Practice Improvement, Canadian Medical Protective Association, Ottawa, ON.
Department of Obstetrics & Gynecology, Queensway Carleton Hospital, Ottawa, ON.
J Obstet Gynaecol Can. 2020 Jan;42(1):38-47.e5. doi: 10.1016/j.jogc.2019.05.011. Epub 2019 Aug 13.
This study implemented a quality improvement program based on knowledge of medico-legal risk in obstetrics and sought to evaluate the impact of this program on workplace culture.
The study conducted needs assessments with front-line providers working in the obstetrical unit of the Queensway Carleton Hospital, an urban community hospital in Ottawa, Ontario, and included the safety, communication, operational reliability, and engagement (SCORE) survey. The study investigators delivered training in quality improvement science and co-developed three projects that were based on their alignment with local needs and aggregate medico-legal risk data: an organized team response to the need for an immediate cesarean section, a protocol for managing patients who present at term with pre-labour rupture of membranes, and regular morning team briefings. Outcome measures were determined for each project from a quality improvement indicator framework, and coaching was provided to project leads. Participants completed the SCORE survey and a program effectiveness tool after the intervention.
The majority of participants (75.2% of 153 pre-intervention and 63.1% of 157 post-intervention participants) completed the SCORE surveys. Post-intervention improvements were found in teamwork, learning environment, and safety climate, whereas levels of provider burnout remained high. Program effectiveness was highly rated, and most projects showed qualitative improvements.
This study showed positive workplace culture change associated with the quality improvement intervention. Lessons learned from the implementation of this program can inform future quality improvement initiatives.
本研究实施了一项基于产科医学法律风险知识的质量改进计划，并评估了该计划对工作场所文化的影响。
本研究对安大略省渥太华市皇后道卡尔顿医院产科病房的一线医护人员进行了需求评估，包括安全、沟通、运营可靠性和参与度（SCORE）调查。研究人员提供了质量改进科学培训，并共同制定了三个项目，这些项目基于与当地需求和综合医学法律风险数据的一致性：有组织的团队对立即行剖宫产的需求做出反应、管理足月胎膜早破患者的方案，以及定期的晨间团队简报。每个项目都从质量改进指标框架中确定了结果衡量指标，并为项目负责人提供了指导。干预后，参与者完成了 SCORE 调查和计划效果工具。
大多数参与者（153 名干预前的参与者中有 75.2%，157 名干预后的参与者中有 63.1%）完成了 SCORE 调查。团队合作、学习环境和安全氛围方面的得分在干预后有所提高，而提供者的倦怠水平仍然很高。计划效果的评价很高，大多数项目都显示出定性的改进。
本研究显示，质量改进干预措施与积极的工作场所文化变化相关。从该计划的实施中吸取的经验教训可以为未来的质量改进计划提供信息。
