Risk Watch (February '20)

Service: Risk Management
Type: Risk Watch

Selected research, publications, and resources to promote evidence-informed risk management in Canadian healthcare organizations. Prepared by the Healthcare Risk Management staff at the Healthcare Insurance Reciprocal of Canada (HIROC). Some titles are open access while others may require a subscription or library access; the librarian at your organization may be able to assist you. Please contact riskmanagement@hiroc.com for assistance if required.

Editor's Note

Lori Borovoy headshot
                        Lori Borovoy

In this month’s Risk Watch, we feature a number of articles focusing on quality improvement (QI). Smith et al. explore personal and organizational outcomes of university-led QI courses for healthcare professionals. Balch Samora et al. explore QI writing program development and increased competencies of manuscripts for academic journal publication. Olmos-Ochoa et al. focus on building capacity for resilience in the QI practice facilitator workforce, including nine recommendations for challenges facilitators face. 

If you have any comments about these articles or Risk Watch, please email me at lborovoy@hiroc.com. We look forward to hearing from you.

Hot Off the Press


Fourteen years of quality improvement education in healthcare: a utilisation-focused evaluation using concept mapping

Smith F, Alexandersson P, Bergman B, et.al. BMJ Open Quality. 2019 (online, December):1-9.

Study in Sweden to explore personal and organizational outcomes identified by participants over 14 years of university-led quality improvement (QI) courses for healthcare professionals. Included in the study were 331 previous QI course participants and 19 stakeholders involved in the analysis. Authors reported the results showed that it is possible training in QI with a strong experiential teaching approach fosters long term improvement capability for the course participants and long term improvement capability in their respective organizations.  


Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis

McHugh S, Lawton R, O’Hara J, et al. BMJ Qual Saf. 2020 (online, January):1-12.

Study in the UK synthesizing 15 articles to describe the use of team reflexivity in healthcare and its impact on patient safety. Results showed the most common forms of team reflexivity were post-simulation debriefs and review of in situ video footage, with communication during teamworking as the most prominent improvement focus. Authors noted all methods of have some positive impact on contributory patient safety factors, and suggest video review may be best placed to empower participants to implement change and allow teams to learn together about the complexities of their daily interactions and routine practices.


The challenges of making informed decisions about treatment and trial participation following a cancer diagnosis: a qualitative study involving adolescents and young adults with cancer and their caregivers

Hart R, Cameron D, Cowie F, et al. BMC Health Serv Res. 2020 (online, January):1-13.

Study to assess how adolescents process the diagnosis of cancer and make decisions about their treatment. Results showed that adolescents prefer to defer treatment decisions to healthcare professional rather than make their own decisions. Authors suggested this could make it difficult to have informed discussions with these patients about their care and question whether these patients are able to fully understand the diagnosis.


Directed intervention to improve the rate of admission medication reconciliation in an acute care hospital

Kyi H, Sundus S, Marcus H, et al. BMJ Open Qual. 8. 2019 (online, December):1-5.

Study in the US to improve the percentage of medication reconciliation completion rates at an acute care facility by providing education to staff and integrating the electronic medical record to include a section where providers can identify whether the reconciliation process had taken place. Results showed an 18.5% increase in medication reconciliation completion following implementation. Authors suggest improvements to the electronic health record can have a significant impact on patient safety. 


Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework

Levesque J, Sutherland K. BMC Health Serv Res. 2020 (online, January):1-14. 

Study to develop a framework for measuring performance in healthcare that identified 12 constructs to assess performance. Authors noted “the framework proposed here uses measures that are dynamic, sensitive to context, and to interlinked processes in healthcare delivery”, suggesting this approach can identify gaps in currently used indicators and influence the development of measures that more accurately reflect performance.


Writing group increases quality improvement writing competency

Balch Samora J, Spencer S, Valleru J, et al. Am J Med Qual. 2019 (online, November):1-6.

Study at a large academic children’s hospital in the US to improve writing quality improvement (QI) manuscripts for academic journal publication through development of a QI writing program. Program participants conducted pre and post course QI writing skills self-evaluations in four competency domains: SQUIRE guidelines, writing for peer-reviewed journals, QI publication submission steps, and critically examining QI results. Results showed writing competencies doubled in three of four domains and increased 70% in the fourth. Fifteen of 17 of the course participants submitted manuscripts to peer-reviewed journals and at time of the article, 12 had been accepted. A QI writing competency example from the self assessment is provided.  


