Elina Pietikäinen

Multilayered approach to patient safety culture

Background The concept of patient safety culture (PSC) has increasingly been used in the development of patient safety. However, no theoretical framework on the nature of the underlying phenomenon has been created. Multiple characterisations of the key dimensions of PSC exist, but they yield little theory on patient safety culture or its relation to patient safety. The authors propose a dynamic and multilayered construct of patient safety culture and illustrate the critical dimensions at each layer. Conclusions PSC can be defined as the willingness and ability of an organisation to understand safety as well as the willingness and ability to act on safety. Patient safety requires controlling and steering the organisation, and being mindful of the social processes and psychological phenomena.

System modeling with the DISC framework: evidence from safety-critical domains

The objective of this paper is to illustrate the development and application of the Design for Integrated Safety Culture (DISC) framework for system modeling by evaluating organizational potential for safety in nuclear and healthcare domains. The DISC framework includes criteria for good safety culture and a description of functions that the organization needs to implement in order to orient the organization toward the criteria. Three case studies will be used to illustrate the utilization of the DISC framework in practice.

Applying different quality and safety models in healthcare improvement work: Boundary objects and system thinking

A number of theoretical models can be applied to help guide quality improvement and patient safety interventions in hospitals. However there are often significant differences between such models and, therefore, their potential contribution when applied in diverse contexts. The aim of this paper is to explore how two such models have been applied by hospitals to improve quality and safety. We describe and compare the models: (1) The Organizing for Quality (OQ) model, and (2) the Design for Integrated Safety Culture (DISC) model. We analyze the theoretical foundations of the models, and show, by using a retrospective comparative case study approach from two European hospitals, how these models have been applied to improve quality and safety. The analysis shows that differences appear in the theoretical foundations, practical approaches and applications of the models. Nevertheless, the case studies indicate that the choice between the OQ and DISC models is of less importance for guiding the practice of quality and safety improvement work, as they are both systemic and share some important characteristics. The main contribution of the models lay in their role as boundary objects directing attention towards organizational and systems thinking, culture, and collaboration.

Researchers' Roles in Patient Safety Improvement.

Objectives In this article, we explore how researchers can contribute to patient safety improvement. We aim to expand the instrumental role researchers have often occupied in relation to patient safety improvement. Methods We reflect on our own improvement model and experiences as patient safety researchers in an ongoing Finnish multi-actor innovation project through self-reflective narration. Results Our own patient safety improvement model can be described as systemic. Based on the purpose of the innovation project, our improvement model, and the improvement models of the other actors in the project, we have carried out a wide range of activities. Our activities can be summarized in 8 overlapping patient safety improvement roles: modeler, influencer, supplier, producer, ideator, reflector, facilitator, and negotiator. Conclusions When working side by side with “practice,” researchers are offered and engage in several different activities. The way researchers contribute to patient safety improvement and balance between different roles depends on the purpose of the study, as well as on the underlying patient safety improvement models. Different patient safety research paradigms seem to emphasize different improvement roles, and thus, they also face different challenges. Open reflection on the underlying improvement models and roles can help researchers with different backgrounds—as well as other actors involved in patient safety improvement—in structuring their work and collaborating productively.