Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work.

Mats Hedsköld; Magna Andreen Sachs; Torleif Rosander; Mia von Knorring; Karin Pukk Härenstam

Study

Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work.

February 3, 2021

Hedsköld M, Sachs MA, Rosander T, et al. BMC Health Serv Res. 2021;21(1):48.

View more articles from the same authors.

Intensive care units (ICUs) are complex environments that carry high risk for medical errors. This qualitative study characterized the role of front-line ICU managers in organizing for safe care and creating a culture of safety.

PubMed citation

Free full text

Related Resources From the Same Author(s)

March 11, 2020

Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study.

May 19, 2021

The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis.

August 25, 2021

Evaluation of older persons' medications: a critical incident technique study exploring healthcare professionals' experiences and actions.

June 23, 2021

Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project.

October 20, 2021

Exploring psychological safety in healthcare teams to inform the development of interventions: combining observational, survey and interview data.

October 28, 2020

"Time is of the essence": relationship between hospital staff perceptions of time, safety attitudes and staff wellbeing.

December 8, 2021

Safer paediatric surgical teams: a 5-year evaluation of crew resource management implementation and outcomes.

November 8, 2017

Support opportunities for second victims lessons learned: a qualitative study of the top 20 US News and World Report Honor Roll Hospitals.

January 19, 2022

The role of feedback in emergency ambulance services: a qualitative interview study.

April 6, 2022

How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties.

March 18, 2020

Psychological safety during the test of new work processes in an emergency department.

April 6, 2022

Effect of burnout among physicians on observed adverse patient outcomes: a literature review.

June 16, 2021

Internet of things in healthcare for patient safety: an empirical study.

March 16, 2022

A qualitative study of what care workers do to provide patient safety at home through telecare.

June 23, 2021

Associations of person-related, environment-related and communication-related factors on medication errors in public and private hospitals: a retrospective clinical audit.

November 17, 2021

Experience of learning from everyday work in daily safety huddles: a multi-method study.

September 14, 2022

The impact of hospital accreditation on the quality of healthcare: a systematic literature review.

October 27, 2021

Suffering in silence: a qualitative study of second victims of adverse events.

November 27, 2013

The development of the concept of return-on-investment from large-scale quality improvement programmes in healthcare: an integrative systematic literature review.

January 11, 2023

Adaptive design: adaptation and adoption of patient safety practices in daily routines, a multi-site study.

August 12, 2020

A human factors intervention in a hospital--evaluating the outcome of a TeamSTEPPS program in a surgical ward.

April 14, 2021

Adverse events in women giving birth in a labor ward: a retrospective record review study.

November 3, 2021

Health care workers' experiences of workplace incidents that posed a risk of patient and worker injury: a critical incident technique analysis.

July 14, 2021

Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) - a randomized controlled trial.

November 30, 2022

Patient safety when receiving telephone advice in primary care - a Swedish qualitative interview study.

February 23, 2022

Patients and relatives as auditors of safe practices in oncology and hematology day hospitals.

March 31, 2021

Nursing guidelines for comprehensive harm prevention strategies for adult patients in acute hospitals: an integrative review and synthesis.

February 23, 2022

Patient safety culture as a space of social struggle: understanding infection prevention practice and patient safety culture within hospital isolation settings - a qualitative study.

December 14, 2022

Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study.

March 16, 2016

Differences in medication reconciliation interventions between six hospitals: a mixed method study.

June 29, 2022

A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour.

March 18, 2020

Diagnostic errors reported in primary healthcare and emergency departments: a retrospective and descriptive cohort study of 4830 reported cases of preventable harm in Sweden.

October 9, 2019

From fable to reality at Parkland Hospital: the impact of evidence-based design strategies on patient safety, healing, and satisfaction in an adult inpatient environment.

February 10, 2021

How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis.

January 26, 2022

Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis.

January 12, 2022

Interdisciplinary clinicians' attitudes, challenges, and success strategies in providing care to transgender people: a qualitative descriptive study.

October 19, 2022

Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology.

August 5, 2020

Measurement matters: changing penalty calculations under the hospital acquired condition reduction program (HACRP) cost hospitals millions.

February 24, 2021

Organizational readiness to change as a leverage point for improving safety: a national nursing home survey.

September 8, 2021

Prescribers' perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis.

March 10, 2021

Organizational conditions for engagement in quality and safety improvement: a longitudinal qualitative study of community pharmacies.

February 6, 2019

Closing the loop on test results to reduce communication failures: a rapid review of evidence, practice and patient perspectives.