Sustaining effective quality improvement: building capacity for resilience in the practice facilitator workforce

Olmos-Ochoa T, Ganz M, Barnard J, et al. BMJ Qual Saf. 2019 (December):28(12):1016-1020.

Study from the US focusing on the skilled practice facilitator to support effective change and highlight the associated challenges. The Coordination Toolkit and Coaching project uses a case study of enhanced facilitator support. Review of reflections identified nine facilitation challenges such as mismatched expectations, supporting QI methods and data collection, and managing team dynamics; recommendations for each are provided.  


Patient and caregiver priorities in the transition from hospital to home: results from province-wide group concept mapping

Kiran T, Wells D, Okrainec K, et al. BMJ Qual Saf. 2020 (online, January):1-11.

Study in Canada involving over 700 patients and caregivers to understand what influenced their experience in transition from hospital to home. Not having enough home care services to meet the need was consistently highlighted as the number one priority area for improving the transition from hospital to home. Other top priorities included involving patients and caregivers in discharge planning and providing them with a number to call once home.


Effect of cognitive aids on adherence to best practice in the treatment of deteriorating surgical patients: a randomized clinical trial in a simulation setting

Koers L, van Haperen M, Meijer C. JAMA Surg 2019 (online, November):E1-E8.

Study in the Netherlands to test the effectiveness of cognitive aids on adherence to best practice in the management of postoperative patient deterioration. Fifty surgical teams participated in 150 simulations. Results showed cognitive aids reduced the omissions of critical steps in the management of deteriorating surgical patients from 33% to 10%. Authors noted the failure to adhere to critical management steps is associated with the occurrence of a complication, and each additional step missed increased the odds of a complication. An example of a cognitive aid is provided.

Other Resources of Interest

Clearing the haze: how the legalization of recreational cannabis may affect your medical practice (January 2020). Canadian Medical Protective Association article outlining the potential impact of legalization of cannabis on the healthcare system.

Coronavirus outbreak: legal and practical insights and perspectives (January 2020). Borden Ladner Gervais LLP (CDN) article with an overview of clinical and legal issues for the healthcare sector.

Creating a safe space: psychological safety of healthcare workers (January 2020). Canadian Patient Safety Institute manuscript identifying the supports available to healthcare workers around the world.

Disclosing harm associated with pathological analysis or diagnostic imaging: a team-based approach (December 2019). Canadian Medical Protective Association article with guidance for disclosing harm to patients involving physicians who do not usually have direct contact with patients.

Emergency department shifts and decision to admit: is there a lever to pull to address crowding? (December 2019). BMJ Quality and Safety (UK) editorial which explores crowded emergency departments and effects on quality.

Healthcare simulation dictionary—second edition (January 2020). Agency for Healthcare Research and Quality and Society for Simulation in Healthcare (US) resource for healthcare simulationists to enhance communication and clarity in teaching, education, assessment, research, and systems integration activities.

How hospitals can protect themselves from cyber attack (January 2020). Canadian Medical Association Journal News article on thing healthcare systems can do to prepare for cyber breaches.

How to hire a great chief risk officer: a guide to the recruitment of chief risk officers and other senior risk professionals (December 2019). The Institute of Risk Management (UK) guide on how to define top risk roles, identify key skills and attributes, recruitment process and candidates assessment.

Sharing health care data with digital giants: overcoming obstacles and reaping benefits while protecting patients (January 2020). Journal of the American Medical Association (US) opinion paper on data sharing arrangements between healthcare delivery organizations and digital companies and public controversy.

Start the new year off right by preventing these top 10 medication errors and hazards (January 2020). Institute for Safe Medication Practices (US) article summarizing common medication errors and how to prevent them.

Team debriefs: participate and minimize your medical-legal risks (December 2019). Canadian Medical Protective Association article on structuring team debriefs to focus on learning and protect information from disclosure.

The clearer the better: waiver’s unclear indemnity is not enforceable (January 2020). Borden Ladner Gervais LLP (CDN) article highlighting the importance of using clear language in waivers to ensure parties understand what they are signing.

Transitions between hospital and home (January 2020). Health Quality Ontario (now part of Ontario Health) quality standard outlining 10 quality statements for patient transitions, and supporting resources.