Social determinants of the impact of hospital management boards on quality management: a study of 109 European hospitals using a parsonian approach.

BACKGROUND: The consolidated framework for implementation research states that personal leadership matters in quality management implementation. However, it remains to be answered which characteristics of plural leadership in hospital management boards make them impactful. The present study focuses on social determinants of implementation power of hospital boards using Talcott Parsons' sociological concept of adaptation, goal attainment, integration, and latency (AGIL), focusing on the G (goal attainment) and I (integration) factors of this concept. The study aims to test the hypothesis that hospitals with management boards that are oriented toward the quality goal (G) and socially integrated (I) (GI boards) are better at implementing quality management than hospitals with boards lacking these characteristics (non-GI boards). METHODS: A cross-sectional mixed-method design was used for data collection in 109 randomly selected hospitals in seven European countries. Data is based on the study "Deepening our understanding of quality improvement in Europe" (DUQUE). We used responses from (a) hospitals' chief executive officers to measure the variable social integration and the variable quality orientation of the board and (b) responses from quality managers to measure the degree of implementation of the quality management system. We developed the GI index measuring the combination of goal-orientation and integration. A multiple linear regression analysis was performed. RESULTS: Hospitals with management boards that are quality oriented and socially integrated (GI boards) had significantly higher scores on the quality management system index than hospitals with boards scoring low on these features, when controlled for several context factors. CONCLUSIONS: Our findings suggest that the implementation power of hospital management boards is higher if there is a sense of unity and purpose within the boards. Thus, to improve quality management, it could be worthwhile to increase boards' social capital and to increase time designated for quality management in board meetings.

Does interprofessional team-training affect nurses' and physicians' perceptions of safety culture and communication practices? Results of a pre-post survey study.

BACKGROUND: Many hospitals seek to increase patient safety through interprofessional team-trainings. Accordingly, these trainings aim to strengthen important key aspects such as safety culture and communication. This study was designed to investigate if an interprofessional team-training, administered to a relatively small group of nurses and physicians would promote a change in healthcare professionals' perceptions on safety culture and communication practices throughout the hospital. We further sought to understand which safety culture aspects foster the transfer of trained communication practices into clinical practice. METHODS: We conducted a pre-post survey study using six scales to measure participants' perceptions of safety culture and communication practices. Mean values were compared according to profession and participation in training. Using multiple regression models, the relationship between safety culture and communication practices was determined. RESULTS: Before and after the training, we found high mean values for all scales. A significant, positive effect was found for the communication practices of the physicians. Participation in the training sessions played a variably relevant role in the communication practices. In addition, the multiple regression analyses showed that specific safety culture aspects have a cross-professional influence on communication practices in the hospital. CONCLUSIONS: This study suggest that interprofessional team-trainings of a small group of professionals can successfully be transferred into clinical practice and indicates the importance of safety culture aspects for such transfer processes. Thus, we recommend the consideration of safety culture aspects before starting a training intervention.

Measuring social capital of hospital management boards in European hospitals: A validation study on psychometric properties of a questionnaire for Chief Executive Officers.

BACKGROUND: The commitment of hospital managers plays a key role in decisions regarding investments in quality improvement (QI) and the implementation of quality improvement systems (QIS). With regard to the concept of social capital, successful cooperation and coordination among hospital management board members is strongly influenced by commonly shared values and mutual trust. The purpose of this study is to investigate the reliability and validity of a survey scale designed to assess Social Capital within hospital management boards (SOCAPO-B) in European hospitals. METHODS: Data were collected as part of the EU funded mixed-method project "Deepening our understanding of quality improvement in Europe (DUQuE)" from 210 hospitals in 7 European countries (France, Poland, Czech Republic, Germany, Portugal, Spain, and Turkey). The Chief Executive Officers (CEOs) completed the SOCAPO-B scale (six-item survey, numeric scale, 1='strongly disagree' to 4='strongly agree') regarding their perceptions of social capital within the hospital management board. We investigated the factor structure of the social capital scale using exploratory and confirmatory factor analyses. Internal consistency was assessed using Cronbach's alpha, while construct validity was assessed through Pearson's correlation coefficients between the scale items. RESULTS: A total of 188 hospitals participated in the DUQuE-study. Of these, 177 CEOs completed the questionnaire(172 observations for social capital) Hospital CEOs perceive relatively high social capital among hospital management boards (average SOCAPO-B mean of 3.2, SD = 0.61). The exploratory factor analysis resulted in a 1-factor-model with Cronbach's alpha of 0.91. Pearson's correlation coefficients between the single scale items ranged from 0.48 to 0.68. CONCLUSIONS: The SOCAPO-B-scale can be used to obtain reliable and valid measurements of social capital in European hospital management boards, at least from the CEO's point of view. The brevity of the scale enables it to be a cost-effective and tool for measuring social capital in hospital management boards. TRIAL REGISTRATION: This validation study was not registered.

