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7. A Quality Improvement Initiative Using Peer Audit and Feedback to Improve Compliance with the Surgical Safety Checklist

Author

Fridrich, Annemarie, Imhof, Anita, Staender, Sven, Brenni, Mirko, and Schwappach, David

Subjects
360 Social problems & social services, 610 Medicine & health
Abstract

BACKGROUND The surgical safety checklist (SSC) published by the WHO in 2009 is used as standard in surgery worldwide to reduce perioperative patient mortality. However, compliance with the SSC and quality of its application is often not satisfactory. Internal audits and feedbacks seem promising for improving SSC application. The purpose of this study is to investigate whether an intervention consisting of peer observation and immediate peer feedback can be implemented with high fidelity and acceptance. METHODS Data was obtained from a national pilot programme that was initiated in Switzerland in 2018 to measure and improve compliance with the SSC using peer audit and feedback. A total of 11 hospitals with 14 sites implemented the full intervention. Each hospital formed an interprofessional project team that should perform at least 30 observations with feedback on SSC application documented in an observation tool developed specifically for this programme. Since the SSCs of the study hospitals differ greatly regarding checklist items, for each of the three SSC sections standard items were defined: four at Sign In, five at Team Time Out, two at Sign Out. Frequency analyses were performed for initiation characteristics, SSC application at item-level, feedback characteristics and programme evaluation. RESULTS The 11 hospitals documented 715 valid observations and feedback on SSC application was provided for 79% of the observations. In 61% all team members stopped their work for the SSC application and in 71% the items were read off from the checklist (instead of recalled from memory). On average, 86% of the standard items were read out by the checklist coordinator, whilst the two items at Sign Out were read out only in 60% and 74%, respectively. Additional visual checks with another source (e.g., patient wristband) took place in only 41% and verbal confirmation of the items (by someone else other than the checklist coordinator) was obtained on an average of 76% across all three checklist sections. The surgical teams reacted positively in 64% to the peer feedback. CONCLUSION Both implementation fidelity and acceptability of the intervention were high-the present intervention seems suitable for regular monitoring of the quality of SSC application with internal resources. Peer observation facilitated identifying weaknesses regarding the SSC process and application at item-level. Across all hospitals, the Sign Out section in general, visual control for item checks and lack of work interruption of all team members during SSC application showed up as the main areas of improvement.

Published
2022

12. quality improvement initiative using peer audit and feedback to improve compliance.

Author

Fridrich, Annemarie, Imhof, Anita, Staender, Sven, Brenni, Mirko, and Schwappach, David

Abstract

Background The Surgical Safety Checklist (SSC) published by the WHO in 2009 is used as standard in surgery worldwide to reduce perioperative patient mortality. However, compliance with the SSC and quality of its application are often not satisfactory. Internal audits and feedbacks seem promising for improving SSC application. Objective The purpose of this study is to investigate whether an intervention consisting of peer observation and immediate peer feedback can be implemented with high fidelity and acceptance. Method Data were obtained from a national pilot programme that was initiated in Switzerland in 2018 to measure and improve compliance with the SSC using peer audit and feedback. A total of 11 hospitals with 14 sites implemented the full intervention. Each hospital formed an interprofessional project team that should perform at least 30 observations with feedback on SSC application documented in an observation tool developed specifically for this programme. Since the SSCs of the study hospitals differ greatly regarding checklist items, for each of the three SSC sections standard items were defined: four at Sign In, five at Team Time Out and two at Sign Out. Frequency analyses were performed for initiation characteristics, SSC application at item level, feedback characteristics and programme evaluation. Results The 11 hospitals documented 715 valid observations, and feedback on SSC application was provided for 79% of the observations. In 61%, all team members stopped their work for the SSC application, and in 71%, the items were read off from the checklist (instead of recalled from memory). On average, 86% of the standard items were read out by the checklist coordinator, whilst the two items at Sign Out were read out only in 60% and 74%. Additional visual checks with another source (e.g. patient wristband) took place in only 41%, and verbal confirmation of the items (by someone else other than the checklist coordinator) was obtained on an average of 76% across all three checklist sections. The surgical teams reacted positively in 64% to the peer feedback. Conclusion Both implementation fidelity and acceptability of the intervention were high—the present intervention seems suitable for regular monitoring of the quality of SSC application with internal resources. Peer observation facilitated identifying weaknesses regarding the SSC process and application at item level. Across all hospitals, the Sign Out section in general, visual control for item checks and lack of work interruption of all team members during SSC application showed up as the main areas of improvement. [ABSTRACT FROM AUTHOR]

Published
2022
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13. Development of a Generic Workshop Appraisal Scale (WASC) for Organizational Health Interventions and Evaluation

Author

Fridrich, Annemarie, Bauer, Georg F, Jenny, Gregor J, Fridrich, Annemarie, Bauer, Georg F, and Jenny, Gregor J

