Role of Champions in the Implementation of Patient Safety Practice Change
Bibliographic record
Abstract
D espite an intensified research focus and concerted efforts to achieve high reliability in healthcare, patient safety leaders have charged that progress has been "frustratingly slow" (Leape and Berwick 2005).This is not to say that healthcare organizations have not made concerted efforts; over 4,000 organizations voluntarily joined the Institute for Healthcare Improvement (IHI) 5 Million Lives patient safety campaign, and nearly 300 joined Canada's Safer Healthcare Now! campaign.The slow pace of improvement is more likely due to the fact that achieving successful change, which is difficult in any organization, can prove especially challenging in organizations as large and complex as those that provide healthcare.Considering the investments in resources, energy and time that patient safety initiatives often require and the importance of these changes to quality of care, it is in the best interest of healthcare organizations to maximize their chances of successful implementation by having as many facilitating factors in place as possible.The presence of clinical champions has been promoted as one such success factor for patient safety practice change.These clinicians, dubbed "special people" by some authors, are thought by some to be a driving force behind the implementation of a wide range of change initiatives in healthcare settings (Ash et al. 2003).For example, a study of the adoption of safer alternatives to blood transfusion in hospitals found that "the presence of local clinicians who advocated or Abstract Practitioners of patient safety practice change agree that champions are central to the success of implementation.The clinical champion role is a concept that has been widely promoted yet empirically underdeveloped in health services literature.Questions remain as to who these champions are, what roles they play in patient safety practice change and what contexts serve to facilitate their efforts.This investigation used a multiple-case study design to critically examine the role of champions in the implementation of rapid response teams (RRTs), an innovative complex patient safety intervention, in two large urban acute care facilities.An analysis of interviews with key individuals involved in the RRT implementation process revealed a typology of the patient safety practice champion that extended beyond clinical personnel to include managerial and executive staff.Champions engaged to a varying extent in a number of core activities, including education, advocacy, relationship building and boundary spanning.Individuals became champions both through informal emergence and a combination of formal appointment and informal emergence.By identifying and elaborating upon specific features of the champion role, this study aims to expand the dialogue about champions for patient safety practice change.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.047 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.007 | 0.010 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.002 | 0.007 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".