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IntroductionHealthcare-associated infections are an important patient safety concern, especially in the context of the COVID-19 pandemic. Infection prevention and control implemented in healthcare settings are largely focused on the practices of healthcare professionals. Patient and family engagement is also recognised as an important patient safety strategy. The extent to which patients and families can be engaged, their specific roles and the strategies that support their engagement in infection prevention remain unclear. The overarching objective of the proposed study is to explore how patients and families can effectively be engaged in infection prevention by developing a consensus framework with key stakeholders.Design and methodsThe proposed study is based on a cross-sectional exploratory study at one of the largest university hospitals in North America (Montreal, Canada). The targeted population is all healthcare professionals, managers and other non-clinical staff members who work on clinical units, and the in-patients and their families. The study is based on Q methodology that takes advantage of both quantitative and qualitative methods to identify the consensus among the various stakeholders. This exploratory Q research approach will provide a structured way to elicit the stakeholders’ perspectives on patient and family engagement in infection prevention.Ethics and disseminationThe research ethics board approved this study. The research team plans to disseminate the findings through different channels of communication targeting healthcare professionals, managers in healthcare settings, and patients and family caregivers. The findings will also be disseminated through peer-reviewed journals in healthcare management and in quality and safety improvement.

We describe an innovative research protocol to: (a) examine patient-level longitudinal associations between nurse staffing practices and the risk of adverse events in acute care hospitals and; (b) determine possible thresholds for safe nurse staffing.A dynamic cohort of adult medical, surgical and intensive care unit patients admitted to 16 hospitals in Quebec (Canada) between January 2015-December 2019.Patients in the cohort will be followed from admission until 30-day postdischarge to assess exposure to selected nurse staffing practices in relation to the subsequent occurrence of adverse events. Five staffing practices will be measured for each shift of an hospitalization episode, using electronic payroll data, with the following time-varying indicators: (a) nursing worked hours per patient; (b) skill mix; (c) overtime use; (d) education mix and; and (e) experience. Four high-impact adverse events, presumably associated with nurse staffing practices, will be measured from electronic health record data retrieved at the participating sites: (a) failure-to-rescue; (b) in-hospital falls; (c) hospital-acquired pneumonia and; and (d) venous thromboembolism. To examine the associations between the selected nurse staffing exposures and the risk of each adverse event, separate multivariable Cox proportional hazards frailty regression models will be fitted, while adjusting for patient, nursing unit and hospital characteristics, and for clustering. To assess for possible staffing thresholds, flexible non-linear spline functions will be fitted. Funding for the study began in October 2019 and research ethics/institutional approval was granted in February 2020.To our knowledge, this study is the first multisite patient-level longitudinal investigation of the associations between common nurse staffing practices and the risk of adverse events. It is hoped that our results will assist hospital managers in making the most effective use of the scarce nursing resources and in identifying staffing practices that minimize the occurrence of adverse events.目的: 我们描述了一份创新的研究方案: (a) 检查急诊护理医院护士配置方法与不良事件风险之间的患者水平纵向关联; (b) 确定安全护士配置的可能阈值。 设计: 2015年1月至2019年12月期间, 魁北克省 (加拿大) 16家医院收治的成人医疗、外科和重症监护病房患者动态队列研究。 方法: 将从入院到出院后30天里, 对队列研究中的患者进行随访, 以评估与随后发生的不良事件相关的选定护士工作实践的暴露情况。将使用电子工资单数据, 测量住院期间各轮班的五种人员配置方法, 并采用以下时变指标: (a) 各患者的护理工作时间; (b) 技能混合; (c) 加班使用; (d) 教育混合和; 以及 (e) 经验。将从参与站点检索的电子健康记录数据中测量四个可能与护士配置方法相关的高影响不良事件: (a) 抢救失败; (b) 住院量下降; (c) 院内获得性肺炎和; 以及 (d)静脉血栓栓塞。为检测所选护士人员配置暴露与各种不良事件风险之间的关系, 将拟合单独的多变量Cox比例风险脆弱性回归模型, 同时调整患者、护理单位和医院特征, 并进行聚类分析。为评估可能的人员配置阈值, 将拟合灵活的非线性样条函数。我们于2019年10月, 获得该项研究的资助,于2020年2月获得研究伦理/机构的批准。 讨论: 据我们所知, 此项研究是第一次多地点患者水平的纵向调查, 其针对普通护士配置方法与不良事件风险之间的关联。希望我们的研究结果能帮助医院管理者最有效地利用稀缺的护理资源, 并找出减少不良事件发生的人员配置方法。.

