Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

How hospitals select their patient safety priorities

An exploratory study of four Veterans Health Administration hospitals

George, Judy; Parker, Victoria A.; Sullivan, Jennifer L.; Greenan, Mary A.; Chan, Jeffrey; Shin, Marlena H.; Chen, Qi; Shwartz, Michael; Rosen, Amy K.

doi: 10.1097/HMR.0000000000000260
Features: PDF Only
Buy
PAP

Background Hospitals face ongoing pressure to reduce patient safety events. However, given resource constraints, hospitals must prioritize their safety improvements. There is limited literature on how hospitals select their safety priorities.

Purpose The aim of this research was to describe and compare the approaches used by Veterans Health Administration (VA) hospitals to select their safety priorities.

Methodology Semistructured telephone interviews with key informants (n = 16) were used to collect data on safety priorities in four VA hospitals from May to December 2016. We conducted a directed content analysis of the interview notes using an organizational learning perspective. We coded for descriptive data on the approaches (e.g., set of cues, circumstances, and activities) used to select safety priorities, a priori organizational learning capabilities (learning processes, learning environment, and learning-oriented leadership), and emergent domains. For cross-site comparisons, we examined the coded data for patterns.

Results All hospitals used multiple approaches to select their safety priorities; these approaches used varied across hospitals. Although no single approach was reported as particularly influential, all hospitals used approaches that addressed system level or national requirements (i.e., externally required activities). Additional approaches used by hospitals (e.g., responding to staff concerns of patient safety issues, conducting a multidisciplinary team investigation) were less connected to externally required activities and demonstrated organizational learning capabilities in learning processes (e.g., performance monitoring), learning environment (e.g., staff’s psychological safety), and learning-oriented leadership (e.g., establishing a nonpunitive culture).

Practice Implications Leaders should examine the approaches used to select safety priorities and the role of organizational learning in these selection approaches. Exclusively relying on approaches focused on externally required activities may fail to identify safety priorities that are locally relevant but not established as significant at the system or national levels. Organizational learning may promote hospitals’ use of varied approaches to guide their selection of safety priorities and thereby benefit hospital safety improvement efforts.

Judy George, PhD, MHSA, is Health Science Specialist, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts.

Victoria A. Parker, DBA, is Associate Dean and Associate Professor, Peter T. Paul College of Business and Economics, University of New Hampshire, Durham; and Investigator, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts.

Jennifer L. Sullivan, PhD, is Investigator, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts, and Research Assistant Professor, Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts.

Mary A. Greenan, MPH, is Project Manager, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts.

Jeffrey Chan, BS, is Project Manager, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts.

Marlena H. Shin, JD, MPH, is Investigator, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts.

Qi Chen, PhD, MD, is Investigator, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts, and Assistant Professor, Department of Surgery, Boston University School of Medicine, Massachusetts.

Michael Shwartz, PhD, MBA, is Senior Researcher, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts.

Amy K. Rosen, PhD, is Senior Research Career Scientist, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts, and Professor, Department of Surgery, Boston University School of Medicine, Massachusetts. E-mail: amy.rosen2@va.gov.

Financial support for this research was provided by the U.S. Department of Veterans Affairs, Veterans Health Administration, National Center for Patient Safety, the Patient Safety Center of Inquiry on Measurement to Advance Patient Safety, P.I. Amy K. Rosen, XVA 68-023.

This research was presented as part of a Boston University School of Public Health doctoral dissertation defense in Boston, MA, and at the AcademyHealth Annual Research Meeting in New Orleans, LA, on June 27, 2017.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved