Assessing Patient Safety Culture: Insights from a Neurological Institute.

Introduction-Aim: Assessment of patient safety culture is important for enhancing hospital service quality and clinical outcomes. This study aimed to evaluate the safety of patient culture among health professionals in a neurological institute, in order to identify areas of improvement. The second objective of our study was to determine the influence of the sociodemographic data of the participants on the awareness of patient safety. METHODS: A cross-sectional descriptive study was conducted among healthcare workers exercising at a neurological institution using a validated Hospital Survey of Patient Safety Culture questionnaire containing ten safety care dimensions. RESULTS: A total of 123 responses to the questionnaire were analyzed, accounting for 34.5% of the total (Cronbach's alpha=0.677). Among the participants, 61.8% considered the level of awareness regarding patient safety to be acceptable. The dimensions considered as strengths were "Organizational learning and continuous improvement" with the highest positive response (60.3%) "Relationship patient-staff member" (58.9%) and "Teamwork within units" (58.9%). However, the dimensions considered as weaknesses were "Management support for patient safety" with 28.5% of positive responses and "Communication openness and non-punitive response to error" (40%). CONCLUSION: Patient safety culture among healthcare professionals is at an average with "Organizational learning and continuous improvement" being a positive aspect. However, improvements should be made in all dimensions to enhance and promote patient safety within the institution.

Improvement proposals and actions in medication error reports: Quality and strength: A cross-sectional study.

Background and Aims: Medication errors (MEs) are a significant source of preventable harm in patient care. Voluntary incident reporting and ME reporting systems are essential for managing medication safety. Analyzing aggregated ME reports instead of individual reports can reveal organizational risks. Organizational culture influences reporting activity and the effectiveness of safety improvements depends on their system-focus. This study uses aggregated ME reports to investigate the ME management process and reporting culture in medication safety. It aims to create a hierarchy for ME improvement actions and analyze their strength and management flow in aggregated reports. Methods: A retrospective, cross-sectional study was conducted to review improvement proposals and actions of ME reports in a Finnish tertiary hospital in 2017-2021. The improvement proposals and actions were categorized into strength classes during three stages: reporter proposals, manager proposals, and documented actions. The report management flow was analyzed. Descriptive statistics were used to describe the characteristics and the chi-squared test for categorical variables in the statistical analysis. Results: A new strength classification hierarchy was created with three classes and corresponding numerical values: "strong (3)," "medium (2)," and "weak (1)" Additionally, categories for "no action (0)" and "vague (0)" were included. Out of 5463 ME reports analyzed, improvement proposals and actions were predominantly weak, ranging from 23.4% to 54.2% across different stages of the management process. A significant proportion had no action included (20.5-49.1%) or were vague (4.2-20.6%). Conclusion: Analyzing the strength of improvement proposals and actions in aggregated ME reports provides new insights into reporting culture and the ME management. The new combined strength classification hierarchy is a suitable tool for this analysis.

How do cultural elements shape speak-up behavior beyond the patient safety context? An interprofessional perspective in an obstetrics and gynecology department.

Introduction: Interprofessional working and learning thrives with speak-up behavior. Efforts to improve speak-up have mainly focused on isolated techniques and training programs within the patient safety scope, yet sustained improvement requires a cultural shift beyond this scope. This research investigates the influence of culture elements on speak-up behavior in interprofessional teams beyond the patient safety context. Methods: An exploratory qualitative study design was used in a Dutch hospital's Obstetrics and Gynecology department. A representative sample of stakeholders was purposefully selected, resulting in semi-structured interviews with 13 professionals from different professional backgrounds (nurses, midwifes, managers, medical specialists, and residents). A speak-up pledge was developed by the research team and used to prime participants for discussion. Data analysis involved three-step coding, which led to the development of themes. Results: This study has identified six primary cultural themes that enhance speak-up behavior. These themes encompass the importance of managing a shared vision, the role of functional hierarchy, the significance of robust interpersonal relationships, the formulation of a strategy delineating when to speak up and when to exercise restraint, the promotion of an open-minded professional mindset, and the integration of cultural practices in the context of interprofessional working and learning. Conclusion: Six crucial cultural elements have been pinpointed to boost the practice of speaking up behavior in interprofessional working and learning. Remarkably, hierarchy should not be held responsible as the wrongdoer; instead, can be a great facilitator through respect and appreciation. We propose that employing transformational and humble leadership styles can provide guidance on effectively integrating the identified cultural elements into the workplace and provide an IMOI framework for effective interprofessional speak-up beyond patient safety.

Inspiring nurses' sustainability mindset: Exploring the Mediating Role of Organizational Culture on the relationship between Pro-social Leader behaviors and nurses' sustainability consciousness.

BACKGROUND: Since nurses are at the frontline of healthcare delivery, their actions and understanding of the environment have a big impact on how long healthcare systems can last. It is essential to comprehend the elements that impact nurses' sustainability consciousness to encourage ecologically conscious actions in the healthcare industry. AIM: This study aimed to explore the relationship between pro-social leader behaviors and nurses' sustainability consciousness and testify to the mediating role of organizational culture in this relationship. DESIGN: A cross-sectional descriptive correlational design by STROBE criteria was used. METHODS AND TOOLS: An approach to a judgmental non-probability sampling technique was employed to obtain data from 350 nurses in an Egyptian hospital. Three measurement surveys were employed: Organizational Culture Survey, Prosociality Scale, and, Sustainability Consciousness Questionnaire (SCQ-S). Relationships were shown using structural equation modeling and descriptive and inferential statistics. RESULTS: 53.4% of nurses have high perceptions of organizational culture, and the majority of nurses (85.7%) have high perceptions of prosocial leader behaviors. Furthermore, 60.9% of nurses have high perceptions of sustainability consciousness. Additionally, Prosocial leader behaviors positively correlated with organizational culture (r = 0.129) and nurses' sustainability consciousness (r = 0.274). The indirect effect of prosocial leader behaviors on nurses' sustainability consciousness through organizational culture is calculated by multiplying the coefficients of both direct effects (0.129 * 0.159 = 0.811). This means that for each unit increase in prosocial leader behaviors, we would expect a 0.811 unit increase in nurses' sustainability consciousness through the mediating effect of organizational culture. The model appears to match the data well based on the model fit parameters (CFI = 1.000, IFI = 1.000, RMSEA = 0.114). CONCLUSIONS: The study highlights the impact of pro-social leader behaviors on nurses' sustainability consciousness through the organizational culture as a mediating factor. NURSING IMPLICATIONS: Findings from this research can promote environmental stewardship and sustainable practices in the healthcare sector by illuminating the elements that can encourage and support a sustainability-oriented mindset among nurses. To promote a more sustainable future for the nursing profession, the findings can guide activities in nursing education, corporate culture transformation, and leadership development.

Family Medicine Presence on Labor and Delivery: Effect on Safety Culture and Cesarean Delivery.

PURPOSE: Currently, 40% of counties in the United States do not have an obstetrician or midwife, and in rural areas the likelihood of childbirth being attended to by a family medicine (FM) physician is increasing. We sought to characterize the effect of the FM presence on unit culture and a key perinatal quality metric in Iowa hospital intrapartum units. METHODS: Using a cross-sectional design, we surveyed Iowa physicians, nurses, and midwives delivering intrapartum care at hospitals participating in a quality improvement initiative to decrease the incidence of cesarean delivery. We linked respondents with their hospital characteristics and outcomes data. The primary outcome was the association between FM physician, obstetrician (OB), or both disciplines' presence on labor and delivery and hospital low-risk, primary cesarean delivery rate. Unit culture was compared by hospital type (FM-only, OB-only, or Both). RESULTS: A total of 849 clinicians from 39 hospitals completed the survey; 13 FM-only, 11 OB-only, and 15 hospitals with both. FM-only hospitals were all rural, with <1,000 annual births. Among hospitals with <1,000 annual births, births at FM-only hospitals had an adjusted 34.3% lower risk of cesarean delivery (adjusted incident rate ratio = 0.66; 95% CI, 0.52-.0.98) compared with hospitals with both. Nurses endorsed unit norms more supportive of vaginal birth and stronger safety culture at FM-only hospitals (P <.05). CONCLUSIONS: Birthing hospitals staffed exclusively by FM physicians were more likely to have lower cesarean rates and stronger nursing-rated safety culture. Both access and quality of care provide strong arguments for reinforcing the pipeline of FM physicians training in intrapartum care.

"Necessary evil": the difficulties of establishing programmatic culture in the transfer portal era.

The implementation of the transfer portal and eased transfer restrictions has drastically impacted the migration of college football players. While such athlete autonomy aligns with sweeping organizational policy adopted, and mandated, by the National Collegiate Athletic Association (NCAA), the absence of barriers preventing the mobility of players may have a resultant effect on the development of sustained organizational culture. Through interviews with direct stakeholders currently coaching football at the Football Bowl Subdivision (FBS) level, the findings of this study reveal that while the transfer portal is commonly utilized to achieve short-term success, building a roster composed predominantly of transfer players was perceived as unsustainable in the desired cultivation of meaningful organizational culture. As coaches grapple with the intensified demands to win football games, the findings of this study indicate that sustained long-term programmatic success may be more suitably achieved through the cultivation of distinct organizational culture rather than a reliance on transfer players.

Patient Safety Culture and Safety Attitudes in the Estonian Context: Simultaneous Bilingual Cultural Adaptation and Validation of Instruments.

Objectives: This study aimed to simultaneously and bilingually validate the Hospital Survey on Patient Safety Culture (HSOPSC 2.0) and the Safety Attitudes Questionnaire (SAQ). Methods: The validation included translation, cultural adaptation, and assessment of validity and consistency. Data were collected in three hospitals in 2022 via online and paper surveys, with Estonian- and Russian-speaking employees participating. Results: In total, 579 (30%) participants from the three hospitals completed both questionnaires. Among them, 293 (51%) were Russian-speaking and 286 (49%) were Estonian-speaking. Cronbach's αhy for HSOPSC 2.0 was ≥0.60, except in the Russian version for the three dimensions. Cronbach's α for SAQ was ≥0.60, except in the Russian version for one dimension. Pearson's correlations of the Estonian HSOPSC 2.0 ranged from 0.26 to 0.60 and in the Russian version from 0.18 to 0.47. Conclusion: The validity of the HSOPSC 2.0 and SAQ questionnaires was confirmed in the Estonian versions. Minor corrections were recommended for the Russian. Both versions are considered suitable for assessing PSC in Estonian hospitals.

System Innovation: A Holistic Approach to Disrupting With Love and Human Caring, by Julie Kennedy Oehlert and Kathleen Sitzman.

The bright vision presented by this book provides an invigorating push to bring out the inner anarchist hidden in even the most complacent of health professionals. This book renews the ongoing discussion of how theory-driven change can be used to ground and promote the integration of love and human caring into system innovation. Each chapter of this book provides concrete and realistic application strategies to front-line practice and gives intensive guidance on how to linguistically and intellectually challenge the barriers within an organization that can undermine a vision of holistic caring. For leaders of teams, this book provides invaluable tools to build a culture of caring and maintain a team that perceives caring from both leadership and the organization as a whole. For team members, this book is a reminder that an expectation of workplace culture that is positive, supportive, and fosters growth is not out of reach; it simply has yet to be implemented within their system.

[The Influence of Diversity Management of Nursing Organization on Organizational Commitment: Double Mediating Effect of Diversity Sensitivity Orientation and Positive Nursing Organizational Culture].

PURPOSE: The aim of this study was to identify the double mediating effect of effect of diversity sensitivity orientation and positive nursing organizational culture between diversity management and organizational commitment. METHODS: Participants were 245 nurses working in six tertiary hospitals located in 3 different regions. Data collection was conducted from February 13, 2023 to March 6, 2023 through online self-reported questionnaire. The data were analyzed by IBM SPSS Statistics 27 and SPSS PROCESS Macro 4.2 program. RESULTS: The direct effect of diversity management on organizational commitment was significant (ß = .21, p < .001). The indirect effect of diversity management on organization commitment was .34 (95% confidence interval [CI] = .23~.47). The double mediating effect of diversity sensitivity orientation and positive nursing organizational culture in the relationship between diversity management and organizational commitment was .02 (95% CI = .00~.05). CONCLUSION: Diversity sensitivity orientation and positive nursing organizational culture show double mediating effect on the relationship between diversity management and organizational commitment. Education program and human resource management strategy for enhancing diversity management, diversity sensitivity orientation and positive nursing organizational culture should be provided to improve organizational commitment, and which are needed active support of the association and nursing organization.

Public management approaches to an aging workforce: organizational strategies for strategies for adaptability and efficiency.

This study investigates the impact of psychological age climate on the motivation of aged workers in China and explores the mediating mechanisms at play. Two proposed chains of mediation capture the potential mechanisms underlying this process. The first chain involves the task and knowledge characteristics of work design, specifically autonomy arrangements and skill-based job demands, as mediators. The second chain focuses on the social and physical/contextual aspects of work design, including social support and ergonomic working conditions. The study sample consisted of 1,094 Chinese employees aged between 50 and 70 years (M = 55.66, SD = 4.274). Our findings reveal that a positive psychological age climate-organizational norms and practices that value and support older workers-significantly boosts their motivation to continue working. This enhancement in motivation is mediated by increased job autonomy and robust social support within the workplace, confirming that these elements are crucial for translating a positive age climate into tangible outcomes. Contrary to existing literature, our research does not support the mediating role of job design tailored to aged workers' skills and ergonomic working conditions. This indicates that in the cultural and organizational context of China, where collective values and respect for elder wisdom predominate, autonomy and social support directly influence workers' motivation more profoundly than ergonomic and job design considerations. The study underscores the importance of creating inclusive organizational cultures and implementing targeted support strategies to retain and engage aged workers effectively. It suggests that public policymakers and organizational leaders should focus on fostering positive psychological age climates and providing necessary autonomy and social resources to meet the unique needs of an aging workforce, thereby enhancing both individual and organizational outcomes in a globally aging society.

The last resort: reducing avoidable employee harm by improving the application of the disciplinary policy and process.

Introduction: There is growing evidence within the healthcare sector that employee investigations can harm individuals involved in the process, an organization's culture and the delivery of its services. Methods: This paper details an intervention developed by an NHS Wales organization to reduce the number of its employee investigations through an organization-wide focus that promoted a 'last resort' approach and introduced the concept of 'avoidable employee harm'. A range of associated improvement initiatives were developed to support behavior change among those responsible for determining whether an employee investigation should be initiated. Results: Over a 13-month period, organizational records showed an annual reduction of 71% in investigation cases post-intervention, resulting in an estimated 3,308 sickness days averted annually and total estimated annual savings of £738,133 (based on direct savings and costs averted). This indicates that the organization has started to embrace the "last resort" approach to using employee investigations to address work place issues. The programme was supported with training for those responsible for commissioning and leading the organization's employee investigations. Analysis of survey data from those who attended training workshops to support the programme indicated that participants showed an increased awareness of the employee investigation process post-workshop and an understanding of the concept of avoidable employee harm. Discussion: The programme is congruent with the Healthy Healthcare concept, as the study illustrates how its practices and processes have a beneficial impact on staff, as well as potentially on patients. This study highlights wider issues for consideration, including the: (1) the role of Human Resources (HR), (2) taking a multi-disciplinary approach, (3) culture and practice, (4) the responsibility of the wider HR profession.

Understanding how organizational culture shapes the experiences of direct support professionals: A qualitative meta-synthesis from an organizational justice perspective.

Direct support professionals (DSPs) are critical to the quality of life of people with intellectual and developmental disabilities, yet high turnover rates significantly affect the quality and consistency of their services. A qualitative meta-synthesis could help understand how organizational culture shapes the experiences of DSPs. A systematic search found six articles that met all inclusion criteria. The initial findings show that although DSPs perceived their work as worthy and rewarding, they did not feel valued or supported by management either monetarily or professionally. The analysis revealed an overarching theme with elements congruent with the organizational justice literature. Findings suggest that cultivating a culture of justice and fairness is vital to retaining quality DSPs, promoting organizational outcomes, and improving the quality of life of people with intellectual and developmental disabilities.

Revisiting organizational culture in healthcare: Heterogeneity as a resource.

Aligning culture to be similar across work units is a common organizational tactic, but its appropriateness for the multidisciplinary context of healthcare is far from certain. Variation in perceptions of culture across large health systems may serve a functional purpose in delivering high quality care and ameliorating job stress; however, past research in healthcare has focused on culture as the average set of values and norms (i.e., cultural content) rather than on (dis)agreement about values and norms among organizational members (i.e., cultural structure). This survey-based study examines both cultural content (averages among individuals) and structure (distances between individuals) in departments of a large U.S. healthcare organization (total sample = 26,314 workers, response rate = 84%). We used linear models to associate four commonly used culture measures with outcome measures (perceived care quality, intent to stay, and manageable job stress). We found substantial heterogeneity in perceptions for multiple culture types. We found curvilinear relationships between heterogeneity for all culture types and outcomes, suggesting that heterogeneity promotes positive outcomes up to a certain point after which the positive effect declines. For research, our findings point to the importance of studying culture in healthcare with greater focus on heterogeneity; for practice, this study highlights how culturally-focused efforts to improve care quality and worker experience in healthcare should be more precise about balancing cultural alignment and heterogeneity.

Corrigendum: Leadership as a determinant of need fulfillment: implications for meta-theory, methods, and practice.

[This corrects the article DOI: 10.3389/fpsyg.2024.1427072.].

Leadership as a determinant of need fulfillment: implications for meta-theory, methods, and practice.

Of all the most prominent business concepts (e.g., DE&I, employee well-being, employee engagement, organizational culture, etc.) none rivals leadership in terms of public interest and annual monetary investment. Despite the obvious importance of leadership as a determinant of many important outcomes, the concept of leadership has been surprisingly hard to pin down, lacking consensus as to its precise meaning. As numerous authors introduce ever more constructs (e.g., servant leadership, toxic leadership, sustainable leadership, transformational leadership, etc.), the leadership concept has become emblematic of the problem of construct proliferation. Like the related fields of employee engagement, subjective well-being, and organizational culture, the leadership field is in desperate need of a clearly articulated meta-theory to house its many constructs, allowing theory and measurement to build up instead of continuing to pile up. This paper argues for grounding the concept of leadership within the psychological literature on human needs. In reviewing the leading definitions of leadership in the literature we find that they are reducible to a core set of follower needs that can be facilitated or inhibited by leaders. We propose that there is substantial value in adopting a comprehensive needs-based taxonomy over current approaches. We consider the impact of setting the concepts of leadership within existing need constructs for each of the following: (a) theory, especially the development of leadership frameworks and particularly how the concept of leadership relates to the concepts of organizational culture, employee well-being, and employee engagement; (b) methods, including the value of applying a comprehensive, structured model; and (c) practice, where we emphasize the practical advantages of clear operational definitions.

Informal institutions and corporate innovation: A Perspective from Red Culture.

Since the 20th century, Red Culture has served as a significant informal institution guiding revolutionary trajectory and developmental course. However, integrating Red Culture into contemporary corporate management and leveraging its constructive influence within today's market-driven economy necessitates comprehensive exploration and thoughtful consideration. This study aims to explore the potential influence of Red Culture on contemporary innovation. Empirical findings reveal substantial and affirmative effects of Red Culture on corporate innovation. Specifically, a heightened Red Culture ambiance correlates with a marked increase in both innovation input and output within corporate. Further investigation underscores Red Culture's pivotal governance role in mitigating strategic manipulation of innovation and research and development practices, especially within the overarching framework of innovation-driven strategies. Moreover, Red Culture synergizes with formal innovation incentive mechanisms, jointly fostering corporate innovation. This study provides micro-level empirical evidence that elucidates the impact of Red Culture on corporate innovation. Additionally, it furnishes valuable policy insights for the practical implementation and enhancement of pertinent Red Culture initiative.

Preparing for Value: Evaluating Organizational Culture in Health Care Transformation.

The health care industry is experiencing a transformative shift from traditional fee-for-service models to value-based care (VBC), emphasizing improved patient outcomes, enhanced quality, and reduced costs. While Centers for Medicare & Medicaid Services Innovation Center models focus on financial and quality outcomes, a critical opportunity for reform lies in organizational culture. VBC signifies a cultural and systemic evolution aligned with the quintuple aim of enhancing equitable patient outcomes, improving quality, reducing costs, and prioritizing provider well-being. Cultural impacts play a pivotal role in this transformation.

Siloed mentality, health system suboptimization and the healthcare symphony: a Canadian perspective.

