Promoting resilience across and within healthcare organizations is a key component of Safety-II. This qualitative study involving six teams across three hospitals in the Netherlands found that healthcare professionals, managers, and quality advisors hold differing perspectives regarding the right approach to clinical practices and the importance of certain clinical actions. The authors underscore the importance of team reflections to foster resilience and accountability across all levels within healthcare organizations.

Ensuring staff have a safe work environment and patients receive safe care are separate but complementary goals. This study describes how elected politicians and healthcare leaders balance workplace safety regulations and patient quality and safety goals in long-term care facilities. Tensions between the groups were identified (e.g., where leaders see flexibility, elected leaders see vagueness). Study themes include creating and improving channels for communication, and clear delineation of roles and responsibilities.

Barcode medication administration (BCMA) technology is a useful tool to reduce medication administration errors (MAE) in the operating room. This study used a pre-post design to estimate the rate of MAE before and after BCMA implementation on infusion pumps. MAE were significantly reduced and up to 90% of errors were considered preventable, if the staff had utilized BCMA. Reasons for not using BCMA included unreadable barcodes, lack of time, and resistance to new processes.

Safety culture is recognized as an essential component of reducing or preventing errors and improving overall patient safety. This commentary calls for greater consistency in defining and measuring safety culture across settings. The authors describe challenges faced by patient safety professionals and researchers, and offer recommendations on overcoming them.

Non-technical skills (NTS), such as teamwork, can be learned through simulation-based team training (SBTT) but must also transfer into practice to be successful. This study reports on an anesthesia team’s transfer of NTS into clinical practice through focus groups at two weeks and six months after participation in in-situ interprofessional SBTT. Participants reported improved practice, but requested more frequent SBTT and debriefing, both in practice and after trainings.

Patient safety incident investigations are important tools for identifying failures and facilitators of patient harm. This article provides an overview of the regulatory bodies in Norway that are involved in investigating adverse events and how the language used during these investigative activities can support or impede the process.

A just culture in healthcare balances organizational and individual responsibility and accountability when medical errors occur. This qualitative study including five healthcare organizations in the Netherlands concluded that open communication and emotional responses are important components of just culture. Researchers also identified several challenges in fostering a just culture, including how individual accountability is addressed and how to combine transparency with patient and clinician privacy.

There is a long-standing tension between health care regulation and just culture principles. This qualitative study explored the experiences of mental health professionals, managers and other healthcare organization staff, as well as inspectors, regarding the role of healthcare inspectors in enabling a just culture. Three themes emerged – (1) the role of the inspector as both a catalyst for learning and a potential barrier, (2) just culture involves relationships between different layers within and outside the organization, and (3) to enable just culture in which inspectors would strike a balance between organizational responsibility and timely regulatory intervention.

This qualitative study conducted in Norway explored how changes in hospital supervision due to new quality improvement regulations and regulatory inspectors’ work, promote or hamper resilience and learning in hospitals. Based on interviews and focus groups with regulatory inspectors, the authors suggest that the government should encourage regulators and local policymakers to communicate positive experiences and smart adaptations in hospital practice.

Measuring errors and adverse events in health care remains challenging, but is essential to achieving safe care. Using qualitative research and informal data, the authors discuss the importance of “soft signals” in patient safety risk assessment, which are warning signs that are not typically formally measured but that indicate problems with safe care, such as patient complaints about poor hygiene, observed disruptive staff behavior, and whistleblower complaints.

Based on qualitative data from healthcare professionals and managers at two Norwegian hospitals, this study examined how next-of-kin in cancer care play a role in organizational resilience. Findings show that next-of-kin complement healthcare professionals in the four “potentials” considered essential for resilient performance: potential to respond, potential to monitor, potential to learn, and potential to anticipate.

… … de Kam D, Kok J, Grit K, Leistikow I, Vlemminx M, Bal R. How incident reporting systems can stimulate social …

The authors discuss how involving families in the investigations of fatal adverse events can improve the investigations by broadening perspectives and providing new information, but can also present challenges due to emotions, trust, and potential conflicts in perspectives between providers and families.

A part of the SAFE-LEAD program to promote safety culture in Norwegian nursing homes and home care services, this paper describes perceived challenges by managers and employees in nursing home and home care services prior to intervention implementation. Focus groups with managers and employees reported several challenges, including: lack of care continuity; difficulties balancing budgetary and care needs; lack of communication between care systems and tools (such as different EHR systems that do not communicate), and; inadequate time leading to different error reporting cultures.

This qualitative study examined how perioperative teams integrate surgical safety checklists into daily surgical practice and existing risk management strategies.  Perceived usefulness was the primary factor associated with use (69%); nurse anesthetists and anesthesiologists were more likely than other provider types to express that their existing safety protocols were sufficient and that elements of the checklist are redundant. The perception of usefulness was found to have considerable impact on checklist execution and communication, and the tool is most effective when it is an integrated part of the multidisciplinary risk management strategy.

Using survey data from home healthcare works in Norway, this study examined the relationship between patient safety culture and transformational leadership, job demands/resources and work engagement. The authors found that transformational leadership, job resources and work engagement were positively correlated with patient safety culture, and that transformational leadership was the strongest predictor for safety culture, which is consistent with prior research.

Patients in long-term care are at risk for many types of adverse events. This article describes a leadership development intervention to promote safety culture in Norwegian nursing homes and home care services. A WebM&M commentary reviewed quality and safety issues in nursing homes.

Patient and family engagement enriches both incident reporting and adverse event investigations. These qualitative interviews with Dutch hospital managers highlight two assets patients and families offer during incident investigations: they provide details hospital staff cannot otherwise capture and the opportunity to regain trust. An Annual Perspective discussed novel approaches to engaging patients in their safety.

Patient safety in the homecare setting has begun to garner increasing attention. This systematic review explored patient safety issues related to the emerging use of telecare to provide remote services for patients at home. Many risks were identified, but the authors conclude more study is needed to understand telecare-related patient safety.

This study found that methods of detecting and monitoring safety hazards differed widely across five European countries, making it impractical to attempt international comparisons of patient safety.