Facilitators and barriers for high-reliability training in medical centers

Abstract

Objective: The study aims to determine the facilitators and barriers to conducting large-scale CRM-based training in a national health care system (VHA). While there are some studies on this topic, none review training in a federal system or provide data on changes within the system.
Methods: Design: Focus Groups collecting qualitative data. Review Methods: We held focus-groups for Clinical Team Training (CTT) facility Points of Contact (POC) and CTT Master Trainers. Responses were collected live and presented to all participants in each focus group session to ensure participant comfort and accuracy. All subgroup leaders agreed on iteratively and qualitatively reviewing participant responses from the four open-ended and three poll questions. Each subgroup leader was assigned a question to conduct a preliminary review of participant responses. After the initial review, a second leader also reviewed the participant responses. Over multiple iterations, themes emerged and were formalized by the team.
Results: The focus groups revealed that Leadership engagement in cultural change is imperative. The focus groups also identified that language and examples used in the curriculum may have inadvertently marginalized individuals by making some non-clinical team members feel excluded as part of the team. Our results support the need for highly visible leadership engagement, adequate time to undertake and complete projects, and overcoming skepticism. See table 1 for themes from each question.
Conclusions: Qualitative analysis revealed that Leadership engagement in cultural change is imperative. Focus groups identified that specific language and examples used in the curriculum may have inadvertently marginalized individuals who do not have clinical backgrounds. In addition, some participants felt that the use of the term “Projects” created a negative connotation for the required quality improvement project on each unit and instead preferred the terms “micro-project,” “safety strategy,” or “quick wins.”
Implemented changes: The program’s name has been rebranded to NCPS Team Training, taking the word clinical out to be more inclusive of all team members who engage in the care of a patient in the clinical setting. A complimentary video series was developed for facility Master Trainers to use as a supplement to their teaching or exclusively as the teaching tool as they facilitate the tabletop simulation exercises. Another change is that the Unit Based Safety Project has been renamed as Unit Based Safety Initiative (UBSI) to remove the stigma of a “project.”

Keywords

Communication / Teamwork / Leadership / Inclusion

ACKNOWLEDGEMENTS

This material results from work supported with resources and using facilities at the Veterans Health Administration National Center for Patient Safety. This is a quality improvement project and not research per Department of Veterans Affairs, Office of Research & Development Program Guide 1200.21, VHA Operations Activities That May Constitute Research, available at https://www.research.va.gov/ resources/policies/ProgramGuide-1200-21-VHA-O perations-Activities.pdf. There was no funding for this study. The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs of the United States government. This article is being submitted as an original quality improvement initiative; these data have not been reported in any other forum. None of the authors have any conflict of interest regarding this report. The Department of Veterans Affairs supported the work, and as a government product, we do not hold the copyright.

AUTHORS CONTRIBUTIONS

Regina Knowles - original concept, writing and editing. Carol M. Jones - writing and editing. Blake Webb, MD - writing and editing. Deborah Welsh, MS - data analysis, writing and editing. Peter D. Mills, PhD, MS - figures, writing and editing, submitting paper for publication.

ETHICAL STATEMENT

Informed patient consent was not required because no patient clinical or identity data was collected, and no patient interventions were completed during the course of study. Therefore ethical review board approval was not required and waived.

FUNDING

This work has no external financial support.

CONFLICTS OF INTEREST DISCLOSURE

The author declares that there is no conflicts of interest.

ETHICS APPROVAL

The Publication Ethics Committee of the Sciedu Press. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

PROVENANCE AND PEER REVIEW

Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

DATA SHARING STATEMENT

No additional data are available.

OPEN ACCESS

This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).

COPYRIGHTS

Copyright for this article is retained by the author(s), with first publication rights granted to the journal.

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