November 25, 2020

Negative emotions experienced by healthcare staff following medication administration errors: a descriptive study using text-mining and content analysis of incident data.

December 21, 2022

The psychometric properties of the 'Hospital Survey on Patient Safety Culture' in Dutch hospitals.

January 21, 2009

Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence.

April 12, 2023

Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews.

February 10, 2021

Use of prescribing safety quality improvement reports in UK general practices: a qualitative assessment.

July 14, 2021

The perception of patient safety in an alternate site of care for elective surgery during the first wave of the novel coronavirus pandemic in the United Kingdom: a survey of 158 patients.

March 24, 2021

Patient safety measurement tools used in nursing homes: a systematic literature review.

December 7, 2022

Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis.

August 17, 2022

What is needed to sustain improvements in hospital practices post-COVID-19? A qualitative study of interprofessional dissonance in hospital infection prevention and control.

May 4, 2022

The critical role of health information technology in the safe integration of behavioral health and primary care to improve patient care.

November 10, 2021

Building a program of expanded peer support for the entire health care team: no one left behind.

October 13, 2021

Combined impact of Medicare's hospital pay for performance programs on quality and safety outcomes is mixed.

August 10, 2022

Understanding the factors influencing implementation of a new national patient safety policy in England: lessons from 'Learning from Deaths'.

May 18, 2022

Patients' perceptions of safety in emergency medical services: an interview study.

December 2, 2020

Differences between professionals' views on patient safety culture in long-term and acute care? A cross-sectional study.

September 22, 2021

Provider bias in prescribing opioid analgesics: a study of electronic medical records at a hospital emergency department.

September 8, 2021

Seniors managing multiple medications: using mixed methods to view the home care safety lens.

March 2, 2016

The relationship of medical assistants' work engagement with their concerns of having made an important medical error: a cross-sectional study.

July 13, 2022

The impact of health care strikes on patient mortality: a systematic review and meta-analysis of observational studies.

November 30, 2022

Reduction in omission events after implementing a rapid response system: a mortality review in a department of gastrointestinal surgery.

March 15, 2023

Psychosocial working conditions as determinants of concerns to have made important medical errors and possible intermediate factors of this association among medical assistants - a cohort study.

March 8, 2023

The work of nurses to provide good and safe services to children receiving hospital-at-home: a qualitative interview study from the perspectives of hospital nurses and physicians.

October 20, 2021

Getting the whole story: integrating patient complaints and staff reports of unsafe care.

July 28, 2021

Differences between managers’ and safety professionals’ perceptions of upwards influence attempts within safety practice.

July 13, 2022

Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study.

July 11, 2012

Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation.

February 17, 2021

Correlation between the number of patient-reported adverse events, adverse drug events, and quality of life in older patients: an observational study.

November 2, 2022

Learning environments, reliability enhancing work practices, employee engagement, and safety climate in VA cardiac catheterization laboratories.

April 6, 2022

Examining causes and prevention strategies of adverse events in deceased hospital patients: a retrospective patient record review study in the Netherlands.

June 16, 2021

Inpatient telemedicine and new models of care during COVID-19: hospital design strategies to enhance patient and staff safety.

September 15, 2021

Patient perspectives on the usefulness of an artificial intelligence-assisted symptom checker: cross-sectional survey study.

March 11, 2020

Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study.

June 29, 2022

The role of the informal and formal organisation in voice about concerns in healthcare: a qualitative interview study.

June 16, 2021

Lifetime prevalence and correlates of patient-perceived medical errors experienced in the U.S. ambulatory setting: a population-based study.

November 18, 2020

Reducing preventable adverse events in obstetrics by improving interprofessional communication skills--results of an intervention study.

March 1, 2023

Tele-Rapid Response Team (Tele-RRT): the effect of implementing patient safety network system on outcomes of medical patients- a before and after cohort study.

January 11, 2023

Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review.

December 8, 2021

Medicines reconciliation in the emergency department: important prescribing discrepancies between the shared medication record and patients' actual use of medication.

March 16, 2022

Explaining the negative effects of patient participation in patient safety: an exploratory qualitative study in an academic tertiary healthcare centre in the Netherlands.

February 1, 2023

Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update.

June 22, 2022

EMS non-conveyance: a safe practice to decrease ED crowding or a threat to patient safety?

October 27, 2021

Hemodialysis bleeding events and deaths: an 18-year retrospective analysis of patient safety and root cause analysis reports in the Veterans Health Administration.

November 24, 2021

Cybersecurity in health is an urgent patient safety concern: we can learn from existing patient safety improvement strategies to address it.