Correction to: Healthcare professionals' perspectives on working conditions, leadership, and safety climate: a cross-sectional study.

In the original publication of this article [1], the authors missed that reverse coding was necessary for the item "Do you work separate from your colleagues?" before calculating the scale 'social relations'. So they corrected the analysis accordingly. The results with the revised scale show that there are no longer any significant differences between nurses and physicians with regard to this scale.

Healthcare professionals' perspectives on working conditions, leadership, and safety climate: a cross-sectional study.

BACKGROUND: Promoting patient and occupational safety are two key challenges for hospitals. When aiming to improve these two outcomes synergistically, psychosocial working conditions, leadership by hospital management and supervisors, and perceptions of patient and occupational safety climate have to be considered. Recent studies have shown that these key topics are interrelated and form a critical foundation for promoting patient and occupational safety in hospitals. So far, these topics have mainly been studied independently from each other. The present study investigated hospital staffs' perceptions of four different topics: (1) psychosocial working conditions, (2) leadership, (3) patient safety climate, and (4) occupational safety climate. We present results from a survey in two German university hospitals aiming to detect differences between nurses and physicians. METHODS: We performed a cross-sectional study using a standardized paper-based questionnaire. The survey was conducted with nurses and physicians to assess the four topics. The instruments mainly consisted of scales of the German version of the COPSOQ (Copenhagen Psychosocial Questionnaire), one scale of the Copenhagen Burnout Inventory (CBI), scales to assess leadership and transformational leadership, scales to assess patient safety climate using the Hospital Survey on Patient Safety Culture (HSPSC), and analogous items to assess occupational safety climate. RESULTS: A total of 995 completed questionnaires out of 2512 distributed questionnaires were returned anonymously. The overall response rate was 39.6%. The sample consisted of 381 physicians and 567 nurses. We found various differences with regard to the four topics. In most of the COPSOQ and the HSPSC-scales, physicians rated psychosocial working conditions and patient safety climate more positively than nurses. With regard to occupational safety, nurses indicated higher occupational risks than physicians. CONCLUSIONS: The WorkSafeMed study combined the assessment of the four topics psychosocial working conditions, leadership, patient safety climate, and occupational safety climate in hospitals. Looking at the four topics provides an overview of where improvements in hospitals may be needed for nurses and physicians. Based on these results, improvements in working conditions, patient safety climate, and occupational safety climate are required for health care professionals in German university hospitals - especially for nurses.

[DNVF-Memorandum III - Methods for Health Services Research, Part 4 - Concept and Methods for Organizational Health Services Research. Chapter 2 - Methodological Approaches for Organizational Health Services Research: Measures, Data Sources, Data Collection and Data Analysis]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung. Kapitel 2 ­ Methodische Ansätze der organisationsbezogenen Versorgungsforschung: Zielgrößen, Datenquellen, Datenerhebung und Datenanalyse.

Organizational health services research is still a relatively young field of research in Germany which is of increasing interest. The German Network Health Services Research e.V. (DNVF e.V.) published in 2009 - supported by expert associations and individual members of the DNVF - a guide on "Methods for organizational health services research" of the Memorandum III, part 1 1. Originating from this publication and facilitated by the increasing relevance of the field, a necessity to refine the conceptual and methodological basis became evident. The update and extension of the publication from 2009 consists of 3 chapters: (1) Definition and concept of organizational health services research, (2) Methodological approaches in organizational health services research: indicators, data sources, data collection and data analysis, (3) Methodological approaches for the design, evaluation and implementation of complex interventions in healthcare organizations. The aim of the second chapter is to derive methodological requirements and characteristics of organizational health services research - based on the unique characteristics of the research field presented in chapter 1.