Aims The objectives of the study were to: (1) examine the relationships between three different qualitative perceptions of safety culture and the Canadian Patient Safety Climate Survey factors; (2) determine whether these perceptions are associated with different hand hygiene practices. Background Healthcare-associated infections and safety cultures are a worldwide issue. During the A/H1N1 Influenza pandemic, Europe and North America did not have the same responses. Importantly, healthcare professionals' perceptions can influence patient safety through infection prevention practices like hand hygiene. Design A cross-sectional design was used with data collected in 2015. Methods The Canadian Patient Safety Culture Survey and hand hygiene observations were gathered from three healthcare centres (two Canadian and one European). Descriptive analyses and ANOVAs were conducted to explore healthcare professionals' safety perceptions and practices. Results The rates of hand hygiene practices varied widely between the three sites, ranging from 35–77%. One site (Site 3) was found to have the highest scores of management follow-up, feedback about incidents, supervisory leadership for safety, unit learning culture and senior leadership support for safety, and the highest levels of overall patient safety grades for the unit and organization. Conclusion The quantitative results of this study support the previously described model based on qualitative results: individual culture, blaming culture and collaborative culture. Differences between continents emerged regarding infection prevention practices and the way we qualify infections. The results raise concerns about infection practices and about safety cultures and challenges worldwide.

Patient safety has become a worldwide concern in relation to infectious diseases (Ebola/severe acute respiratory syndrome/flu). During the pandemic, different sanitary responses were documented between Europe and North America in terms of vaccination and compliance with infection prevention and control measures. The purpose of this study was to explore the health care professionals' perceptions of biological risks, patient safety, and their practices in European and Canadian health care facilities. A qualitative-descriptive design was used to explore the perceptions of biological risks and patient safety practices among health care professionals in 3 different facilities. Interviews (n = 39) were conducted with health care professionals in Canada and Europe. The thematic analysis pinpointed 3 main themes: risk and infectious disease, patient safety, and occupational health and safety. These themes fit within safety cultures described by participants: individual culture, blame culture, and collaborative culture. The preventive terminology used in the European health care facility focuses on hospital hygiene from the perspective of environmental risk (individual culture). In Canadian health care facilities, the focus was on risk management for infection prevention either from a punitive perspective (blame culture) or from a collaborative perspective (collaborative culture). This intercultural dialogue described the contextual realities on different continents regarding the perceptions of health care professionals about risks and infections.

Purpose The purpose of the present systematic review is to identify the interventions that improve hand hygiene compliance (HHC) specifically among nurses. Methods A systematic review was performed guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to evaluate the short and long-term effects of interventions to promote hand hygiene practices among nurses in the hospital setting. A search of the Cumulative Index to Nursing and Allied Health Literature, Medline Global Health, and Embase was conducted in addition to studies identified by the most recent systematic review. Six studies met inclusion criteria: three randomized controlled trials (RCTs), one controlled before and after studies (CBAs), and two interrupted times series (ITS). Findings One RCT reported effectiveness and 6-month sustainability of the effect related to multimodal-directed and multimodal with team leadership–directed strategies. The other two RCTs found positive effect of education and feedback on compliance; however, compliance rates declined after 1 month. Education was also found to improve HHC up to 3 months postintervention. An electronic reminder and feedback system evaluated by an ITS improved HHC and detected variation in HHC through the day. Conclusions This review showed that single and combined interventions do improve hand hygiene practices among nurses; however, there is a need for more methodologically robust studies to define the most effective and sustainable interventions. Clinical Relevance Although hand hygiene is the most effective measure to prevent healthcare-associated infections, compliance with hand hygiene remains low. Nurses are among the healthcare providers who spend the most time in direct patient contact. Therefore, there is a need for research to identify the interventions that improve HHC in this group.

Nearly 250 pivot nurse in oncology (PNO) are practising in Quebec to support cancer patients. Yet, it is increasingly obvious that this number is insufficient. A study was conducted to estimate the need for PNOs for the province. Professional consensus was reached using the nominal group technique and the Delphi method. The data obtained help to make staffing decisions based on findings measured in PNOs’ current work reality. It is the authors’ hope that these results will contribute to human resources planning that better meets the needs of cancer patients and their families.