Measuring and optimizing a health system is challenging when patient care is split between many independent organizations. For example, patients receive care from their primary care provider, outpatient specialist clinics, hospitals, private providers and, in some instances, family members. These silos are maintained through different funding sources (or lack of funding) which incentivize siloed service delivery. A shift towards prioritizing patient outcomes and keeping the patient at the centre of care is emerging. However, competing philosophies on patient needs, how health is defined and how health is produced and funded is creating and engraining silos in the delivery of health services. Healthcare and health outcomes are produced through a series of activities conducted by diverse teams of health professionals working in concert. Health professionals are continually learning from each patient interaction; however, silos are barriers to information exchange, collaborative evidence generation and health system improvement. This paper presents a systems view of healthcare and provides a systems lens to approach current challenges in health systems. The first part of the paper provides a background on the current state and challenges to healthcare in Canada. The second part presents potential reasons for continued health system underperformance. The paper concludes with a system perspective for addressing these challenges.

The dynamic feasibility of resisting (R), accepting (A), or directing (D) ecological change.

Ecological transformations are occurring as a result of climate change, challenging traditional approaches to land management decision-making. The resist-accept-direct (RAD) framework helps managers consider how to respond to this challenge. We examined how the feasibility of the choices to resist, accept, and direct shifts in complex and dynamic ways through time. We considered 4 distinct types of social feasibility: regulatory, financial, public, and organizational. Our commentary is grounded in literature review and the examples that exist but necessarily has speculative elements because empirical evidence on this newly emerging management strategy is scarce. We expect that resist strategies will become less feasible over time as managers encounter situations where resisting is ecologically, by regulation, financially, or publicly not feasible. Similarly, we expect that as regulatory frameworks increasingly permit their use, if costs decrease, and if the public accepts them, managers will increasingly view accept and direct strategies as more viable options than they do at present. Exploring multiple types of feasibility over time allows consideration of both social and ecological trajectories of change in tandem. Our theorizing suggested that deepening the time horizon of decision-making allows one to think carefully about when one should adopt different approaches and how to combine them over time.

La viabilidad dinámica de resistir (R), aceptar (A) o dirigir (D) el cambio ecológico Resumen Las transformaciones ecológicas ocurren por el cambio climático, lo que representa un reto para los enfoques tradicionales para decidir en torno a la gestión de tierras. El marco resistir­aceptar­dirigir (RAD) ayuda a los gestores a considerar cómo responder a este reto. Analizamos cómo la viabilidad de las opciones para resistir, aceptar y dirigir cambia de manera compleja y dinámica con el tiempo. Consideramos cuatro tipos distintos de viabilidad: regulatoria, económica, pública y de organización. Nuestro comentario está basado en la revisión bibliográfica y los ejemplos que existen, pero por necesidad tiene elementos especulativos ya que la evidencia empírica sobre esta estrategia emergente de gestión es escasa. Esperamos que las estrategias de resistir se vuelvan menos viables con el tiempo conforme los gestores encuentren situaciones en las que resistir no es viable de forma ecológica, económica, pública o por regulación. Al igual esperamos que cada vez más los marcos regulatorios permitan su uso, si el costo disminuye, y si el público los acepta, los gestores verán cada vez más viables las estrategias de aceptar y dirigir que las que utilizan actualmente. La exploración de varios tipos de viabilidad a lo largo del tiempo permite considerar las trayectorias sociales y ecológicas del cambio en conjunto. Nuestra teoría sugiere que profundizar en el horizonte temporal de las decisiones permite que se analice con cuidado sobre cuando se deben adoptar enfoques diferentes y cómo combinarlos con el tiempo.

Toward a sustainability performance management framework.

Although the United Nations (UN) has continued to introduce the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) to address global sustainability, the world is becoming less sustainable. This is not surprising since our knowledge about effective sustainability performance management is scanty. The present study attempts to develop a sustainability performance management framework to deal effectively with the prevailing sustainability problems. It starts by introducing the "wicked" nature of sustainability problems, followed by a research methodology to build the sustainability performance management framework. The review suggests that the framework's components are related to the organizational culture of sustainability, the sustainability strategy employed by the firm, the corporate sustainability practices implemented, and the resulting outputs and outcomes in terms of sustainability performance. The connections between these elements are fundamentally critical, along with a feedback loop to address the dynamic, wicked sustainability problems. Finally, a Sustainability Performance Management framework and its associated propositions are derived, followed by future research directions and practical implications.