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Medical errors in obstetric departments are commonly reported and may involve both mother and neonate. The complexity of obstetric care, the interactions between various disciplines, and the inherent limitations of human performance make it critically important for these departments to provide patient-safe and friendly working environments that are open to learning and participative safety. Obstetric care involves stressful work, and health care professionals are prone to develop burnout, this being associated with unsafe practices and lower probability for reporting safety concerns. This study aims to test the mediating role of burnout in the relationship of patient-safe and friendly working environment with unsafe performance. The full population of professionals working in an obstetrics department in Malta was invited to participate in a cross-sectional study, with 73.6% (n = 184) of its members responding. The research tool was adapted from the Sexton et al.’s Safety Attitudes Questionnaire – Labor and Delivery version and surveyed participants on their working environment, burnout, and perceived unsafe performance. Analysis was done using Structural Equation Modeling. Results supported the relationship between the lack of a perceived patient-safe and friendly working environment and unsafe performance that is mediated by burnout. Creating a working environment that ensures patient safety practices, that allows communication, and is open to learning may protect employees from burnout. In so doing, they are more likely to perceive that they are practicing safely. This study contributes to patient safety literature by relating working environment, burnout, and perceived unsafe practice with the intention of raising awareness of health managers’ roles in ensuring optimal clinical working environment for health care employees.

This study aims to examine nurses’ motivation for leadership and explore important challenges nurses face in leadership positions.

Semi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data.

Nurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership.

Studies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers.

The role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002).

By identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness.

The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department.

This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts “availability” and “receptiveness” as antecedents for collaboration will be applied in the analysis.

Close collaboration between departments was an essential precondition for the functioning of the new emergency department. The study shows how a lack of antecedents for collaboration affected the working relation and communication between employees and departments, which spurred negative feelings and reproduced conflicts. This situation was seen as a potential threat for the safety of the emergency patients.

This study presents a single case study, at a specific point in time, and should be used as an illustrative example of how contextual and situational factors affect the working environment and through that patient safety.

Few studies provide an in-depth investigation of what actually takes place when collaboration between professional groups goes wrong and escalates, and how problems in collaboration may affect patient safety.

Within the framework of learning from errors, this study focused on how operative risks and potential errors are addressed in guidance to surgical residents during authentic surgical operations. The purpose of this paper is to improve patient safety and to diminish medical complications resulting from possible operating errors. Further in the process of the optimal contexts for instruction aimed at preventing risks and errors in the practical hospital environment was evaluated.

The five authentic surgical operations were analyzed, all of which were organized as training sessions for surgical residents. The data (collected via video-recoding) were analyzed by a consultant surgeon and an education expert working together.

The results showed that the risks and potential errors in the surgical operations were rarely addressed in guidance during operations. The guidance provided mostly concerned technical issues, such as instrument handling, and exploration of critical anatomical structures. There was little guidance focusing on situation-based risks and potential errors, such as unexpected procedural challenges, teamwork and practical decision-making. The findings showed that optimal context of learning about risks and potential errors of surgical operation are not always the authentic operation context.

The study was conducted in an authentic surgical operation-cum-training context. The originality of the study derives from its focus on guidance related to risk and error prevention in surgical workplace learning. The findings can be used to create a meaningful learning environment – including powerful guidance – for practice-based surgical learning, maximally addressing patient safety, but giving possibilities also for other training options.

Health care is a complex system, mandating adoption of unrelenting updates of guidelines and best practices. Securing a balanced system of current practice and matching documentation has always been a challenge due to impaired connection between traditional forms of documentation (e.g. policies, procedures, and guidelines) and users. Departmental manuals always find their way back to shelves away from the workplace, and continuous interaction with customers and complexity of business processes hinder timely update and consequently sustainable improvement. The paper aims to discuss this issue.

In late 2014, the corresponding author visited Japan as part of Kaizen benchmark tour that introduced the concepts and applications of “Kaizen,” the Japanese word for continuous improvement, in Toyota factory and health care institutes in Fukuoka, Nagoya, and Tokyo. Soon thereafter, the authors adopted Kaizen to be the organizational theme for improvement. QPS team launched several initiatives throughout 2015 to improve the quality of documentation. Documents submitted had one thing in common, all participants used flowcharts, diagrams, and even drawings to simplify hard-to-understand processes. This challenge highlighted the utilization of diagrams, well-organized forms, infographics, and other methods to simplify processes and to vitalize documents.