Objective: The general purpose of the study was to evaluate a specific prevention program and its effects on infection prevention practices as part of continuous improvements in patient safety. Infection prevention is a global priority aimed at reducing mortality and morbidity rates related to infections acquired while under care.Methods: A descriptive study was carried out through a documentation analysis and semi-structured interviews with 13 healthcare professionals working in a healthcare centre where the infection prevention program was developed and implemented.Results: The thematic analysis identified three major axes: perceptions concerning audits and huddles strategies, the positive effects of the program on team building and, finally, its sustainability and continuous improvement.Conclusions: Globally, program enhanced the habits of professionals by developing an accurate perception of infections and the way to manage the related risk. The program Controlling Specific Infections Successful Strategies (CSISS) is seen as effective and sustainable by the participants. It contributes to a collaborative safety culture to reduce nosocomial infection rates.

Innovation in patient engagement and empowerment has been identified as a priority area in the Canadian healthcare system. This article describes the development and implementation of the We Should Talk campaign at an academic pediatric hospital. Through the use of a guiding theoretical framework and a multidisciplinary project team, a multimedia campaign was designed to inspire staff, patients and families to effectively communicate to improve patient safety. The We Should Talk campaign provides a case study for how an organization can foster frontline improvement through the engagement of patient, families, and healthcare providers.

Au Québec, près de 250 infirmières pivot en oncologie (IPO) sont déployées au Québec pour soutenir les personnes atteintes d’un cancer. Il devient toutefois de plus en plus évident que ce nombre est insuffisant. Une étude a été menée afin d’estimer les besoins en IPO pour la province. L’établissement d’un consensus professionnel par la technique du groupe nominal et la méthode Delphi ont été utilisés pour atteindre cet objectif. Les données obtenues permettent de baser les décisions de planification des effectifs sur des évidences mesurées dans la réalité du travail actuel des IPO. Ainsi, il est espéré que celles-ci contribueront à une meilleure planification des effectifs pour répondre aux besoins de personnes atteintes de cancer et leurs proches.

INTRODUCTION Although the Child Hospital Consumer Assessment of Healthcare Providers and Systems is a validated tool for the inpatient experience, it may not address features unique to the pediatric emergency department (PED). There is currently no publicly available validated patient-reported experience survey for the PED, and what matters most in this setting remains unknown. METHODS Twelve semistructured interviews were conducted with a convenience sample of parents of children younger than 14 years at a Canadian PED. Data analysis was performed using inductive thematic analysis to identify aspects of patient-reported experiences that matter most to parents in the PED. RESULTS Five themes were identified: (1) making waiting a positive experience, (2) taking the time to provide care, (3) forging a positive partnership, (4) speak up for safe care, and (5) making the environment feel safer. Parents highlighted that while waiting for care is not desirable, it is made more acceptable through the communication of wait time estimates and the presence of child activities in the waiting room. Furthermore, although interactions with providers are brief, parents emphasized the importance of creating an environment of partnership with open communication, taking the time to examine their child, and actively demonstrating the provision of safe, quality care. CONCLUSIONS Results from this study suggest that a patient-reported experience survey in the PED may need to embed elements not currently captured in Child Hospital Consumer Assessment of Healthcare Providers and Systems, such as waiting room experience, comprehensiveness of health assessments, and observations of safety measures. Future studies can use these findings to develop a patient-reported experience survey for use in the PED.

