Reconceptualizing Patient Safety Beyond Harm: Insights From a Mixed-Methods Qualitative Inquiry.

BACKGROUND: Although patients' and care partners' perspectives on patient safety can guide health care learning and improvements, this information remains underutilized. Efforts to leverage this valuable data require challenging the narrow focus of safety as the absence of harm. PURPOSE: The purpose of this study was to gain a broader insight into how patients and care partners perceive and experience safety. METHODS: We used a mixed-methods approach that included a literature review and interviews and focus groups with patients, care partners, and health care providers. An emergent coding schema was developed from triangulation of the 2 data sets. RESULTS: Two core themes-feeling unsafe and feeling safe-emerged that collectively represent a broader view of safety. CONCLUSION: Knowledge from patients and care partners about feeling unsafe and safe needs to inform efforts to mitigate harm and promote safety, well-being, and positive outcomes and experiences.

Insights on a National Safety Improvement Learning Collaborative: Using the Consolidated Framework for Implementation Research.

Background: There is a growing interest in quality improvement collaboratives (QICs), even though less remains known about contextual factors that impact collective and local project implementation. A study was undertaken that used the Consolidated Framework for Implementation Research (CFIR) to explore the contextual factors impacting the use of this nationwide QIC in Canada. Methods: A deductive or direct qualitative content analysis using CFIR was employed to explore the contextual factors impacting the implementation of a nationwide QIC and participating organizations. Data were used from document analysis and semi-structured interviews with participants from 30 participating healthcare organizations across Canada. Results: A variety of contextual factors emerged, which influenced the uptake of the QICs across different settings, including intervention characteristics, outer setting, inner setting, and process factors. This study illustrates how organizations can consider a multi-pronged, theory-driven approach to guide the evaluation of safety and quality improvement efforts. Conclusions: This study provides insights into contextual factors that impact the implementation of local safety projects involved in a larger QIC, which may serve as a template or blueprint for healthcare leaders in their efforts to guide the co-design, implementation and evaluation of safety and quality improvement efforts.

Integrating Implementation Science in a Quality and Patient Safety Improvement Learning Collaborative: Essential Ingredients and Impact.

BACKGROUND: There is a current lack of research exploring the contextual factors of why and how quality improvement collaboratives (QICs) work. To this end, a mixed methods study was undertaken to improve our understanding of what works for whom and in what context among participants in a nationwide Canadian QIC. METHODS: The authors used a mixed methods approach consisting of a written survey and 30-to-45-minute telephone interviews with collaborative team members, coaches, and senior leaders of participating safety improvement project (SIP) organizations to identify the essential elements of an integrated approach involving implementation science/knowledge translation, quality improvement (QI), patient safety, and collaborative learning/networked approach to enhancing safety and quality and building implementation capabilities. Survey data were analyzed using descriptive statistics. Interview data were analyzed by three team members using thematic analysis and development of an emergent coding schema. RESULTS: Four themes emerged as the essential elements: (1) integrating implementation science into the QI/patient safety learning collaborative; (2) reinforcing of and opening eyes to implementation science by an expert implementation specialist; (3) valuing the sense making and strategies shared by coaches; and (4) experiencing challenges to implementation amplified by the COVID-19 pandemic. Teams also reported improvements in teamwork and patient outcomes as a result of participating in the QIC. CONCLUSION: This study's findings provide deeper insight into the "essential ingredients" (expert implementation specialist, coaches) grounded in an integrated approach that drew from QI, patient safety, and implementation science. Organizations can use the key learnings on how best to implement quality and safety projects by leveraging the sense making of the expert implementation specialist and coaches in an integrated networked learning approach.

[French vice-consul George Soulié de Morant and golden acupuncture needles].

The literature study and physical measurement were adopted to analyze the origin and relevant texture information of a box of French golden acupuncture needles stored in Yunnan University of CM. In 1901 the French vice-consul George Soulié de Morant went to China, based on his Chinese linguistic skills, he studied with several Chinese medicine masters during that time. After returning to France, he researched clinic acupuncture with western medical doctors and published articles and books on it, which led him to be a Nobel Prize nominee. He made a box of acupuncture needles, collected by Yunnan University of CM, in which nine needles made by the gold-copper and silver-zinc alloy, decorated with ruby and sapphire representing tonification and dispersion. The parameter of material, thickness and length match well to the description in Zhengjiufa (Chinese Acupuncture). Being the golden box with needles of its kind in the whole world, it has more value of medicine, education, historical and cultural relics than jewellery, which is the wisdom and innovation stimulated by ancient Chinese medical theory in the western world.