Health services under pressure: a scoping review and development of a taxonomy of adaptive strategies.

Objective: The objective of this review was to develop a taxonomy of pressures experienced by health services and an accompanying taxonomy of strategies for adapting in response to these pressures. The taxonomies were developed from a review of observational studies directly assessing care delivered in a variety of clinical environments.

Design: In the first phase, a scoping review of the relevant literature was conducted.

Embracing multiple aims in healthcare improvement and innovation.

Background: Healthcare and other industries have to manage and coordinate a number of different aims and longer-term ambitions. They must maintain quality, manage costs, support and retain the workforce, manage regulatory demands and consider wider societal objectives. These aims are all legitimate, but they are not necessarily aligned, neither in their time frame nor in their nature.

How to do no harm: empowering local leaders to make care safer in low-resource settings.

In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term.

Coping with more people with more illness. Part 1: the nature of the challenge and the implications for safety and quality.

Health systems are under more pressure than ever before, and the challenges are multiplying and accelerating. Economic forces, new technology, genomics, AI in medicine, increasing demands for care-all are playing a part, or are predicted to increasingly do so. Above all, ageing populations in many parts of the world are exacerbating the disease burden on the system and intensifying the requirements to provide effective care equitably to citizens.

Coping with more people with more illness. Part 2: new generation of standards for enabling healthcare system transformation and sustainability.

In Part 2 of this two-part contribution made on behalf of the Innovation and Systems Change Working Group of the International Society for Quality in Health Care (ISQua), we continue the argument for refashioning health systems in response to ageing and other pressures. Massive ageing in many countries and accompanying technological, fiscal and systems changes are causing the tectonic plates of healthcare to shift in ways not yet fully appreciated. In response, while things remain uncertain, we nevertheless have to find ways to proceed.

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PROGRAMME FOR THE CONTINUOUS IMPROVEMENT OF TEAM WORK TO IMPROVE THE SAFETY OF PATIENT CARE.: The analysis of the causes of care-related adverse events shows that in order to improve safety, human and organisational factors must be taken into account, and action taken to target team work. Based on this observation, the French National Health Authority designed and tested with volunteer teams the Programme for the Continuous Improvement of Team Work, between 2013 and 2016.

Improving the safety climate in hospitals by a vignette-based analysis of adverse events: a cluster randomised study.

Objective: To assess the impact of a vignette-based analysis of adverse events (AEs) on the safety climate (SC) of care units.

Design: Prospective, open, cluster (a unit) randomised controlled trial.

Setting: Eighteen acute care units of seven hospitals in France.

Safety analysis over time: seven major changes to adverse event investigation.

Background: Every safety-critical industry devotes considerable time and resource to investigating and analysing accidents, incidents and near misses. The systematic analysis of incidents has greatly expanded our understanding of both the causes and prevention of harm. These methods have been widely employed in healthcare over the last 20 years but are now subject to critique and reassessment.

Are "Human Factors" the Primary Cause of Complications in the Field of Implant Dentistry?

Complications in medicine and dentistry are usually analyzed from a purely technical point of view. Rarely is the role of human behavior or judgment considered as a reason for adverse outcomes. When the role of human factors is considered, these are usually described in general terms rather than specifically identifying the factors responsible for an adverse event.

Insurance statements related to regional anaesthesia: A French database analysis.

Background: Adverse events in the perioperative period remain frequent, occurring in about 30% of the hospital admission and may be avoidable in nearly 50% of cases. Improving safety needs a continuous assessment of the risk level.

Material And Methods: Data from the MACSF-Sou medical insurance company, including all the statements declared by anaesthesiologists and intensivists, were analyzed retrospectively by three experts, senior anaesthesiologists, of the SFAR, the French society of anesthesia and intensive care (Société française d'anesthésie réanimation) to describe the risk associated with regional anaesthesia.

Insurance statements from French anaesthesiologists and intensivists: A database analysis.

Background: From its origins, anaesthesia is a leading medical specialty for improving patient safety. However, perioperative adverse events remain frequent and may be preventable in 50% of cases. We conducted a collaborative retrospective study analysis of the insurance-database of the MACSF-Sou Medical insurance company to assess the perioperative risk.

Preparing national health systems to cope with the impending tsunami of ageing and its associated complexities: Towards more sustainable health care.

Healthcare systems across the world are experiencing increased financial, organizational and social pressures attributable to a range of critical issues including the challenge of ageing populations. Health systems need to adapt, in order to sustainably provide quality care to the widest range of patients, particularly those with chronic and complex diseases, and especially those in vulnerable and low-income groups. We report on a workshop designed to tackle such issues under the auspices of ISQua, with representatives from Argentina, Australia, Canada, Columbia, Denmark, Emirates, France, Ireland, Jordan, Qatar, Malaysia, Norway, Oman, UK, South Africa and Switzerland.

Patient safety and the control of time in primary care: A review of the French tempos framework by the LINNEAUS collaboration on patient safety in primary care.

Background: The tempos framework provides GPs with a flexible and practical guide to reflect on their organization and practices in the analysis of adverse events and supplement existing classification systems. The tempos framework specifies five timescales that need to be managed by physicians: the disease's tempo (unexpected rapid changes, slow reaction to treatment); the office's tempo (day-to-day agenda and interruptions); the patient's tempo (time to express symptoms, compliance, and emotion); the system's tempo (time for appointments, exams, and feedback); and the time to access to knowledge.

Objective: This paper reviews the tempos framework and two studies that underpin its conceptual development.

Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits.

Delayed diagnosis of paediatric cancers is reported regularly and is a source of remorse for physicians and parents and a leading cause of malpractice claims. We did a systematic review of information about the distribution, determinants, and consequences of time to diagnosis of paediatric malignancies and compared these findings with those of court-appointed expert witnesses in malpractice claims in Canada and France. Time to diagnosis varied widely between tumour types in the 98 relevant studies (medians ranged from 2-260 weeks) without any significant decrease with time.

Development of a safety culture: initial measurements at six hospitals in France.

A cross-sectional and descriptive survey of a safety culture (SC) was conducted in 20 clinical units in France. A self-administered questionnaire measuring 12 dimensions of safety culture was given to healthcare professionals. The overall response rate was 65%.

Problems and promises of innovation: why healthcare needs to rethink its love/hate relationship with the new.

Innovation is often regarded as uniformly positive. This paper shows that the role of innovation in quality improvement is more complicated. The authors identify three known paradoxes of innovation in healthcare.

The natural lifespan of a safety policy: violations and system migration in anaesthesia.

Background: Safety rules continue growing rapidly, as if constraining human behaviour was the unique avenue for reaching ultimate safety. Safety rules are essential for a safe system, but their multiplication can have counterproductive effects.

Objective: To monitor, in an anaesthesia ward, compliance with a process-oriented safety rule, and understand barriers and facilitators which help and hinder physicians from following guidelines.

The "zero risk" concept for hospital-acquired infections: a risky business!

Nosocomial infections represent a serious public health problem. Some recent studies, most of which used strong educational programs, showed a dramatic decrease in the rates of nosocomial infections, particularly catheter-related infections in the intensive care unit. Thus, the concept of "zero risk" is flourishing in the recent literature, and some insurance networks have decided to limit reimbursement for treatment of some of the health care-associated infections, on the grounds that most of them are preventable.