Key wordsSpread strategies, Transforming Care at the Bedside programAbstractPurpose: The purpose of this study was to describe how spread strategies facilitate the successful implementation of the Transforming Care at the Bedside (TCAB) program and their impact on healthcare workers and patients in a major Canadian healthcare organization.Design: This study used a qualitative and descriptive design with focus groups and individual interviews held in May 2014. Participants included managers and healthcare providers from eight TCAB units in a university health center in Quebec, Canada. The sample was composed of 43 individuals.Methods: The data were analyzed using NVivo according to the method proposed by Miles and Huberman.Findings: The first two themes that emerged from the analysis are related to context (organizational transition requiring many changes) and spread strategies for the TCAB program (senior management support, release time and facilitation, rotation of team members, learning from previous TCAB teams, and engaging patients). The last theme that emerged from the analysis is the impact on healthcare professionals (providing front-line staff and managers with the training they need to make changes, team leadership, and increasing receptivity to hearing patients' and families' needs and requests).Conclusions: This study describes the perspectives of managers and team members to provide a better understanding of how spread strategies can facilitate the successful implementation of the TCAB program in a Canadian healthcare organization.Clinical Relevance: Spread strategies facilitate the implementation of changes to improve the quality and safety of care provided to patients.In the healthcare sector, the pace of rising health expenditures is not sustainable and requires an improvement in the network's performance and the re-establishment of balance in public finances (Institut sur la gouvernance d'organisations prives et publics, 2014). Within this context, we must identify strategies for optimizing effective practices, increasing the efficiency of the nurse's workflow, and eliminating waste in order to reduce costs within a reasonable period of time (Chalkidou, 2009; Cornell et al., 2010; Grossmeier, Terry, Cipriotti, & Burtaine, 2010). Initiated in 2003, the Transforming Care at the Bedside (TCAB) initiative was developed through a partnership between the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI) to promote changes as well as to engage front-line staff in developing innovations directly aimed at improving work processes and patient care (IHI, 2014).IHI's TCAB program engages front-line staff in leading process improvement efforts aimed at improving patient outcomes and the work environment (Hassmiller & Bolton, 2009). TCAB has five foundational elements where change is targeted (IHI, 2014): (a) safe and reliable care, (b) vitality and teamwork, (c) patient-centred care, (d) value-added work processes, and (e) transformational leadership. TCAB facilitates positive results for a variety of reasons. It creates a work culture that promotes improved performance and value-added activities (Bolton & Aronow, 2009). Since 2003, several hospitals throughout the United States have been involved in TCAB, and the program has now spread to other countries, including Canada (O'Connor, Ritchie, Drouin, & Covell, 2012). While there are several studies on the impact of TCAB, there is a paucity of research on how to spread TCAB strategies effectively within an organization. The greatest challenge for healthcare managers and teams is not in identifying best practices, but in spreading those practices to care providers as quickly as possible; in fact, the success of implementing a best practice depends on how quickly it can be spread (Flanders, Kaufman, Saint, & Parekh, 2009; Massoud, Nielson, Nolan, Schall, & Sevin, 2006). …

Purpose Quality improvement (QI) is a pillar of good clinical governance and is at the center of modern health care. The Royal College of Physicians and Surgeons of Canada mandated, in CanMeds 2015, that QI should be taught and the competencies assessed in all postgraduate residency programs. The objective is to report on the feasibility and impact of teaching QI to radiation oncology residents at a single institution. Methods and materials A QI team consisting of a clinical fellow, 3 staff physicians, and an expert in QI methods was created within our Department of Radiation Oncology. QI teaching took place in a longitudinal manner, with approximately 12 hours of direct faculty teaching. A mandatory curriculum divided into foundation and intermediate and advanced competencies was devised. Phase 1 teaching, delivered during 2 academic half-days, consisted of didactic lectures, practical workshops, and self-directed online modules. Phase 2 required intermediate-year residents to complete a 9-month QI project. A QI day hosted by the department invited QI experts to teach and enabled residents to present their work, with merit prizes awarded. Our program evaluation used validated assessment tools (self-assessment, QI knowledge-based assessments, and balanced score cards) before and after curriculum implementation and answers quantified using satisfaction indices (SI). Results Subjective and objective assessments demonstrated improvements in residents' QI knowledge acquisition following curriculum implementation. Those who had completed a project (n = 4) had greater confidence with QI methodology compared with those who had completed phase 1 alone (n = 2) (mean SI, 53% precurriculum to 66.5% and 90%). The majority lacked previous QI teaching and knowledge, but learner attitudes improved (SI, 50%-70%) and 91% of colleagues were enthusiastic about the program being implemented. Conclusion We have demonstrated that implementation of a QI curriculum for radiation oncology residents is feasible and that early results suggesting improvements of attitude and knowledge are positive. We anticipate that the QI skills gained will enable the residents to elevate the quality of their practice throughout their subsequent careers.

