Dissertation committee:
Ηρακλής Μητσογιάννης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ανδρέας Σκολαρίκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αθανάσιος Παπατσώρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Φίλος, Καθηγητής, Τμήμα Δημόσιας Διοίκησης, Πάντειο Πανεπιστήμιο
Μιχαήλ Κουτσιλιέρης, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κυριάκος Σουλιώτης, Καθηγητής, Σχολή Κοινωνικών και Πολιτικών Επιστημών, Οικονομικό Πανεπιστήμιο Πελοποννήσου
Κωνσταντίνος Στραβοδήμος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
INTRODUCTION: Patient safety is considered as a crucial component of quality in healthcare services which however cannot be measured directly. The concept of value in healthcare calls for measures that capture the patient’s view of importance. Moreover, patients’ safety reports and experience measurement correlate with rates of actual patient harm. The impact of integrating patient's safety reporting into active care may contributes to reducing patient harm when staff compliance is high and may provide important learning opportunities. Ηospitals implement evidence-based guidelines in order to improve quality of perioperative care and patient safety in the operating room,. Researchers have contributed in the development of healthcare quality as well as and patient safety indicators for internal assessment, monitoring and improvement in perioperative care process. As result, a significant percentage of errors are attributed to communication breakdowns and lack of effective teamwork. Teamwork and communication techniques can improve quality and safety, reduce patient harm, promote cross-professional collaboration and common goal setting, decrease workload issues, and improve both staff and patient satisfaction. It is suggested thathospitalsshould monitor indicators for quality and patient safety in orderto measure and assessperioperative processes so as to create safe perioperative systems.
AIM: To investigate patient’s perceptions of participation in the medical decisionmaking about a surgery, and their experiences ofPerioperative Care provided. Furthermore, this study aims to investigate healthcare professional’s perceptions of the doctor-patient relationship in the Surgical decisionmaking,the quality of the surgical care provided, the safety climate, on professional Satisfaction, as well as teamwork and communication during all Perioperative Care phases.
MATERIAL-METHOD: A total of 820 patients (response rate 68,33 %) and 118 health professionals (response rate 73,75%). participated in the study. The research was conducted based on a structured semi-quantified questionnaire during two years 2019-2020 in two General Public Hospitals of the 1st Health Region of Attica-Ministry of Health, Greece. The research tools utilized for the survey purposes were: Shared Decision Making-Q-9 and Patient Reported Outcome Measures (for adult patients), Shared Decision Making-Q-Doc-Physician version (for surgeons), Observational Teamwork Assessment for Surgery-OTAS and Safety Attitudes Questionnaire/SAQ (for surgery health professionals). For the analysis of quantitative and qualitative data was used both descriptive and conclusive statistical analysis. The categorical variables werepresented as absolute (n) and relative (%) frequencies, while quantitative variables werepresented as mean, standard deviation, median, minimum value, and maximum value. The Kolmogorov-Smirnov test (histograms) was used to test the normality of the distribution of the quantitative variables. Quantitative variables were found to follow normal distribution. T-test was used to estimate correlation between a quantitative variable and a dichotomous variable Variance analysis was used to estimate correlation between quantitative variable and categorical variable with >2 categories. Correlation between quantitative variables that were normally distributed was assessed by Pearson’s correlation coefficient. Spearman’s correlation coefficient was used to estimate corralation between a quantitative variable and an ordinal variable. In case that a dependent variable was quantitative and >2 independent variables were found to be statistically significant at the 0.2 level (p<0.2), multiple linear regression was applied with backward deletion of variables. In regression models, Significance level was set to 0,05. . In linear regression models, adjusted coefficients’ beta with 95% CI for the independent variables Statistical analysis was performed with IBM SPSS v.21.0
RESULTS: High levels of patient participation in shared decision making (84), and patients’ satisfying experience of healthcare services (6-6.3-6.2). The elderly were associated with better experience in the Perioperative Period (p=0.002). Furthermore, patient participationin Shared Decision Making on the doctors part was found to be high (80.5). Mean scores values in all dimensions of the Healthcare Quality assessment were quite high, which indicates a fairly good Healthcare Quality (7-9.1/10 and 4.3/6). Healthcare professionals’ satisfaction with working in the Operating Room (7.9)and collaboration with nurses (7.2) and doctors( 7.3) was found to be high . Fatigue experienced by healthcare professionals was quite high (4.6), while their stress levels were moderate (4.7). Positive attitude (mean score >50) was recorded in all factors of the Safety Attitudes Questionnaire. Healthcare Professionals’ satisfaction with error handling errors by the Hospital Management was found to be moderate (3.8),whereas the degree to which the patient’s health was affected by errors was low (1.6). Most Healthcare Professionals stated that reporting errors in the Operating Room should be voluntary (72%) and if they were to perceive a colleague’s error that could causeserious harm to a patient, they would report it to their superior (61.7%). The evaluation of the 5 scales for the teamwork assessment was rather high (4.4-5.1).
CONCLUSIONS: Measurement and assessment of perioperative processes can derive Quality and Safety Indicators in the context of Surgical Care. Indicators describe the expected performance for a specific patient or related health outcomes when standards of care are met. Health Professionals in the Operating Room are allowed to monitor and assess the patients’ fulfillment of expectations and experiences as a consequence of the good organization,in order to meet their needs. Monitoring aspects of perioperative procedures reflects the quality, safety, efficiency, effectiveness and productivity of the Operating Room and contributes to coordination, teamwork, communication, job satisfaction while reducing fatigue and stress levels, and determining improvement actions.
Keywords:
Surgical quality and patient safety,Perioperative procedures,Surgical care,Healthcare improvement,Patient safety,Patient satisfaction,Patient experience,Teamwork in healthcare