[DNVF-Memorandum III - Methods for Health Services Research, Part 4 - Concept and Methods for Organizational Health Services Research: Short Version]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung: Kurzfassung.

Organizational health services research in Germany is of increasing relevance. Based on the guide on methods for organizational health services research of the Memorandum III, part 1 from the year 2009, the fundamentals and standards have now been refined. The memorandum captures the theoretical framework, basic methodological approaches and methods in health services research for the design, evaluation and implementation of complex interventions in healthcare organizations.

Quality management and perceptions of teamwork and safety climate in European hospitals.

OBJECTIVE: This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians. METHOD: We used a multi-method, cross-sectional approach to collect survey data of quality management systems and perceived teamwork and safety climate. Our data analyses included descriptive and multilevel regression methods. SETTING AND PARTICIPANTS: Data on implementation of quality management system from seven European countries were evaluated including patient safety culture surveys from 3622 clinical leaders and 4903 frontline clinicians. MAIN OUTCOME MEASURES: Perceived teamwork and safety climate. RESULTS: Teamwork climate was reported as positive by 67% of clinical leaders and 43% of frontline clinicians. Safety climate was perceived as positive by 54% of clinical leaders and 32% of frontline clinicians. We found positive associations between implementation of quality management systems and teamwork and safety climate. CONCLUSIONS: Our findings, which should be placed in a broader clinical quality improvement context, point to the importance of quality management systems as a supportive structural feature for promoting teamwork and safety climate. To gain a deeper understanding of this association, further qualitative and quantitative studies using longitudinally collected data are recommended. The study also confirms that more clinical leaders than frontline clinicians have a positive perception of teamwork and safety climate. Such differences should be accounted for in daily clinical practice and when tailoring initiatives to improve teamwork and safety climate.

The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals.

OBJECTIVE: To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. DESIGN: A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways. SETTING AND PARTICIPANTS: Seventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. MAIN OUTCOME MEASURE: Four composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways. RESULTS: Accreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke). CONCLUSIONS: Accreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.

Is social capital as perceived by the medical director associated with coordination among hospital staff? A nationwide survey in German hospitals.

Effective coordination among all members of hospital staff has been shown to be associated with better quality of care. The literature indicates that social capital, a form of organizational resource, may facilitate the task of coordination. However, to the best of our knowledge, no study has yet examined this link within a healthcare setting. Thus, the objective of this study was to analyze the relationship between social capital and coordination among hospital staff, as perceived by the medical director being a key informant of the hospital. In 2008, we surveyed the medical directors of 1224 German hospitals by the use of a standardized questionnaire. We conducted stepwise multivariate linear regression and controlled for hospital size, ownership and teaching status. In total, 551 medical directors (45%) responded to the survey. We found social capital to be a significant predictor of coordination (ß = 0.444, p < 0.001). The regression model explained 28% of the variance in coordination. Higher levels of social capital can be associated with better coordination among members of hospital staff, as perceived by the medical director. Therefore, investment in social capital may facilitate better organization of work processes in hospitals and may therefore help to improve patient outcomes. However, longitudinal studies are needed in order to explain the causal relationship between social capital and coordination among hospital staff.

Effectiveness and feasibility of an interprofessional training program to improve patient safety-A cluster-randomized controlled pilot study.