In 2010, in an effort to increase patient involvement in decision-making about health care redesign, a Quebec university health care organization implemented the Transforming Care at the Bedside (TCAB). This article presents the results from a qualitative study exploring health professionals’ perceptions of TCAB and the effect on turnover and overtime. This descriptive, qualitative study utilized focus groups, individual interviews, and a review of administrative documents for data collection. Participants included hospital workers from five units implementing TCAB. The data generated by the interviews and focus groups were analyzed using NVivo with the method proposed by Miles and Huberman (1994). During the first year of implementation of TCAB, the team noted the importance of taking time to see the effects of the changes and thereby facilitate the involvement of other team members. A number of TCAB team members also cited communication as a facilitating element for informing team members of changes. According to the participants, the TCAB strategies that were implemented have had a positive impact on practice and on the work environment, and turnover showed an improvement. There was no change in absenteeism. TCAB has the potential to impact not only nurses’ work, but interprofessional team work as well, through changes that involve everyone. Future research should focus on how to support team members to reduce resistance to change and increase social support in order to implement and sustain changes.

Crowding is extremely problematic in Canada, as the emergency department (ED) utilization is considerably higher than in any other country. Consequently, an increase has been noted in waiting times for patients who present with injuries of lesser acuity such as wrist injuries. Wrist fractures are the most common broken bone in patients younger than 65 years. Many nurses employed within EDs are requesting wrist radiographs for patients who present with wrist complaints as a norm within their working practice. Significant potential advantages can ensue if EDs adopt a triage nurse-requested radiographic protocol; patients can benefit from a significant time-saving of 36% in ED length of stay (M. Lindley-Jones & B. J Finlayson, 2000)— when nurses initiated radiographs in triage. In addition, the literature suggests that increased rates of patient and staff satisfaction may be achieved, without compromising quality of radiographic request or quality of service (W. Parris,S. McCarthy, A. M. Kelly, & S. Richardson, 1997). Studies have shown that nurses are capable of requesting appropriate radiographs on the basis of a preset protocol. As there are no standardized set of rules for assessing patients, presenting with suspected wrist fractures, a training program as well as a diagnostic algorithm was developed to prepare emergency nurses to appropriately request wrist radiographs. The triage nurse-specific training program includes the following topics: wrist anatomy and physiology, commonly occurring wrist injuries, mechanisms of injury, physical assessment techniques, and types of radiographic images required. The triage nurse algorithm includes the clinical decision-making process. Providing triage nurses with up-to-date evidence-based educational material not only allowed triage nurses to independently assess and request wrist radiographs for patients with potential wrist fractures but also strengthening the link between competent nursing care and better patient outcomes. A review of the literature also found that such initiatives increase patient and staff satisfaction as well as promoting efficient use of right staff at the right time.

The objective of the study was to document the impact of Transforming Care at the Bedside (TCAB) program on health care team's effectiveness, patient safety, and patient experience. A pretest and posttest (team effectiveness) and a time-series study design (patient experience and safety) were used. The intervention (the TCAB program) was implemented in 8 units in a multihospital academic health science center in Montreal, Quebec, Canada. The impact of TCAB interventions was measured using the Team Effectiveness (TCAB teams, n = 50), and Clostridium difficile-associated diarrhea and vancomycin-resistant Enterobacter rates (patient safety) and Hospital Consumer Assessment of Healthcare Providers and Systems (patient experience; n = 551 patients). The intervention was composed of 4 learning modules, each lasting 12 to 15 weeks of workshops held at the start of each module, combined with hands-on learning 1 day per week. Transforming Care at the Bedside teams also selected 1 key safety indicator to improve throughout the initiative. Pretest and posttest differences indicate improvement on the 5 team effectiveness subscales. Improvement in vancomycin-resistant Enterococcus rate was also detected. No significant improvement was detected for patient experience. These findings call to attention the need to support ongoing quality improvement competency development among frontline teams.

This article presents the experiences of patients engaged in co-designing care under a program entitled, "Transforming Care at the Bedside," based at an academic health sciences center. This descriptive, qualitative study collected data through individual interviews. Participants included patients from 5 units in an academic health sciences center in Quebec, Canada. A total of 6 individual interviews were conducted in November 2014, 15 months after the Transforming Care at the Bedside work began in September 2013. Content analysis was used to analyze the qualitative data. Being listened to and informed gave patients an opportunity to better understand patient needs and the complexity of care in the unit and in the organization. The experience enabled patients to better translate the patient experience for the team's benefit and influence the team's perspective and decisions. Through this experience, several patients felt motivated and empowered and that they afforded consideration through this experience. This study highlights the importance of creating opportunities for patients and health care providers to share their unique experiences and expertise to better understand each other's reality. In this context, they developed a more comprehensive understanding of the issues and worked together to implement realistic changes on behalf of the patients.

