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Improving Patient Safety through Structural Empowerment.

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Title:Improving Patient Safety through Structural Empowerment.
Authors:Atmospera-Walch, Nancy A.
Contributors:Nursing Practice (department)
Keywords:Patient Safety
Structural Empowerment
Just Culture
Punitive Culture
Safety Culture
show 4 moreMagnet Recognition
Magnet Model
Patient Satisfaction
and Staff Satisfaction
show less
Date Issued:May 2017
Publisher:University of Hawaiʻi at Mānoa
Abstract:In November 1999, the Institute of Medicine (IOM) issued the Report, “To err is human, building a safer health system” (Kohn, Corrigan, & Donaldson, 2000). The report revealed evidence that doctors and other health care professionals can make mistakes. The report also stated a lesser known the fact that the US health care system was not doing enough to prevent these mistakes, and preventable medical errors killed as many as 98,000 people a year (Kohn, Corrigan, & Donaldson, 2002). Deaths from medical errors to was compared to that from three fully loaded jumbo jets crashing every other day (Consumer Reports Health, 2009, p.2).
To address and improve patient safety, healthcare organizations have looked to the Just Culture Model. Just Culture is an environment where errors are readily disclosed, an essential element for patient safety to become a reality (Vogelsmeier, A., & Scott-Cawiezell. 2007). Examples of human factor issues are a lack of communication or miscommunication, fatigue, fear of speaking up, a culture of blame, and shame (Gorini, A., Miglioretti, M., & Pravettoni, G. 2012). The American Nurses Association published a Position Statement on Just Culture in 2010. “The American Nurses Association (ANA) supports the Just Culture concept and its use in healthcare to improve patient safety (ANA, 2010). The ANA supports the collaboration of state boards of nursing, professional nursing associations, hospital associations, patient safety centers, and individual health care organizations in developing regional and statewide Just Culture initiatives” (p. 1).
The primary objective of this DNP project is to implement an Evidence-Based strategy that creates a Just Culture at Shriners Hospital for Children in Honolulu. The interventions to support the innovation, the characteristics of the plan, sampling information, data collection procedures, and program evaluation plan were organized using two Models: a) the American Nurses Credentialing Center (ANCC) Magnet Model, and b) the ACE Star Model of Knowledge.
The two models were merged to show how the content and process models could be combined and was used as the guiding model for the DNP.
Twenty-two staff participated in the Just Culture Education program. All the staff participants worked in the inpatient pilot unit. Participants were RNs, HR (Human Resources) personnel, PI (Performance Improvement) PCA (Patient Care Assistant) and staff, with no reported title designation. This project evaluated the changes in employee perception of the patient safety culture before and after having gone through to a Just Culture education delivered as an interactive workshop. Overall the training results are positive with participant gains in knowledge and confidence in Just Culture competencies. Results on the training content indicated satisfaction while the format, i.e., a mix of lecture and discussion, though viewed favorably could be further examined for areas of improvement. The promising results will help support full implementation at Shriner’s Hospital for Children in Honolulu, and other Shriner’s Hospitals nationwide. The staff has taken the first step as evidenced by increased candor in their responses to 2016 AHRQ survey. With these results, SHCH has now a foundation to move toward the culture of safety.
Description:D.N.P. Thesis. University of Hawaiʻi at Mānoa 2017.
URI:http://hdl.handle.net/10125/62613
Rights:All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Appears in Collections: D.N.P. - Nursing Practice


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