Introduction: Interprofessional healthcare teams are important actors in improving patient safety. To train these teams, an interprofessional training program (IPTP) with two interventions (eLearning and blended learning) was developed to cover key areas of patient safety using innovative adult learning methods. The aims of this study were to pilot test IPTP regarding its effectiveness and feasibility. The trial was registered with DRKS-ID: DRKS00012818. Methods: The design of our study included both a pilot investigation of the effectiveness of the two interventions (eLearning and blended learning) and testing their feasibility (effectiveness-implementation hybrid design). For testing the effectiveness, a multi-center cluster-randomized controlled study with a three-arm design [intervention group 1 (IG1): eLearning vs. intervention group 2 (IG2)]: blended learning (eLearning plus interprofessional in-person training) vs. waiting control group (WCG) and three data collection periods (pre-intervention, 12 weeks post-intervention, and 24 weeks follow-up) was conducted in 39 hospital wards. Linear mixed models were used for the data analysis. The feasibility of IPTP was examined in 10 hospital wards (IG1) and in nine hospital wards (IG2) using questionnaires (formative evaluation) and problem-focused interviews with 10% of the participants in the two intervention groups. The collected data were analyzed in a descriptive exploratory manner. Results: Pilot testing of the effectiveness of the two interventions (eLearning and blended learning) showed no consistent differences between groups or a clear pattern in the different outcomes (safety-related behaviors in the fields of teamwork, error management, patient involvement, and subjectively perceived patient safety). Feasibility checks of the interventions showed that participants used eLearning for knowledge activation and self-reflection. However, there were many barriers to participating in eLearning, for example, lack of time or access to computers at the ward. With regard to in-person training, participants stated that the training content sensitized them to patient-safety-related issues in their everyday work, and that awareness of patient safety increased. Discussion: Although the interventions were judged to be feasible, no consistent effects were observed. A possible explanation is that the duration of training and the recurrence rate may have been insufficient. Another conceivable explanation would be that participants became more sensitive to patient safety-critical situations due to their knowledge acquired through the IPTP; therefore, their assessment post-intervention was more critical than before. In addition, the participants reported high pre-measurement outcomes. Future studies should examine the evidence of the intervention within a confirmatory study after adapting it based on the results obtained.

The relationship between transformational leadership and social capital in hospitals--a survey of medical directors of all German hospitals.

CONTEXT: The German hospital market has been undergoing major changes in recent years. Success in this new market is determined by a multitude of factors. One is the quality of the social relationships between staff and the presence of shared values and rules. This factor can be considered an organization's "social capital." OBJECTIVE: This study investigates the relationship between social capital and leadership style in German hospitals using a written survey of medical directors. DESIGN AND SETTING: In 2008, a cross-sectional representative study was conducted with 1224 medical directors from every hospital in Germany with at least 1 internal medicine unit and 1 surgery unit. Among the scales included in the standardized questionnaire were scales used to assess the medical directors' evaluation of social capital and transformational leadership in the hospital. We used a multiple linear regression model to examine the relationship between social capital and internal coordination. We controlled for hospital ownership, teaching status, and number of beds. PARTICIPANTS: In total, we received questionnaires from 551 medical directors, resulting in a response rate of 45.2%. The participating hospitals had an average of 345 beds. The sample included public (41.3%), not-for-profit (46.9%), and for-profit (11.7%) hospitals. RESULTS: The data, which exclusively represent the perceptions of the medical directors, indicate a significant correlation between a transformational leadership style of the executive management and the social capital as perceived by medical directors. A transformational leadership style of the executive management accounted for 36% of variance of the perceived social capital. CONCLUSION: The perceived social capital in German hospitals is closely related to the leadership style of the executive management. A transformational leadership style of the executive management appears to successfully strengthen the hospital's social capital.

Using the Global Trigger Tool in surgical and neurosurgical patients: A feasibility study.

BACKGROUND: The Global Trigger Tool (GTT) has become a worldwide used method for estimating adverse events through a retrospective patient record review. However, little is known about the facilitators and the challenges in the GTT-implementation process. Thus, this study followed two aims: First, to apply a comprehensive set of feasibility criteria to qualitatively and systematically assess the GTT-implementation process in three departments of German university hospitals. Second, to identify the facilitators and the obstacles met in the GTT-implementation process and to derive recommendations for supporting other hospitals in implementing the GTT in clinical practice. METHODS: The study used a qualitative documentary method based on process documentation, with written and verbal feedback from the reviewer, as well as evaluating the study sites during the implementation process. The study was conducted in three departments, each in a different German university hospital. The authors applied a comprehensive set of 22 feasibility criteria assessing the level of challenge in GTT implementation. The results were synthesized and they focused on the facilitators and the challenges. RESULTS: Of these 22 feasibility criteria, nine were assessed as a low-level challenge, eleven regarded as a moderate-level challenge, and two with a problematic level of challenge. In particular, the lack of time and staff resources, the quality of the information in the patient records, organizational procedures, and local issues, posed major challenges in the implementation process. By contrast, the use of local coordinators and an external expert made important contributions to the GTT implementation. CONCLUSIONS: Considering the facilitators and the obstacles beforehand may help with the implementation of the GTT in routine practice. In particular, early and effective planning can reduce or prevent critical challenges in terms of time, staff resources, and organizational aspects.

