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The Relationship Between Safety Climate and Performance in Intensive Care Units: The Mediating Role of Managerial Safety Practices and Priority of Safety.

ABSTRACT: Patient safety is defined as the absence of preventable harm to a patient during the delivery of healthcare. Evidence from several reports and research studies reflect the high incidence and subsequent high cost of patient harm in general and within intensive care units. Against this background, this study tests a theoretical framework addressing relationships among patient safety climate dimensions and their impact on safety performance. The dimensions refer to safety in terms of procedure suitability and information flow, managerial safety practices, and priority of safety. A retrospective cross-sectional analytical research study was conducted. The target population was recruited from the three intensive care units in the main tertiary level hospital in Malta. A sample of 215 healthcare professionals, who fit the eligibility criteria, participated in this research study, achieving a response rate of 82.7%. The "Survey on Patient Safety Climate" was utilized. Findings support the following hypotheses: the higher the extent to which safety procedures are perceived as suitable to the intensive care units' daily work demands and processes, the lower the intensive care units' clinical incidents (r = -0.269, p ? 0.01) and the higher the extent to which safety information flow is perceived as clear and unambiguous to the intensive care units' daily work demands and processes, the lower the intensive care units' clinical incidents (r = -0.295, p ? 0.01). Findings also support the following hypotheses: managerial safety practices mediate the relationship between safety procedure suitability/safety information flow and clinical incidents (p = 0.009, p = 0.014, respectively) and priority of safety mediates the relationship between safety procedure suitability/safety information flow/managerial safety practices and clinical incidents (p = 0.002, p = 0.002, p = 0.042, respectively). Health service managers must ensure employees perceive safety procedures as suitable and safety information as clear and unambiguous, emphasize the manager's role as a safety referent and safety change agent and create an organization that prioritizes safety over work pace, workload and pressure for production. Essentially, health service managers need to create safety leaders to drive the organization to patient safety.

SUBMITTER: Teuma Custo P

PROVIDER: S-EPMC6820301 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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The Relationship Between Safety Climate and Performance in Intensive Care Units: The Mediating Role of Managerial Safety Practices and Priority of Safety.

Teuma Custo Patrick P Teuma Custo Rebecca R Buttigieg Sandra S

Frontiers in public health 20191023

Patient safety is defined as the absence of preventable harm to a patient during the delivery of healthcare. Evidence from several reports and research studies reflect the high incidence and subsequent high cost of patient harm in general and within intensive care units. Against this background, this study tests a theoretical framework addressing relationships among patient safety climate dimensions and their impact on safety performance. The dimensions refer to safety in terms of procedure suit ...[more]

PMID: 31709215

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Project description:BackgroundHealthcare organisations differ in performance even if they are located in the same country or region. Suitable managerial practices and organisational processes can lead to better health outcomes. As a result, hospitals are constantly looking for managerial arrangements that can improve outcomes and keep costs down. This study aims to identify different managerial models in neonatal intensive care units (NICUs) and their impact on a large number of outcomes.MethodsThe research was conducted in Italy, within the SONAR project. SONAR's aim was to identify the characteristics of NICUs, monitor outcomes and promote best practices. This study includes 51 of the 63 NICUs that took part in the SONAR project. Questionnaires on the activities and managerial features were administered to doctors and nurses working in NICUs. A total of 643 questionnaires were analysed from doctors and a total of 1601 from nurses. A cluster analysis was performed to identify managerial models of NICUs.ResultsThree managerial models emerged from cluster analysis: traditional, collaborative and individualistic. In the "traditional" model the doctor is above the nurse in the hierarchy, and the nurse therefore has exclusively operational autonomy. The "collaborative" model has as key elements professional specialisation and functional coordination. The "individualistic" model considers only individual professional skills and does not concern the organisational conditions necessary to generate organisational effectiveness. The results also showed that there is an association between managerial model and neonatal outcomes. The collaborative model shows best results in almost all outcomes considered, and the traditional model has the worst. The individualistic model is in the middle, although its values are very close to those of traditional model.ConclusionsHealth management needs to assess NICU strategically in order to develop models to improve outcomes. This study provides insights for management useful for designing managerial characteristics of NICUs in order to achieve better results. NICUs characterised by a collaborative model in fact show better neonatal outcomes.

