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Context Bureaucratic organisational culture is less favourable to quality improvement, whereas organisations with group (teamwork) culture are better aligned for quality improvement. Objective To determine if an organisational group culture shows better alignment with patient safety climate. Design Cross-sectional administration of questionnaires. Setting 40 Hospital Corporation of America hospitals. Participants 1406 nurses, ancillary staff, allied staff and physicians. Main outcome measures Competing Values Measure of Organisational Culture, Safety Attitudes Questionnaire (SAQ), Safety Climate Survey (SCSc) and Information and Analysis (IA). Results The Cronbach alpha was 0.81 for the group culture scale and 0.72 for the hierarchical culture scale. Group culture was positively correlated with SAQ and its subscales (from correlation coefficient r=0.44 to 0.55, except situational recognition), ScSc (r=0.47) and IA (r=0.33). Hierarchical culture was negatively correlated with the SAQ scales, SCSc and IA. Among the 40 hospitals, 37.5% had a hierarchical dominant culture, 37.5% a dominant group culture and 25% a balanced culture. Group culture hospitals had significantly higher safety climate scores than hierarchical culture hospitals. The magnitude of these relationships was not affected after adjusting for provider job type and hospital characteristics. Conclusions Hospitals vary in organisational culture, and the type of culture relates to the safety climate within the hospital. In combination with prior studies, these results suggest that a healthcare organisation's culture is a critical factor in the development of its patient safety climate and in the successful implementation of quality improvement initiatives. [ABSTRACT FROM PUBLISHER]

National surveys have revealed significant differences in patient outcomes following admission to hospital with acute exacerbation of COPD which are likely to be due to variations in care. We developed a care bundle, comprising a short list of evidence-based practices to be implemented prior to discharge for all patients admitted with this condition, based on a review of national guidelines and other relevant literature, expert opinion and patient consultation. Implementation was then piloted using action research methodologies with patient input. Actively involving staff was vital to ensure that the changes introduced were understood and the process followed. Implementation of a care bundle has the potential to produce a dramatic improvement in compliance with optimum health care practice. [ABSTRACT FROM AUTHOR]

Problem Acute exacerbations of COPD are a major cause of hospital admission and readmission. National surveys have revealed significant differences in patient outcomes which are likely to be due to variations in care. Design A care bundle, comprising a short list of evidence-based practices to be implemented prior to discharge for all patients admitted with this condition was developed, based on a review of National Guidelines and other relevant literature, expert opinion and patient consultation. Implementation was then piloted using action research methodologies in an urban acute hospital. Key measures for improvement Improvements in process measures based around the items in the care bundle were the provision of smoking cessation advice, referral for pulmonary rehabilitation, and review of inhaler technique. A 72 h post-discharge phone call was evaluated. Data from the first year of the bundle were compared with the year prior to its initiation including 30-day readmission rate. Strategies for change The care bundle was launched with events to ensure staff awareness. Weekly meetings were held with review of bundle compliance so that areas for attention could be addressed promptly. A plan, do, study, act (PDSA) cycle approach was used. Examples included ongoing support to develop ward nurses' knowledge of correct inhaler use, nurses attending pulmonary rehabilitation sessions and the use of a "safe discharge" checklist. Effects of change Referral to pulmonary rehabilitation increased by 158% and compliance with assessment for smoking cessation was 100%. Nurse confidence in inhaler technique improved. Roughly 10% of post discharge phone calls identified a cause for concern. The 30-day readmission rate was 10.8% for patients where the bundle was used (n=94) compared to 16.4% where it was not (n=365) (95% CI for difference -2.1% to 13.2%). The bundle has been accepted onto the list of CQUIN measures by London SHA and is being rolled out to further sites. Lessons learnt Actively involving all staff is vital to ensure that the changes introduced are understood and the process followed. Implementation of a care bundle has the potential to produce a dramatic improvement in compliance with optimum health care measures. [ABSTRACT FROM AUTHOR]

Aims: To investigate factors that may contribute to performance adaptation during permanent night work.Methods: Fifteen healthy subjects participated in an adaptation and baseline night sleep, directly followed by seven simulated eight-hour night shifts (2300 to 0700 hours). At the end of each shift they were taken outside and exposed to natural light for 20 minutes. They then slept from approximately 0800 hours until they naturally awoke.Results: There was a significant increase in mean performance on a visual psychomotor vigilance task across the week. Daytime sleep quality and quantity were not negatively affected. Total sleep time (TST) for each of the daytime sleeps was reduced, resulting in an average cumulative sleep debt of 3.53 hours prior to the final night shift. TST for each of the daytime sleep periods did not significantly differ from the baseline night, nor did TST significantly vary across the week. There was a significant decrease in wake time after sleep onset and sleep onset latency across the week; sleep efficiency showed a trend towards greater efficiency across the consecutive daytime sleeps. Hours of wakefulness prior to each simulated night shift significantly varied across the week. The melatonin profile significantly shifted across the week.Conclusions: Results suggest that under optimal conditions, the sleep debt that accumulates during consecutive night shifts is relatively small and does not exacerbate decrements in night-time performance resulting from other factors. When sleep loss is minimised, adaptation of performance during consecutive night shifts can occur in conjunction with circadian adaptation. [ABSTRACT FROM AUTHOR]