Towards high-reliability organising in healthcare: a strategy for building organisational capacity.

In a high-reliability organisation (HRO), safety and quality (SQ) is an organisational priority, and all workforce members are engaged, continuously learning and improving their work. To build organisational capacity for SQ work, we have developed a role-tailored capacity-building framework that we are currently employing at the Johns Hopkins Armstrong Institute for Patient Safety and Quality as part of an organisational strategy towards HRO. This framework considers organisation-wide competencies for SQ that includes all staff and faculty and is integrated into a broader organisation-wide operating management system for improving quality. In this framework, achieving safe, high-quality care is connected to healthcare workforce preparedness. Capacity-building efforts are tailored to the needs of distinct groups within the workforce that fall within three categories: (1) front-line providers and staff, (2) managers and local improvement personnel and (3) SQ leaders and experts. In this paper we describe this framework, our implementation efforts to date, challenges met and lessons learnt.

Simulation in the Executive Suite: Lessons Learned for Building Patient Safety Leadership.

INTRODUCTION: Simulation is a powerful learning tool for building individual and team competencies of frontline health care providers with demonstrable impact on performance. This article examines the impact of simulation in building strategic leadership competencies for patient safety and quality among executive leaders in health care organizations. METHODS: We designed, implemented, and evaluated a simulation as part of a larger safety leadership network meeting for executive leaders. This simulation targeted knowledge competencies of governance priority, culture of continuous improvement, and internal transparency and feedback. Eight teams of leaders in health care organizations-a total of 55 participants-participated in a 4-hour session. Each team performed collectively as a new chief executive officer (CEO) tasked with a goal of rescuing a hospital with a failing safety record. Teams worked on a modifiable simulation board reflecting the current dysfunctional organizational structure of the simulated hospital. They assessed and redesigned accountability structures based on information acquired in encounter sessions with confederates playing the role of internal staff and external consultants. RESULTS: Data were analyzed, and results are presented as qualitative themes arising from the simulation exercise, participant reaction data, and performance during the simulation. Key findings include high degrees of variability in solutions developed for the dysfunctional hospital system and generally positive learner reactions to the simulation experience. CONCLUSIONS: This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.

A combined microscopic-molecular method for the diagnosis of strongylid infections in sheep.

We evaluated a combined microscopic-molecular approach for the diagnosis of key strongylid infections in sheep using panels of well-defined control and test samples. The method established is based on the separation of nematode eggs from faecal samples using a salt flotation procedure, the extraction and column-purification of genomic DNA, followed by real-time PCR and melting-curve analysis. Specific and semi-quantitative amplification from (a minimum of 0.1-2.0pg) genomic DNA of Haemonchus contortus, Teladorsagia circumcincta, Trichostrongylus spp., Cooperia oncophora, Oesophagostomum columbianum, Oesophagostomum venulosum or Chabertia ovina is achieved using a specific, forward oligonucleotide primer located in the second internal transcribed spacer (ITS-2) of nuclear ribosomal DNA (rDNA) together with a conserved reverse primer in the large subunit of rDNA. Using a panel of well-defined genomic DNA samples from eggs from sheep monospecifically infected with H. contortus or Te. circumcincta, there was a correlation between cycle threshold (Ct) values in the PCR and numbers of egg per gram of faeces, thus allowing the semi-quantitation of parasite DNA in faeces. The findings of the present study indicate that a microscopic-molecular approach provides a useful tool for diagnosis, for epidemiological and ecological surveys as well as for integration into parasite monitoring, drug resistance (i.e. 'egg count reduction') testing or control programmes, particularly following semi- or full-automation.

All together now? Staff views and experiences of a pre-qualifying interprofessional curriculum.

An interprofessional pre-qualifying curriculum for health and social care professionals was introduced at an English university in September 2000. This study explored the experiences of academic staff from a range of professional backgrounds involved in this interprofessional initiative. Data were collected via questionnaires, individual interviews and focus groups and were analysed using Interpretative Phenomenological Analysis. Sixty-one questionnaires were returned out of a possible two hundred (response rate 30.5%); twenty-nine respondents participated in interviews and focus groups. Four main themes emerged from the data: (i) Huge: Size does matter; (ii) Isolation: Together but separate; (iii) Facilitation: Anything but easy; and (iv) Faculty: Do we walk the talk? The study found a cross-Faculty commitment to interprofessional education, but revealed considerable difficulties for those staff responsible for the management and delivery of the curriculum. The vast scale, the complex nature of interprofessional education delivery, the logistics and organizational challenges created significant difficulties for staff, who could at times feel overwhelmed and isolated. Attitudinal barriers to interprofessional education were identified, although the interprofessional curriculum had enhanced interprofessional working within the Faculty. In order to optimize the success of interprofessional education, the significant challenges that exist for academic staff must be addressed, and ownership by staff enabled.