Background Adverse events (AEs) in acute care hospitals are frequent and associated with significant morbidity, mortality, and costs. Measuring AEs is necessary for quality improvement and benchmarking purposes, but current detection methods lack in accuracy, efficiency, and generalizability. The growing availability of electronic health records (EHR) and the development of natural language processing techniques for encoding narrative data offer an opportunity to develop potentially better methods. The purpose of this study is to determine the accuracy and generalizability of using automated methods for detecting three high-incidence and high-impact AEs from EHR data: a) hospital-acquired pneumonia, b) ventilator-associated event and, c) central line-associated bloodstream infection. Methods This validation study will be conducted among medical, surgical and ICU patients admitted between 2013 and 2016 to the Centre hospitalier universitaire de Sherbrooke (CHUS) and the McGill University Health Centre (MUHC), which has both French and English sites. A random 60% sample of CHUS patients will be used for model development purposes (cohort 1, development set). Using a random sample of these patients, a reference standard assessment of their medical chart will be performed. Multivariate logistic regression and the area under the curve (AUC) will be employed to iteratively develop and optimize three automated AE detection models (i.e., one per AE of interest) using EHR data from the CHUS. These models will then be validated on a random sample of the remaining 40% of CHUS patients (cohort 1, internal validation set) using chart review to assess accuracy. The most accurate models developed and validated at the CHUS will then be applied to EHR data from a random sample of patients admitted to the MUHC French site (cohort 2) and English site (cohort 3)—a critical requirement given the use of narrative data –, and accuracy will be assessed using chart review. Generalizability will be determined by comparing AUCs from cohorts 2 and 3 to those from cohort 1. Discussion This study will likely produce more accurate and efficient measures of AEs. These measures could be used to assess the incidence rates of AEs, evaluate the success of preventive interventions, or benchmark performance across hospitals.

Aim To explore the perceptions of nurses in an acute care setting on factors influencing the effectiveness of audit and feedback. Background Audit and feedback is widely used and recommended in nursing to promote evidence-based practice and to improve care quality. Yet the literature has shown a limited to modest effect at most. Audit and feedback will continue to be unreliable until we learn what influences its effectiveness. Method A qualitative study was conducted using individual, semi-structured interviews with 14 registered nurses in an acute care teaching hospital in Montreal, Canada. Results Three themes were identified: the relevance of audit and feedback, particularly understanding the purpose of audit and feedback and the prioritisation of audit criteria; the audit and feedback process, including its timing and feedback characteristics; and individual factors, such as personality and perceived accountability. Conclusion According to participants, they were likely to have a better response to audit and feedback when they perceived that it was relevant and that the process fitted their preferences. Implications for nursing management This study benefits nursing leaders and managers involved in quality improvement by providing a better understanding of nurses' perceptions on how best to use audit and feedback as a strategy to promote evidence-based practice.

Purpose: The recent introduction of a project management office (PMO) in a major healthcare center, led by a nurse, provides a unique opportunity to understand how a PMO facilitates successful implementation of evidence-based practices in care delivery. Design: A case study with embedded units (individuals, projects, and organization). In this study, the case is operationally defined as the PMO deployed in a Canadian healthcare center. Methods: The sources of evidence used in this study were diverse. They consisted of 38 individual interviews, internal documents, and administrative data. The data were collected from March 2009 to November 2011. Content analysis was used to analyze the qualitative data. Findings: PMO experts help improve practices, and the patients thus receive safer and better quality care. Several participants point out that they could not make the changes without the PMO’s support. They mention that they succeeded in changing their practices based on the evidence and acquired knowledge of change management with the PMO members that can be transferred to their practice. Conclusions: With the leadership of the nurse director of the PMO, members provide a range of expertise and fields in evidence-based change management, project management, and evaluation. Clinical Relevance: PMO facilitates the implementation of clinical and organizational practices based on evidence to improve the quality and safety of care provided to patients.