Psychometric properties of the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M).

BACKGROUND: From a management perspective, it is necessary to examine how a hospital's top management assess the patient safety culture in their organisation. This study examines whether the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M) has the same psychometric properties as the HSOPS for hospital employees does. METHODS: In 2008, a questionnaire survey including the HSOPS_M was conducted with 1,224 medical directors from German hospitals. When assessing the psychometric properties, we performed a confirmatory factor analysis (CFA). Additionally, we proved construct validity and internal consistency. RESULTS: A total of 551 medical directors returned the questionnaire. The results of the CFA suggested a satisfactory global data fit. The indices of local fit indicated a good, but not satisfactory convergent validity. Analyses of construct validity indicated that not all safety culture dimensions were readily distinguishable. However, Cronbach's alpha indicated that the dimensions had an acceptable level of reliability. CONCLUSION: The analyses of the psychometric properties of the HSOPS_M resulted in reasonably good levels of property values. Although the set of dimensions within the HSOPS_M needs further scale refinement, the questionnaire covers a broad range of sub-dimensions and supplies important information on safety culture. The HSOPS_M, therefore, is eligible to measure safety culture from the hospital management's points of view and could be used in nationwide hospital surveys to make inter-organisational comparisons.

Influence of Gender, Profession, and Managerial Function on Clinicians' Perceptions of Patient Safety Culture: A Cross-National Cross-Sectional Study.

OBJECTIVES: In recent years, several instruments for measuring patient safety culture (PSC) have been developed and implemented. Correct interpretation of survey findings is crucial for understanding PSC locally, for comparisons across settings or time, as well as for planning effective interventions. We aimed to evaluate the influence of gender, profession, and managerial function on perceptions of PSC and on the interplay between various dimensions and perceptions of PSC. METHODS: We used German and Swiss survey data of frontline physicians and nurses (n = 1786). Data analysis was performed for the two samples separately using multivariate analysis of variance, comparisons of adjusted means, and series of multiple regressions. RESULTS: Participants' profession and managerial function had significant direct effect on perceptions of PSC. Although there was no significant direct effect of gender for most of the PSC dimensions, it had an indirect effect on PSC dimensions through statistically significant direct effects on profession and managerial function. We identified similarities and differences across participant groups concerning the impact of various PSC dimensions on Overall Perception of Patient Safety. Staffing and Organizational Learning had positive influence in most groups without managerial function, whereas Teamwork Within Unit, Feedback & Communication About Error, and Communication Openness had no significant effect. For female participants without managerial functions, Management Support for Patient Safety had a significant positive effect. CONCLUSIONS: Participant characteristics have significant effects on perceptions of PSC and thus should be accounted for in reporting, interpreting, and comparing results from different samples.

Psychometric properties of the Georgian version of the Safety Attitudes Questionnaire: a cross-sectional study.

OBJECTIVE: To study the psychometric properties of the Georgian version of the Safety Attitudes Questionnaire short version. DESIGN: Cross-sectional study. SETTING: Three Georgian hospitals. PARTICIPANTS: Personnel of participating hospitals (n=305 responses, estimated response rate 30%). INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: Psychometric properties (model fit, internal consistency, construct validity, convergent and discriminant validity) of the instrument, factor structure derived from the data. RESULTS: The Georgian version of Safety Attitudes Questionnaire demonstrated acceptable construct validity and internal consistency (Cronbach's alpha 0.61-0.91). Three factors, Teamwork Climate, Safety Climate and Working Conditions, had limited convergent and discriminant validity. Confirmatory factor analysis with the original six-factor model resulted in limited model fit (χ2/df=2.14, root mean square error of approximation (RMSEA)=0.06, goodness of fit index (GFI)=0.83, CFI=0.88, TLI=0.86). Exploratory factor analysis resulted in a modified four-factor model with satisfactory model fit (χ2/df=2.09, RMSEA=0.06, GFI=0.88, CFI=0.93, TLI=0.91). CONCLUSIONS: The Georgian version of the Safety Attitudes Questionnaire (short version) demonstrated acceptable psychometric properties, with acceptable to good internal consistency and construct validity. While the whole model had limited fit to the data, a modified factor model resulted in good model fit. Our findings suggest the dimension Working Conditions has questionable psychometric properties and should be interpreted with caution. Other two correlated dimensions Teamwork Climate and Safety Climate share considerable variance and may be merged. Overall, the instrument can provide valuable information relevant for advancement of patient safety culture in Georgian hospitals.