Abstract

This study presents the development of a generic workshop appraisal scale (WASC) for the evaluation of organizational health interventions. Based on the session evaluation questionnaire (SEQ) by Stiles (1980), we developed a short, generic 10-item scale with pairs of adjectives, covering five facets: comprehensibility, relevance, novelty, activation, and valence. Our study is based on N = 499 employees from four organizations who participated in 41 workshops and filled out an evaluation questionnaire on-site. The questionnaire contained the newly developed WASC, as well as items capturing satisfaction with the developed output and outcome expectancies. Results from confirmative factor analysis confirmed the hypothesized five-factor structure of the WASC. The factor structure was found to be nearly invariant across the four organizations, a result that needs to be replicated in larger samples. Analysis of intra-class correlations indicated that 25% of the variance in workshop appraisal can be explained at workshop level. Hereby, perceived relevance and novelty exhibited lower amounts of shared variance, indicating that corresponding workshop appraisals are influenced more by individual factors and less by group dynamics. Furthermore, results from mediation analysis revealed that participants' workshop appraisals were significantly related to their outcome expectancies, and that this relationship was mediated by output satisfaction. Again, the facets showed differential effects: Relevance and comprehensibility seem to contribute most to the total effect on outcome expectancy, followed by activation, whereas valence and especially novelty play a minor role. Taken together, participants' workshop appraisals - together with output satisfaction and outcome expectancy - may be helpful for monitoring the implementation process and allow for corrective action if necessary.

Published
2020

19. Process and outcome evaluation of an organizational-level stress management intervention in Switzerland

Author

Jenny, Gregor J., Brauchli, Rebecca, Inauen, Alice, Füllemann, Désirée, Fridrich, Annemarie, Bauer, Georg F., Jenny, Gregor J., Brauchli, Rebecca, Inauen, Alice, Füllemann, Désirée, Fridrich, Annemarie, and Bauer, Georg F.

Abstract

This field study evaluates the process and outcome of an organizational-level stress management intervention (SMI) in eight companies, taking into account the lessons learned from previous evaluation research. It utilizes the RE-AIM evaluation framework to capture the Reach and Adoption of the intervention in the companies, the appraisal of the Implementation process and the project's Effectiveness and Maintenance with a range of qualitative and quantitative methods. It applies an adapted research design in the context of a field study involving entire organizations, retrospectively assigning study participants to comparison groups. The results of a longitudinal analysis (n = 1400) showed that the SMI had a positive impact on the participants' job demands and resources, when controlled for baseline levels. Qualitative data analysis revealed that the companies had built capacities for ongoing health promotion and showed what issues must be borne in mind when implementing such projects. The study also showed that participation in such interventions alone does not suffice to achieve the desired impact, but that the individual participants' appraisal of the intervention and the collective involvement of the teams must be further researched to fully understand how change occurs

Published
2017

21. Process and context evaluation of psychosocial health interventions at the workplace-synthesizing theory and generating empirical evidence

Author

Fridrich, Annemarie, Bauer, Georg, and Wehner, Theo

Subjects
ARBEITSSTRESS, THERAPIEERFOLGSEVALUATION (MEDIZIN), HEALTH PSYCHOLOGY, PSYCHISCHE UND PSYCHOSOZIALE BEEINTRÄCHTIGUNGEN (SOZIALE PROBLEME), GESUNDHEITSPSYCHOLOGIE, BETRIEBLICHES GESUNDHEITSMANAGEMENT, PSYCHOLOGICAL AND SOCIOPSYCHOLOGICAL IMPAIRMENT (SOCIAL PROBLEMS), WORKING STRESS, INDUSTRIAL HEALTH MANAGEMENT, THERAPY SUCCESS EVALUATION (MEDICINE), FOS: Psychology, ddc:150, Psychology, ddc:610, Medical sciences, medicine
Published
2015
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22. Process and outcome evaluation of an organizational-level stress management intervention in Switzerland

Author

Jenny, Gregor J, Brauchli, Rebecca, Inauen, Alice, Füllemann, Désirée, Fridrich, Annemarie, Bauer, Georg F, Jenny, Gregor J, Brauchli, Rebecca, Inauen, Alice, Füllemann, Désirée, Fridrich, Annemarie, and Bauer, Georg F

Abstract

This field study evaluates the process and outcome of an organizational-level stress management intervention (SMI) in eight companies, taking into account the lessons learned from previous evaluation research. It utilizes the RE-AIM evaluation framework to capture the Reach and Adoption of the intervention in the companies, the appraisal of the Implementation process and the project's Effectiveness and Maintenance with a range of qualitative and quantitative methods. It applies an adapted research design in the context of a field study involving entire organizations, retrospectively assigning study participants to comparison groups. The results of a longitudinal analysis (n = 1400) showed that the SMI had a positive impact on the participants' job demands and resources, when controlled for baseline levels. Qualitative data analysis revealed that the companies had built capacities for ongoing health promotion and showed what issues must be borne in mind when implementing such projects. The study also showed that participation in such interventions alone does not suffice to achieve the desired impact, but that the individual participants' appraisal of the intervention and the collective involvement of the teams must be further researched to fully understand how change occurs.

