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Innovating an innovation: a mix methods analysis on the implementation of a peer-to-peer audit instrument at Gelre Hospitals Apeldoorn

Pavert, Bram van de (2013) Innovating an innovation: a mix methods analysis on the implementation of a peer-to-peer audit instrument at Gelre Hospitals Apeldoorn.

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Abstract:Innovating an innovation: a mix methods analysis on the implementation of a peer-to-peer audit instrument at Gelre Hospitals Apeldoorn Although most people enjoy good quality healthcare, an alarming and preventable number of adverse events have occurred in recent years. In the US, for example, 275 lives are lost from preventable medical errors every day. Even in the Netherlands, where healthcare is considered excellent, between 1482 and 2032 potentially preventable deaths have occurred in 2004. Literature shows that both safe nursing and a culture of safety are regarded important in reducing medical errors. Gelre Hospitals Apeldoorn agrees and to reduce the number of adverse events, an intervention has been developed. This intervention, called Take Care, is a peer-to-peer audit instrument measuring the nursing process by means of four different components: (1) patient records, (2) interviews with patients, (3) interviews with nurses, and (4) several observations of patient visits and meetings on the ward. The objective of this study was to examine what the effect of the Take Care program is on the variables safety culture, pressure ulcers and falls. In addition, it is mapped what stimulating and obstructing factors are for the actual use of Take Care within Gelre Hospitals Apeldoorn. The setting was the nursing wards at Gelre Hospitals Apeldoorn. Data was collected using a mixed methods approach, with both data analysis on the variables pressure ulcers and falls, and partially structured face-to-face interviews with 24 internal stakeholders, including board members, medical specialists, heads of department, healthcare coordinators and nurses. The effect of Take Care on the variable safety culture was measured using a fixed question, after which the interviewees were asked to explain the given answer. The results indicated that the program did not cause a positive effect on the safety culture perceptions within the departments. Regarding pressure ulcers, there was no difference between the expected pressure ulcers prevalence in 2012 and the observed prevalence in 2011 (χ2 (1, N = 1391) = 1,509, p = .2193). In addition, there was no difference between the data of January 2013 with respect to the data of 2011 (χ2 (1, N = 804) = 0,0053, p = .942). Finally, the results also showed no significant association between several points in time and the number of falls (χ2 (2, N = 6) = 1,267, p = .531). Factors that may affect the actual use of Take Care were measured on three components; the innovation, the user and the organization. Several stimulating factors were found, such as the relevance to patients, the correctness of the program and the availability of materials and amenities. Obstructing factors were also found, including the visibility of the results of Take Care, completeness and the feedback to the user. In conclusion, Take Care has not reached her goals (yet) and the actual use of the program has not been ideal. A number of recommendations are provided in order to increase the support for the program and improve the implementation process.
Item Type:Essay (Master)
Clients:
Gelre Hospitals
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
Link to this item:http://purl.utwente.nl/essays/63829
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