April 7, 2021

The relationship between job stress and patient safety culture among nurses: a systematic review.

March 22, 2023

Real-time debriefing after critical events: exploring the gap between principle and reality.

November 18, 2020

Adverse event reviews in healthcare: what matters to patients and their family? A qualitative study exploring the perspective of patients and family.

June 1, 2022

Changes in burnout and satisfaction with work-life integration in physicians over the first 2 years of the COVID-19 pandemic.

October 26, 2022

National improvements in resident physician-reported patient safety after limiting first-year resident physicians' extended duration work shifts: a pooled analysis of prospective cohort studies.

May 25, 2022

April 27, 2022

An evidence and consensus-based definition of second victim: a strategic topic in healthcare quality, patient safety, person-centeredness and human resource management.

February 15, 2023

Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study.

July 26, 2023

Is detection of adverse events affected by record review methodology? An evaluation of the "Harvard Medical Practice Study" method and the "Global Trigger Tool."

May 8, 2013

Redeployment of health care workers in the COVID-19 pandemic: a qualitative study of health system leaders' strategies.

May 19, 2021

Burnout and sources of stress among health care risk managers and patient safety personnel during the COVID-19 pandemic: a pilot study.

July 7, 2021

Surgical patient safety officers in the United States: negotiating contradictions between compliance and workplace transformation.

February 24, 2021

Impact of state nurse practitioner regulations on potentially inappropriate medication prescribing between physicians and nurse practitioners: a national study in the United States.

December 8, 2021

Exploring the factors that promote or diminish a psychologically safe environment: a qualitative interview study with critical care staff.

September 22, 2021

Related Resources

Patient Safety Innovations

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

July 31, 2023

Patient falls while under supervision: trends from incident reporting.

July 5, 2023

What US hospitals are doing to prevent common device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: results from a national survey in the United States.

June 21, 2023

Patient Safety Innovations

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

May 31, 2023

Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study.

May 3, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

Using a learning system approach to improve safety for prone-position ventilation patients.

April 26, 2023

Patient Safety Innovations

The I-READI Quality and Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical Protocols During a Time of Crisis

March 15, 2023

Interprofessional team collaboration and work environment health in 68 US intensive care units.

November 30, 2022

Exploring care left undone in pediatric nursing.

September 28, 2022

Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.

May 18, 2022

Effects of tall man lettering on the visual behaviour of critical care nurses while identifying syringe drug labels: a randomised in situ simulation.

April 20, 2022

Patient harm and institutional avoidability of out-of-hours discharge from intensive care: an analysis using mixed methods.

March 23, 2022

Outcomes-based nurse staffing during times of crisis and beyond.

February 16, 2022

Using smart IV infusion pumps outside of patient rooms.

February 2, 2022

Supervision, interprofessional collaboration, and patient safety in intensive care units during the COVID-19 pandemic.

November 10, 2021

Factors associated with potentially missed acute deterioration in primary care: cohort study of UK general practices.

October 20, 2021

Implementing a watcher program to improve timeliness of recognition of deterioration in hospitalized children.

June 30, 2021

COVID-19 hospital outbreaks: protecting healthcare workers to protect frail patients. An Italian observational cohort study.

February 3, 2021

Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.

February 3, 2021

Reducing nosocomial transmission of COVID-19: implementation of a COVID-19 triage system.

October 28, 2020

Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation.

October 21, 2020

Restructuring of a general surgery residency program in an epicenter of the coronavirus disease 2019 pandemic: lessons from New York City.

July 29, 2020

The devil is in the detail: how a closed-loop documentation system for IV infusion administration contributes to and compromises patient safety.

July 22, 2020

Untangling infusion confusion: a comparative evaluation of interventions in a simulated intensive care setting.

September 18, 2019

Implementing strategies to identify and mitigate adverse safety events: a case study with unplanned extubations.

February 27, 2019

A qualitative study of speaking out about patient safety concerns in intensive care units.

October 25, 2017

Data-driven implementation of alarm reduction interventions in a cardiovascular surgical ICU.

February 8, 2017

Delayed recognition of deterioration of patients in general wards is mostly caused by human related monitoring failures: a root cause analysis of unplanned ICU admissions.

September 7, 2016

Higher quality of care and patient safety associated with better NICU work environments.

September 2, 2015

See More About The Topic

Hospitals

Intensive Care Units

Facility and Group Administrators

Nurse Managers

Quality and Safety Professionals

Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work.

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

The I-READI Quality and Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical Protocols During a Time of Crisis

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work.

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

The I-READI Quality and Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical Protocols During a Time of Crisis

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site