradigm shift include involvement of patients and families, education for investigators, multidisciplinary analysis teams with competence in and access to relevant parts across organizations, and triage of cases for extensive analyses. A new model for the investigation of suicide that support these actions should facilitate this paradigm shift.

HIGHLIGHTS

• There are weaknesses in the current approaches to investigations of suicide.
• A paradigm shift in investigations is needed to contribute to a better understanding of suicide.
• New knowledge of suicidal behavior, prevention, and patient safety must be applied.

BACKGROUND: Occupational Health Service (OHS) is a service that should support employers and employees with their work environment. Previous research indicates the need for deeper knowledge about the effect of workplace interventions with a focus on planning, organizing and designing the workplace to improve work conditions in hospital settings.

OBJECTIVE: The aim was to evaluate the outcomes, workplace interventions and intervention strategies in hospital settings.

METHODS: A systematic literature review was conducted. CINAHL, MEDLINE, PsycInfo, Scopus, and Web of Science Core Collection were searched in September 2021. The Mixed Methods Appraisal Tool was used to evaluate the quality of the included studies. Study results are presented through a narrative synthesis. A protocol for this study was registered on the Open Science Framework.

RESULTS: Twenty-six studies, published between 2010 and 2021, were included. These included randomized controlled trials (RCTs), non-RCTs, and mixed methods reports with moderate to good quality. The results support the use of workplace interventions to improve work conditions, health, and well-being in hospital settings. Combinations of different interventions, tailored to the specific organization, were used. Important intervention strategies commonly used in the start-up, evaluation, and intervention of successful workplace interventions, were identified. Using a pragmatist complexity approach in workplace interventions can improve outcomes by providing clear intervention strategies and combinations of tailored interventions, related to context specific problems.

CONCLUSION: OHS support in workplace interventions with clear intervention strategies will contribute to improve work conditions, health and well-being in hospital settings.

In a recently published thesis, we propose a cultural shift in the assessment of suicide as an incident of severe patient harm, from a focus on errors and an often speculative avoidability, to healthcare's ability of risk management over time. Patient safety work needs to change in line with the development of knowledge in patient safety. This means a cultural change in the view of patient safety, with a clearer focus on healthcare's abilities in risk management and learning. Legislation and regulations regarding healthcare and the supervisory authority need to support this cultural change in assessment and investigations of patient harm.  A shift from a focus on errors and deviations to quality and positive outcomes of care, proactive patient safety work, risk management, patient safety culture and management commitment is needed.

BACKGROUND: Harm from medications is a major patient safety challenge. Most adverse drug events arise when a medication is prescribed or reevaluated. Therefore, interventions in this area may improve patient safety. A medication plan, that is, a plan for continued treatment with medications, may support patient safety. Participation of patients in the design of health care products or services may improve patient safety. Co-design, as in the Double Diamond framework from the Design Council, England, can emphasize patient involvement. As the COVID-19 pandemic brought restrictions to face-to-face co-design approaches, interest in remote approaches increased. However, it is uncertain how best to perform remote co-design. Therefore, we explored a remote approach, which brought together older persons and health care professionals to co-design a medication plan prototype in the electronic health record, aiming to support patient safety.

OBJECTIVE: This study aimed to describe how remote co-design was applied to create a medication plan prototype and to explore participants' experiences with this approach.

METHODS: Within a case study design, we explored the experiences of a remote co-design initiative with 14 participants in a regional health care system in southern Sweden. Using descriptive statistics, quantitative data from questionnaires and web-based workshop timestamps were analyzed. A thematic analysis of the qualitative data gathered from workshops, interviews, and free-text responses to the survey questions was performed. Qualitative and quantitative data were compared side by side in the discussion.

RESULTS: The analysis of the questionnaires revealed that the participants rated the experiences of the co-design initiative very high. In addition, the balance between how much involved persons expressed their wishes and were listened to was considered very good. Marked timestamps from audio recordings showed that the workshops proceeded according to the plan. The thematic analysis yielded the following main themes: Everyone's perspective matters, Learning by sharing, and Mastering a digital space. The themes encompassed what helped to establish a permissive environment that allowed the participants to be involved and share viewpoints. There was a dynamic process of learning and understanding, realizing that despite different backgrounds, there was consensus about the requirements for a medication plan. The remote co-design process seemed appealing, by balancing opportunities and challenges and building an inviting, creative, and tolerant environment.

CONCLUSIONS: Participants experienced that the remote co-design initiative was inclusive of their perspectives and facilitated learning by sharing experiences. The Double Diamond framework was applicable in a digital context and supported the co-design process of the medication plan prototype. Remote co-design is still novel, but with attentiveness to power relations between all involved, this approach may increase opportunities for older persons and health care professionals to collaboratively design products or services that can improve patient safety.

BACKGROUND: Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design.

OBJECTIVE: This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices.

METHODS: Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers.

RESULTS: A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested.

CONCLUSIONS: After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step.

BACKGROUND: The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees.

OBJECTIVE: The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction and patient safety during and following the Covid-19 pandemic in a medical ward setting.

METHODS: Mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden.

RESULTS: The mixed methods evaluation of the quality improvement project received funding from FUTURUM - Academy for Health and Care Jönköping County Council and Region Jönköping County and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021.

CONCLUSIONS: The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment and employee health, staff turnover, patient satisfaction and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers and society as a whole.

CLINICALTRIAL:

INTERNATIONAL REGISTERED REPORT: DERR1-10.2196/34152.