Project description:Background: Teacher commitment and performance are important factors contributing to student achievement and the quality of education. Therefore, it is critical to draw attention to this issue by identifying factors that influence these two variables. Methods: A survey, consisted of 34 closed-ended questions, was used. The total sample comprised 2,203 teachers, including 832 men and 1,371 women. Data analysis was performed using partial least squares (PLS) structural equation modeling (SEM). Model measurement employed indicator loading, convergent and discriminant validity, Cronbach's testing, composite reliability and average variance extracted (AVE) for internal consistency. Structural model measurement employed coefficient determination (R2), effect size (F2), variant inflation factor (VIF), predictive relevance (Q2) and path analysis measures. Results: The results of the study reveal that academic supervision has a significant positive effect on commitment (β; 0.085, t-statistics; 3.792 and p-value 0.000), academic supervision also affects teacher performance (β; 0.096, t-statistics; 4.416 and p-value 0.000), managerial competence affects teacher commitment (β; 0.195, t-statistics; 8.046 and p-value 0.000), managerial competence also affects teacher performance (β; 0.149, t-statistics; 6.561 and p-value 0.000), organizational commitment affects teacher performance (β; 0.163, t-statistics; 7.263 and p-value 0.000), teacher empowerment affects teacher commitment (β; 0.489, t-statistics; 22.601 and p-value 0.000), and teacher empowerment affects teacher performance (β; 0.489, t-statistics; 22.601 and p-value 0.000). Academic supervision affects teacher commitment mediating by teacher performance (β; 0.014, t-statistics; 3.178 and p-value of 0.001). Managerial competence affects teacher commitment with teacher performance mediation (β; 0.032, t-statistics; 5.588 and p-value 0.000), and teacher empowerment affects teacher commitment with teacher performance mediation (β; 0.080, t-statistics; 7.050 and p-value 0.000). Conclusion: Academic supervision, managerial competence, and teacher empowerment significantly positively affect teacher performance directly and through teacher performance as mediating variable. Teacher empowerment is the most significant factor influencing teacher performance and commitment.

Project description:ImportanceEnd-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time.ObjectiveTo determine the changes in end-of-life practices in European ICUs after 16 years.Design, setting, and participantsEthicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000). During a self-selected continuous 6-month period at each ICU, consecutive patients who died or had any limitation of life-sustaining therapy from September 2015 until October 2016 were included. Patients were followed up until death or until 2 months after the first treatment limitation decision.ExposuresComparison between the 1999-2000 cohort vs 2015-2016 cohort.Main outcomes and measuresEnd-of-life outcomes were classified into 5 mutually exclusive categories (withholding of life-prolonging therapy, withdrawing of life-prolonging therapy, active shortening of the dying process, failed cardiopulmonary resuscitation [CPR], brain death). The primary outcome was whether patients received any treatment limitations (withholding or withdrawing of life-prolonging therapy or shortening of the dying process). Outcomes were determined by senior intensivists.ResultsOf 13?625 patients admitted to participating ICUs during the 2015-2016 study period, 1785 (13.1%) died or had limitations of life-prolonging therapies and were included in the study. Compared with the patients included in the 1999-2000 cohort (n?=?2807), the patients in 2015-2016 cohort were significantly older (median age, 70 years [interquartile range {IQR}, 59-79] vs 67 years [IQR, 54-75]; P?<?.001) and the proportion of female patients was similar (39.6% vs 38.7%; P?=?.58). Significantly more treatment limitations occurred in the 2015-2016 cohort compared with the 1999-2000 cohort (1601 [89.7%] vs 1918 [68.3%]; difference, 21.4% [95% CI, 19.2% to 23.6%]; P?<?.001), with more withholding of life-prolonging therapy (892 [50.0%] vs 1143 [40.7%]; difference, 9.3% [95% CI, 6.4% to 12.3%]; P?<?.001), more withdrawing of life-prolonging therapy (692 [38.8%] vs 695 [24.8%]; difference, 14.0% [95% CI, 11.2% to 16.8%]; P?<?.001), less failed CPR (110 [6.2%] vs 628 [22.4%]; difference, -16.2% [95% CI, -18.1% to -14.3%]; P?<?.001), less brain death (74 [4.1%] vs 261 [9.3%]; difference, -5.2% [95% CI, -6.6% to -3.8%]; P?<?.001) and less active shortening of the dying process (17 [1.0%] vs 80 [2.9%]; difference, -1.9% [95% CI, -2.7% to -1.1%]; P?<?.001).Conclusions and relevanceAmong patients who had treatment limitations or died in 22 European ICUs in 2015-2016, compared with data reported from the same ICUs in 1999-2000, limitations in life-prolonging therapies occurred significantly more frequently and death without limitations in life-prolonging therapies occurred significantly less frequently. These findings suggest a shift in end-of-life practices in European ICUs, but the study is limited in that it excluded patients who survived ICU hospitalization without treatment limitations.

Dataset Information

The Relationship Between Safety Climate and Performance in Intensive Care Units: The Mediating Role of Managerial Safety Practices and Priority of Safety.

Publications

The Relationship Between Safety Climate and Performance in Intensive Care Units: The Mediating Role of Managerial Safety Practices and Priority of Safety.

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