Table 4.
Example quotes from the interview transcripts
| Dimension | Example quotes |
|---|---|
| 1. Harm | Incident reports |
| ‘There is the Q-Pulse system, which is a self-reporting system in the hospital, and there are different categories for reporting, things related to work and things related to safety, and other related to other things to improve quality and safety and so on’ (Doctor 1) | |
| ‘I suppose the most prominent method would be the use of incident report systems’ (Doctor 6) | |
| ‘Within Irish hospitals, the method used to measure, and monitor harm would mainly be incident reporting systems’ (Policy maker 4) | |
| Mortality and morbidity rates | |
| “One major thing would be our departments use of morbidity and mortality rates” (Doctor 6) | |
| 2. Reliability of safety critical processes | Clinical audit |
| ‘Clinical audit, we have a very robust audit and quality improvement department in the hospital, doctors and nurses are invited to carry out audits’ (Doctor 6) | |
| Early warning score | |
| “The early warning score, that was another initiative that was brought in that's countrywide as well” (Nurse 7) | |
| 3. Sensitivity to operations | Observation and conversations with clinical teams |
| ‘Direct observation of procedures, whereby a senior will initially observe you performing procedure and in a structured manner and observe the different steps and analyse what you’re doing and then deliver feedback afterwards’ (Doctor 6) | |
| Safety walk-arounds | |
| ‘There are ground round or ward round. I think every senior in any team should be able to do at least one round every day with the juniors, and there should be a bigger round done every week for example in presence of all seniors’ (Doctor 2) | |
| Safety huddles | |
| ‘There is also what we call the safety pause or the safety huddle, so during the safety huddles, we’ll discuss whether there has been anything wrong, or there is something that isn’t working properly, and needs to be fixed that is related to patient safety, we also discuss whether there are any new guidelines or protocols’ (Nurse 2) | |
| 4. Anticipation and preparedness | Anticipated staffing levels and skill mix |
| ‘anticipating staffing levels, for example, during the winter, there’s going to be a rise in your flu cases, so anticipating that we’re going to need more staff nurses at that time’ (Nurse 9) | |
| Comprehensive risk assessments of patients at admission | |
| ‘There are assessments as soon as the admission takes place in order for us to avoid harm. We will assess several factors, and then we know, does this patient need more care?’ (Nurse 3) | |
| 5. Integration and learning | Analysis of incidents and feedback leading to the implementation of safety lessons |
| ‘When an incident report is filed, this is discussed by specific team that manages incident reports and usually they discuss it with the person that’s involved, not in terms of putting blame, but in terms of addressing how the mistake happened and how to prevent it’ (Doctor 5) | |
| Simulation sessions following patient safety incidents | |
| ‘So, I think simulation plays a big role. We certainly do that. From time to time will run multi-disciplinary simulations with the nurses and sometimes with ICU or other teams’ (Doctor 8) |