The health care system has undergone major changes in the last decade. With greater acuity and complexity of illness, the adoption of innovative technologies and the shortage of health care personnel, the coordination and integration of health care services has become increasingly demanding for administrators. Growing dissatisfaction and concerns about safety issues are being expressed by the users of care who need to navigate through an increasingly complex system and by health care personnel who feel less efficient within the organization. Nursing administrators have a responsibility to address these issues but there is little scientific evidence to guide their actions. There are also few comprehensive models highlighting the main components of nursing administration - models that could guide nursing administration research. This paper presents a conceptual framework for nursing administration and research that links patient health care needs, nursing resources and the nursing care processes to the context of the health care system, and the social, political and cultural environments of care. A selected review of the oncology and cancer care literature is presented to demonstrate how this framework can organize existing knowledge about these concepts in the context of cancer care.

The purpose of this study was to describe how spread strategies facilitate the successful implementation of the Transforming Care at the Bedside (TCAB) program and their impact on healthcare workers and patients in a major Canadian healthcare organization.This study used a qualitative and descriptive design with focus groups and individual interviews held in May 2014. Participants included managers and healthcare providers from eight TCAB units in a university health center in Quebec, Canada. The sample was composed of 43 individuals.The data were analyzed using NVivo according to the method proposed by Miles and Huberman.The first two themes that emerged from the analysis are related to context (organizational transition requiring many changes) and spread strategies for the TCAB program (senior management support, release time and facilitation, rotation of team members, learning from previous TCAB teams, and engaging patients). The last theme that emerged from the analysis is the impact on healthcare professionals (providing front-line staff and managers with the training they need to make changes, team leadership, and increasing receptivity to hearing patients' and families' needs and requests).This study describes the perspectives of managers and team members to provide a better understanding of how spread strategies can facilitate the successful implementation of the TCAB program in a Canadian healthcare organization.Spread strategies facilitate the implementation of changes to improve the quality and safety of care provided to patients.

118 Background: Quality insurance (QI) is a pillar of good clinical governance and is at the centre of modern health care. The Royal College of Physicians and Surgeons of Canada CanMeds 2015 have now mandated that QI should be taught and the competencies assessed in all post-graduate residency programs. To our knowledge, this is the first attempt to create a post-graduate QI curriculum amongst radiation oncology trainees. We aim to describe the feasibility of introducing these professional skills which should be integral to every training program. Methods: A QI team has been created within the department of Radiation Oncology at McGill University consisting of a clinical fellow and 3 staff physicians. QI teaching will take place in a longitudinal manner with the mandatory curriculum divided into foundation, intermediate and advanced competencies depending on years of seniority. Teaching is delivered by a combination of two academic half days, consisting of didactic lectures and practical workshops, and self-directed online modules. Each resident during the intermediate years (PGY2-4) will complete a QI project in 9 months under the supervision of an attending physician. The resident will become well versed with QI tools and techniques by presenting their project at specific 3-monthly time points to their supervisor and QI team. In June we will host a QI day where a QI scholar will be invited to teach, each resident will present their project and merit prizes will be awarded. Formal mandatory assessments will take place with a combination of self-assessment, QI- knowledge based assessments (QI-KATs) and balanced score cards. Results: The curriculum has been developed with input from McGill University curriculum and assessment experts. This is a pilot program for the academic 2016/17 year. We are currently meeting our pre-defined milestones. The program will be formally evaluated and adapted to ensure sustainability. Conclusions: The QI skills gained will enable the individual to maintain the highest standards throughout their subsequent careers. A robust, interactive, sustainable curriculum will ensure that this is delivered effectively within radiation oncology and act as a model for all residency programmes.

Objective: This study sought to explore the perceptions of health care workers about engaging patients as partners on care redesign teams under a program called Transforming Care at the Bedside (TCAB), and to examine the facilitating factors, barriers, and effects of such engagement. Design: This descriptive, qualitative study collected data through focus groups and individual interviews. Participants included health care providers and managers from five units at three hospitals in a university-affiliated health care center in Canada. Methods: A total of nine focus groups and 13 individual interviews were conducted in April 2012, 18 months after the TCAB program began in September 2010. Content analysis was used to analyze the qualitative data. Findings: Health care providers and managers benefited from engaging patients in the decision-making process because the patients brought a new point of view. Involving the patients exposed team members to valuable information that they hadn't previously thought about during decision making. Conclusion: Health care teams stand to benefit from engaging patients in the change process. Patients contribute a different point of view, and this helps to ensure that the changes proposed and implemented address their needs.