Since the hospital utilizes the paper-form prescribing system, prescription errors lead to delays in dispensing time, affecting patient satisfaction in emergency room’s pharmacy. Pharmacy team launched a project using document vitalization as an improvement strategy. Aggregate results showed 16.7 percent reduction in average time per prescription in inpatient pharmacy and 20.0 percent reduction in emergency room pharmacy. Although measurements did not continue over a longer period or were statistically analyzed, they provide a crude indication of possible improvement using document vitalization.

Lack of a sound measurement system with proper statistical analysis prevented the provision of reliable evidence of improvement. Moreover, lack of previous case studies has been an obstacle. It is the authors’ plan to provide measurable evidence of improvement for multiple projects through measurement of process time, customer and employee satisfaction, the number of process errors, etc. Nevertheless, feedback from users provides a rough indication of possible improvement using document vitalization. It is the authors’ aim to incorporate “document vitalization” into the fabric of documentation process and SFHPM culture.

Empowerment creates an energy-filled work environment where staff members feel they are the real change factors and are actively contributing to the advancement and success of their organizations (Taylor 2013). This does not mean allowing chaos and unplanned changes to disrupt process flow but rather to leave room for trial and error in a controlled environment and pilot-testing significant changes before generalization.

The term vitalization itself is a brand new one used in this field, and the authors introduce it for the first time to be a solution that comes from frontliners and can bridge the gap between document and practice. If all document vitalization successes were a tribute to one factor, it would be “empowerment.” Once leaders have the courage to listen to frontline staff voice and allow them to do things differently, the staff members will surprise their organizations with the marvels of their creations.

The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

A Psychiatric Intensive Care Unit (PICU) and or High Dependency Unit (HDU) is a locked, intensive treatment facility available to people experiencing acute psychiatric distress. For many people who access public mental health services in Australia, the PICU/HDU is the primary point of admission, and should represent and facilitate timely assessment and an optimum treatment plan under a recovery framework. Nurses are the largest health discipline working in this specialty area of care. The paper aims to discuss these issues.

A qualitative study aimed to investigate the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. Identifying how nurses provide care in the PICU/HDU will inform a clinical practice guideline to further support this specialty area of care. Four focus groups were facilitated with 52 registered nurses attending.

The nurse participants identified specific skills under four distinct themes; Storytelling, Treatment and recovery, Taking responsibility, and Safeguarding. The skills highlight the expertise and clinical standard required to support a recovery model of care in the PICU.

The research findings highlight urgency for a National PICU/HDU clinical practice guideline.

A PICU/HDU practice guideline will promote the standard of nursing care required in the PICU/HDU. The PICU/HDU needs to be recognised as a patient centred, therapeutic opportunity as opposed to a restrictive and custodial clinical area.

Providing transparency of practice in the PICU/HDU and educating nurses to this specialty area of care will improve client outcome and recovery.

Very few studies have explored the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. A dearth of research exists on what is required to work in this specialty area of care.

The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France.

Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015–2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations.

Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted “patient safety”, a paradoxical injunction to do more with less and conflicting organizational priorities.

This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.

This paper aims to study the elements of social protection, namely, the labour market policy (working conditions), social insurance and social assistance from the law and policy standpoints to safeguard the rights and welfare of the frontline health-care workers (HCWs).

This study applies both doctrinal and non-doctrinal research methods with the legal and authoritative approaches by integrating the three elements of social protections, which are working conditions, insurance protection and social assistance for the protection of HCWs.

A pragmatic approach to the social protection system by integrating these elements can safeguard the rights and welfare of the frontline HCWs amid the pandemic. This approach should be made effective for the sustainability of the HCW and health industry in Malaysia.

This paper highlights the significance of initiating and empowering ad hoc approaches through the social protection system for the practical and effective protection of frontline HCWs who are the backbone of the nation, in the event of pandemic COVID-19. These practical needs and approaches are pivotal in response to HCWs demands in workplace.

While social protection commonly aims to address disadvantaged groups and to combat poverty, this research adopts the social protection approach with the aims to safeguard the rights and welfare of frontline HCWs amid the COVID-19 pandemic.