Published
2015

23. The context, process, and outcome evaluation model for organisational health interventions

Author

Fridrich, Annemarie, Jenny, Gregor J, Bauer, Georg F, Fridrich, Annemarie, Jenny, Gregor J, and Bauer, Georg F

Abstract

To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results.

Published
2015

30. Process and outcome evaluation of an organizational-level stress management intervention in Switzerland

Author

Jenny, Gregor J., Brauchli, Rebecca, Inauen, Alice, Fullemann, Désirée, Fridrich, Annemarie, and Bauer, Georg F.

Subjects
Organizational change, health care facilities, manpower, and services, education, Occupational stress, Evaluation, health care economics and organizations, Health promotion programs, 3. Good health
Abstract

Health Promotion International, 30 (3), ISSN:0957-4824, ISSN:1460-2245

31. Process and outcome evaluation of an organizational-level stress management intervention in Switzerland

Author

Jenny, Gregor J., Brauchli, Rebecca, Inauen, Alice, Füllemann, Désirée, Fridrich, Annemarie, Bauer, Georg F., Jenny, Gregor J., Brauchli, Rebecca, Inauen, Alice, Füllemann, Désirée, Fridrich, Annemarie, and Bauer, Georg F.

Abstract

This field study evaluates the process and outcome of an organizational-level stress management intervention (SMI) in eight companies, taking into account the lessons learned from previous evaluation research. It utilizes the RE-AIM evaluation framework to capture the Reach and Adoption of the intervention in the companies, the appraisal of the Implementation process and the project's Effectiveness and Maintenance with a range of qualitative and quantitative methods. It applies an adapted research design in the context of a field study involving entire organizations, retrospectively assigning study participants to comparison groups. The results of a longitudinal analysis (n = 1400) showed that the SMI had a positive impact on the participants' job demands and resources, when controlled for baseline levels. Qualitative data analysis revealed that the companies had built capacities for ongoing health promotion and showed what issues must be borne in mind when implementing such projects. The study also showed that participation in such interventions alone does not suffice to achieve the desired impact, but that the individual participants' appraisal of the intervention and the collective involvement of the teams must be further researched to fully understand how change occurs

32. Outcome expectancy as a process indicator in comprehensive worksite stress management interventions

Author

Gregor J. Jenny, Annemarie Fridrich, Georg F. Bauer, University of Zurich, and Fridrich, Annemarie

Subjects
Gerontology, Stress management, medicine.medical_specialty, Process (engineering), 1400 General Business, Management and Accounting, Treatment outcome, 610 Medicine & health, 3202 Applied Psychology, Education, 03 medical and health sciences, 0302 clinical medicine, 0502 economics and business, medicine, 030212 general & internal medicine, General Psychology, Applied Psychology, Stress management interventions, 05 social sciences, Outcome expectancy, 3200 General Psychology, 10060 Epidemiology, Biostatistics and Prevention Institute (EBPI), General Medicine, General Business, Management and Accounting, Physical therapy, Occupational stress, Psychology, 050203 business & management, 3304 Education
Abstract

This study investigates the relationship between outcome expectancy for an individual stress management course and the total perceived impact of a comprehensive stress management intervention (SMI). It is based on data from three different measurement points from a longitudinal SMI in Switzerland. Individual and organizational outcome expectancies for stress management courses were captured with two newly developed items (SMI outcome expectancy) immediately after course completion. Perceived individual and organizational impacts of the overall intervention captured with two items of a retrospective impact assessment scale (perceived SMI impact) at the two year follow up survey were used as the outcome measurement. Baseline individual and organizational change commitments (as rated by participants) were included in the analyses as possible moderators. Regression analyses show that individual and organizational outcome expectancies in respect of stress management courses can to some extent predict the perceived impact of the intervention as a whole. At the individual level an intervention will be perceived as most successful when participants already have a high individual change commitment and develop high outcome expectancies during stress management courses.

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33. Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy

Author

Inauen A, Rettke H, Fridrich A, Spirig R, and Bauer GF

Subjects
Attitude of Health Personnel, Cost Savings economics, Cost Savings methods, Education organization & administration, Focus Groups, Hospitals, University economics, Hospitals, University organization & administration, Humans, Organizational Innovation economics, Retrospective Studies, Switzerland, Clinical Competence economics, Health Care Rationing economics, Health Care Rationing organization & administration, National Health Programs economics, National Health Programs organization & administration, Nursing, Team economics, Nursing, Team organization & administration
Abstract

Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project’s success. Conclusions: Project managers should ensure transparency of the project’s progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.

Published
2017
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