Biomedical subjects

David Pryor

Publications and source records attributed to David Pryor.

4 recordsLinked to original sources

PubMed2006

A leadership framework for culture change in health care.

BACKGROUND: In 2005, Ascension Health's strategic direction sharpened the focus of its 2002 Call to Action to provide "Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind, for Life," Ascension Health has used a framework, the Five Cs of Culture Change, to address the call to action--comprehension (understanding the problem), compassion (spirituality and commitment), collaboration (teaming between subcultures and providers), coordination (system processes, infrastructure, and ideation), and convergence (leadership of local culture with spread and dissemination of new norms in a rapid way). THE FIVE CS OF CULTURE CHANGE AND CULTURE SURVEYS: Climate (or culture) of safety results are provided from a baseline systemwide survey of front-line caregivers' assessments of teamwork and patient safety. The findings are aggregated at the hospital level, clinical area level, and caregiver role level, and fed back to executives, managers, and front-line caregivers. The final major element of culture change, and arguably the most important, involves the leadership and fortitude necessary to stimulate convergence of the culture on a new way of doing things. CONCLUSION: Ascension Health will continue to use a systemwide culture survey for front-line assessments' of safety and teamwork across all clinical areas and to discover best practices and track progress in improving performance.

Delivery of Health Care↗

PubMed2006

Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel.

BACKGROUND: The Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007. However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently exist. METHODS: OR personnel in 60 US hospitals were surveyed using the Safety Attitudes Questionnaire. The teamwork climate domain of the survey uses six items about difficulty speaking up, conflict resolution, physician-nurse collaboration, feeling supported by others, asking questions, and heeding nurse input. To justify grouping individual-level responses to a single score at each hospital OR level, the authors used a multilevel confirmatory factor analysis, intraclass correlations, within-group interrater reliability, and Cronbach's alpha. To detect differences at the hospital OR level and by caregiver type, the authors used multivariate analysis of variance (items) and analysis of variance (scale). RESULTS: The response rate was 77.1%. There was robust evidence for grouping individual-level respondents to the hospital OR level using the diverse set of statistical tests, e.g., Comparative Fit Index = 0.99, root mean squared error of approximation = 0.05, and acceptable intraclasss correlations, within-group interrater reliability values, and Cronbach's alpha = 0.79. Teamwork climate differed significantly by hospital (F59, 1,911 = 4.06, P < 0.001) and OR caregiver type (F4, 1,911 = 9.96, P < 0.001). CONCLUSIONS: Rigorous assessment of teamwork climate is possible using this psychometrically sound teamwork climate scale. This tool and initial benchmarks allow others to compare their teamwork climate to national means, in an effort to focus more on what excellent surgical teams do well.

Anesthesiology↗

PubMed2006

Patient safety in surgery.

BACKGROUND: Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist. METHODS: We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis. RESULTS: The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (alpha = 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital [MANOVA omnibus F (59, 1910) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%. CONCLUSIONS: Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety.

Analysis of Variance↗

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A word to Varmus.

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Administrative Personnel↗