Background: The Transforming Care at the Bedside (TCAB) project engages frontline health care providers as the leaders of change and improvement efforts in their work environment. This study explored how health care providers and managers from three TCAB units in a university-affiliated health care center perceived the development of their change capacities following their involvement in this program. Method: This descriptive, qualitative study involved focus groups and individual interviews. Results: Participants learned to work as a team and to expand their outlook. They had access to processes and tools to learn new skills. New relationships also developed among the various players, and they shared new roles, which enabled them to translate the desired changes into action and make the results visible. Conclusion: The study showed the TCAB program helps develop health care providers’ and managers’ change capacities. J Contin Educ Nurs . 2014;45(11):514–520.

Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments.The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments.A pretest and posttest study design was used for this study. The TCAB initiative was implemented in fall 2010 in a university health center in Montreal, Canada. The sample consisted of healthcare workers from four different care units.Statistically significant improvement was observed with the communicating specific information subscale from the measure of processes of care variable, and a significant difference was found between the support from colleagues variable, which was higher at baseline than postprogram. The differences for psychological demand, decisional latitude, and effort-reward were not significant.TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support.

Healthcare is currently in the midst of a construction boom. An increasing number of hospitals are being constructed using the principles of evidence-based design to improve the quality and safety of patient care while at the same maximizing efficiency. As the McGill University Health Centre embarks on a redevelopment journey, performance measurement has been deemed to be a key requirement for monitoring progress toward established objectives. This article discusses the role played by performance measurement in supporting the redevelopment project. Specifically, the importance given to performance measurement, the need for a performance evaluation framework, a description of the framework and the measurement process are presented.

Objective: To document characteristics of nurses’ work interruptions (WIs) during medication administration. Design: A descriptive observational study design was used along with a sample of 102 medication administration rounds. Data were collected on a single medical unit using a unit dose distribution system during fall 2007. Method: Data collection on WIs relied on direct structured observation. The following WI characteristics were recorded: source, secondary task, location, management strategies, and duration. Results: 374 WIs were observed over 59 hours 2 minutes of medication administration time (6.3 WI/hr). During the preparation phase, nurse colleagues (n= 36; 29.3%) followed by system failures such as missing medication or equipment (n= 28; 22.8%) were the most frequent source of WIs. Nurses were interrupted during the preparation phase mostly to solve system failures (n= 33; 26.8%) or for care coordination (n= 30; 24.4%). During the administration phase, the most frequent sources of WIs were self-initiation (n= 41; 16.9%) and patients (n= 39; 16.0%). The most frequent secondary task undertaken during the administration phase was direct patient care (n= 105; 43.9%). WIs lasted 1 min 32 s on average, and were mostly handled immediately (n= 357; 98.3%). Conclusions: The process of medication administration is not protected against WIs, which poses significant risks. Clinical Relevance: Interventions to reduce WIs during the medication administration process should target nurses and system failures to maximize medication administration safety.

Background:Inmanysurveys,nursesciteworkinterruptionsasasignificantcontributortomedication administration errors. Objectives: To review the evidence on (1) nurses’ interruption rates, (2) characteristics of such work interruptions, and (3) contribution of work interruptions to medication administration errors. Approach: Search strategy: CINHAL (1982‐2008), MEDLINE (1980‐2008), EMBASE (1980‐2008), and PSYCINFO (1980‐2008) were searched using a combination of keywords and reference lists. Selection criteria: Original studies published in English using nurses as participants and for which work interruption frequencies are reported. Data collection and analysis: Studies were identified and selected by two reviewers. Once selected, a single reviewer extracted data and assessed quality based on established criteria. Data on nurses’ work interruption rates were synthesized to produce a pooled estimate. Results: Twenty-three studies were considered for analysis. A rate of 6.7 work interruptions per hour was obtained, based on 14 studies that reported both an observation time and work interruption frequency. Work interruptions are mostly initiated by nurses themselves through face-to-face interactions and are of short duration. A lower proportion of interruptions resulted from work system failures such as missing medication. One nonexperimental study documented the contribution of work interruptions to medication administration errors with evidence of a significant association (p = 0.01) when errors related to time of administration are excluded from the analysis. Conceptual shortcomings were noted in a majority of reviewed studies, which included the absence of theoretical underpinnings and a diversity of definitions of work interruptions. Conclusions: Future studies should demonstrate improved methodological rigor through a precise definition of work interruptions and reliability reporting to document work interruption characteristics and their potential contribution to medication administration errors, considering the limited evidence found. Meanwhile, efforts should be made to reduce the number of work interruptions experienced by nurses.