Comparing perceived psychosocial working conditions of nurses and physicians in two university hospitals in Germany with other German professionals - feasibility of scale conversion between two versions of the German Copenhagen Psychosocial Questionnaire (COPSOQ).

BACKGROUND: In 2015, the WorkSafeMed study assessed, amongst others, perceived psychosocial working conditions in nurses (n = 567) and physicians (n = 381) from two German university hospitals using scales from the German standard version of the COPSOQ (Copenhagen Psychosocial Questionnaire). This standard version is based on the international COPSOQ I and II. Since 2017, a further developed version of the German COPSOQ (G-COPSOQ III) has been available and data from this version are stored in the German COPSOQ database. The aim of the present study was to compare scales depicting perceived psychosocial workloads and strain in hospital staff from the WorkSafeMed study with reference data (hospital care nurses, general hospital physicians, reference values across all occupations) from the German COPSOQ database (2012-2017). As preliminary work, we explored whether a conversion of COPSOQ scales based on data from the WorkSafeMed study to the G-COPSOQ III scales was possible. METHODS: We applied a multistep approach for conversion. First, we compared 17 COPSOQ scales used in the WorkSafeMed study with the corresponding scales from the G-COPSOQ III according to content and then decided if a conversion was appropriate. If possible, we converted WorkSafeMed scales - the converted scales comprised the same content and number of items as in G-COPSOQ III. An explorative statistical analysis for each original and converted WorkSafeMed scale followed detecting possible statistical and relevant differences between the scales. We then compared converted WorkSafeMed scales with reference data from the German COPSOQ database. RESULTS: Based on the comparison undertaken according to content, a conversion was possible for 16 scales. Using the data from the WorkSafeMed study, the statistical analysis showed only differences between original and converted COPSOQ scales "control over working time" (mean 40.2 vs. 51.8, dCohen = 0.56) and "social relations" (mean 55.6 vs. 41.8, dCohen = - 0.55). Comparing converted WorkSafeMed scales with reference data revealed higher values for "quantitative demands", "work-privacy-conflict", and "job satisfaction" in the WorkSafeMed sample. CONCLUSIONS: The conversion of WorkSafeMed scales was appropriate, allowed a comparison with three reference values in the German COPSOQ database and revealed some implications for improving psychosocial working conditions of nurses and physicians in university hospitals in Germany.

Applying the Global Trigger Tool in German Hospitals: A Pilot in Surgery and Neurosurgery.

OBJECTIVE: The aim of the study was to assess the feasibility and potential of the Global Trigger Tool (GTT) for identifying adverse events (AEs) in different specialties in German hospitals. METHODS: A total of 120 patient records were randomly selected from two surgical and one neurosurgery departments of three university hospitals in Germany for a period of 2 months per department between January and July 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement GTT. RESULTS: Thirty-nine records (32.5%) contained at least one AE. A total of 53 AEs were found in these 39 records. The incidences of AEs were 18.9% and 35.9% in the two surgical departments and 45.3% in neurosurgery. This corresponded to AE rates of 25.5 to 72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. A total of 71.7% of all identified AEs resulted in temporary harm (category E), 26.4% in temporary harm, requiring prolonged hospitalization (category F), and 1.9% in permanent patient harm. We also identified practical challenges, such as the necessary adaptation of the GTT relative to the respective department. CONCLUSIONS: The application of the GTT is feasible and represents an effective instrument for quality measurement when adapted to the departmental specifics. The trigger detection with the GTT is a valuable addition for proactive analyses of high-risk processes.