In this cluster randomized trial, a strategy that sought to improve nurses' hand hygiene by emphasizing team commitment and leadership engagement did achieve higher hand hygiene rates compared with a standard quality improvement approach. However, the overall rate of hand hygiene adherence remained poor in both groups.

Multicenter collaboratives have been used to successfully address a variety of patient safety problems. However, this study found that despite the growing use of collaboratives, the essential factors for ensuring success of these efforts remain unclear.

This study found a low rate of patient safety incidents involving telephone care interactions. Most incidents were related to failures in clinical reasoning. A past AHRQ WebM&M commentary discussed potential pitfalls in providing medical advice by telephone.

Improving patient safety requires development of a culture of safety and transformation into a learning organization—one that has the capacity to rapidly address problems through information sharing and learning from past experience. In this systematic review, the authors characterize the published literature on organizational safety programs, and summarize published data on error detection methods (such as incident reporting systems), error analysis, and systems to mitigate and reduce specific errors (such as diagnostic errors and medication errors). The review is limited by publication bias (the preferential publication of studies with positive results) and the descriptive nature of most studies, reducing the generalizability of these studies for other organizations. An AHRQ WebM&M perspective discusses organizational approaches to safety improvement in academic and community settings.

This systematic review of studies of teamwork in health care found that adding personnel with specific clinical expertise to teams appeared to improve performance, but did not necessarily improve patient outcomes.

Improving teamwork among providers of different disciplines is a vitally important step in developing a culture of safety. Despite the development of measurement tools and intervention strategies for addressing inpatient teamwork, comparatively little research has addressed issues of team and organizational culture in the outpatient setting. This study sought to evaluate the relationship between teamwork (measured by the Team Climate Inventory) and organizational culture and chronic disease outcomes in ambulatory clinics. Neither teamwork nor organizational culture at the clinic level was significantly correlated with process or outcome measures, but the authors caution that current measurement methods are not optimal for assessing safety culture in small office practices. A prior trial of crew resource management in an outpatient clinic did result in improved diabetes care.

This article addresses the gap in health care quality and safety research and offers a list of topics for future study. The authors argue that the research community's attitude about this field of study must change.

Many health systems rely on telephone triage to determine the urgency with which a patient should be seen by a clinician. Prior research has demonstrated that errors in triage may lead to patient harm. In this study, standardized patients with a variety of symptoms contacted telephone triage nurses at four Dutch general practices. The investigators analyzed the accuracy of triage decisions by comparing the nurses' advice to the national guideline for telephone triage. Both underestimation and overestimation of the severity of patients' illnesses occurred, although errors were less frequent when nurses had received specific training in use of the guideline. A prior AHRQ WebM&M commentary discusses the potential pitfalls inherent to providing medical advice by telephone and strategies for minimizing patient harm in these situations.