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Rutberg, Hans
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Danielsson, M., Nilsen, P., Rutberg, H. & Carlfjord, S. (2018). The professional culture among physicians in Sweden: potential implications for patient safety. BMC Health Services Research, 18(1), Article ID 543.
Open this publication in new window or tab >>The professional culture among physicians in Sweden: potential implications for patient safety
2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 543Article in journal (Refereed) Published
Abstract [en]

Background

Patient safety culture, i.e. a subset of an organization’s culture, has become an important focus of patient safety research. An organization’s culture consists of many cultures, underscoring the importance of studying subcultures. Professional subcultures in health care are potentially important from a patient safety point of view. Physicians have an important role to play in the effort to improve patient safety. The aim was to explore physicians’ shared values and norms of potential relevance for patient safety in Swedish health care.

Methods

Data were collected through group and individual interviews with 28 physicians in 16 semi-structured interviews, which were recorded and transcribed verbatim before being analysed with an inductive approach.

Results

Two overarching themes, “the competent physician” and “the integrated yet independent physician”, emerged from the interview data. The former theme consists of the categories Infallible and Responsible, while the latter theme consists of the categories Autonomous and Team player. The two themes and four categories express physicians’ values and norms that create expectations for the physicians’ behaviours that might have relevance for patient safety.

Conclusions

Physicians represent a distinct professional subculture in Swedish health care. Several aspects of physicians’ professional culture may have relevance for patient safety. Expectations of being infallible reduce their willingness to talk about errors they make, thus limiting opportunities for learning from errors. The autonomy of physicians is associated with expectations to act independently, and they use their decisional latitude to determine the extent to which they engage in patient safety. The physicians perceived that organizational barriers make it difficult to live up to expectations to assume responsibility for patient safety. Similarly, expectations to be part of multi-professional teams were deemed difficult to fulfil. It is important to recognize the implications of a multi-faceted perspective on the culture of health care organizations, including physicians’ professional culture, in efforts to improve patient safety.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Physicians, Patient safety, Safety culture, Qualitative research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-149792 (URN)10.1186/s12913-018-3328-y (DOI)000438433700009 ()29996832 (PubMedID)2-s2.0-85049780334 (Scopus ID)
Available from: 2018-07-23 Created: 2018-07-23 Last updated: 2019-04-09Bibliographically approved
Danielsson, M., Nilsen, P., Rutberg, H. & Årestedt, K. (2017). A National Study of Patient Safety Culture in Hospitals in Sweden. Journal of patient safety
Open this publication in new window or tab >>A National Study of Patient Safety Culture in Hospitals in Sweden
2017 (English)In: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: Using the Hospital Survey on Patient Culture, our aim was to investigate the patient safety culture in all Swedish hospitals and to compare the culture among managers, physicians, registered nurses, and enrolled nurses and to identify factors associated with high overall patient safety.

METHODS: The study used a correlational design based on cross-sectional surveys from health care practitioners in Swedish health care (N = 23,781). We analyzed the associations between overall patient safety (outcome variable) and 12 culture dimensions and 5 background characteristics (explanatory variables). Simple logistic regression analyses were conducted to determine the bivariate association between each explanatory variable and the outcome variable. The explanatory variables were entered to determine the multivariate associations between the variables and the outcome variable.

RESULTS: The highest rated culture dimensions were "teamwork within units" and "nonpunitive response to error," and the lowest rated dimensions were "management support for patient safety" and "staffing." The multivariate analysis showed that long professional experience (>15 years) was associated with increased probability for high overall patient safety. Compared with general wards, the probability for high overall patient safety was higher for emergency care but lower for psychiatric care. The probability for high overall patient safety was higher for both enrolled nurses and physicians compared with managers.

CONCLUSIONS: The safety culture dimensions of the Hospital Survey on Patient Culture contributed far more to overall patient safety than the background characteristics, suggesting that these dimensions are very important in efforts to improve the overall patient safety culture.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2017
Keywords
hospital survey on patient safety culture, patient safety culture, patient safety climate
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:liu:diva-149791 (URN)10.1097/PTS.0000000000000369 (DOI)28234728 (PubMedID)2-s2.0-85013823022 (Scopus ID)
Available from: 2018-07-23 Created: 2018-07-23 Last updated: 2018-08-10Bibliographically approved
Rahmqvist, M., Samuelsson, A., Bastami, S. & Rutberg, H. (2016). Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements. American Journal of Infection Control, 44(5), 500-506
Open this publication in new window or tab >>Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements
2016 (English)In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 44, no 5, p. 500-506Article in journal (Refereed) Published
Abstract [en]

Background: The incidence of health care-acquired infection (HAI) and the consequence for patients with HAI tend to vary from study to study. By including all patients, all medical specialties, and performing a follow-up analysis, this study contributes to previous findings in this research field. Methods: Data from the Swedish National Point Prevalence Surveys of HAI 2010-2012 was merged with cost per patient data from the county Health Care Register (N=6,823). Extended length of stay (LOS) and costs related to an HAI were adjusted for sex, age, intensive care unit use, and surgery. Results: Patients with HAI (n=732) had a larger proportion of readmissions compared with patients with no HAI (29.0% vs 16.5%). Of the total bed days, 9.3% was considered to be excess days attributed to the group of patients with an HAI. The excess LOS comprised 11.4% of the total costs (95% CI, 10.2-12.7). The 1-year overall mortality rate for patients with HAI in comparison to all other patients was 1.75 (95% CI, 1.45-2.11), all 5 of these differences were statistically significant (P<.001). Conclusions: Even if not all outcomes for patients with an HAI can be explained by the HAI itself, the increase in inpatient days, readmissions, associated costs, and higher mortality rates are quite notable. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2016
Keywords
Point prevalence survey; Readmission; Mortality rate
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-128727 (URN)10.1016/j.ajic.2016.01.035 (DOI)000375483200006 ()26988332 (PubMedID)
Note

Funding Agencies|Region Ostergotland, Sweden [LiO 2014-580]

Available from: 2016-06-01 Created: 2016-05-30 Last updated: 2017-11-30
Rutberg, H., Eckhardt, M. & Biermann, O. (2015). Patient safety in Sweden. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 58(1), 16-22
Open this publication in new window or tab >>Patient safety in Sweden
2015 (German)In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, Vol. 58, no 1, p. 16-22Article in journal (Refereed) Published
Abstract [en]

This article describes the patient safety work in Sweden and the cooperation between the Nordic countries in the area of patient safety. It depicts the national infrastructure, methods and partners in patient safety work as well as the development in key areas. Since 2000, the interest in patient safety and quality issues has significantly increased. A national study (2009) showed that more than 100,000 patients (8.6 %) experienced preventable harm in hospitals. Since 2007, all Swedish counties and regions work on the "National commitment for increased patient safety" to systematically minimize adverse events in the healthcare system. Also, a national strategy for patient safety has been proposed based on a new law regulating the responsibility for patient safety (2011) and a zero vision in terms of preventable harm and adverse events. The Nordic collaboration in this field currently focuses on the development of indicators and quality measurement with respect to nosocomial infections, harm in inpatient somatic care, patient safety culture, hospital mortality and polypharmacy in the elderly. The Nordic collaboration is driven by the development, exchange and documentation of experiences and evidence on patient safety indicators. The work presented in this article is only a part of the Swedish and the Nordic efforts related to patient safety and provides an interesting insight into how this work can be carried out.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keywords
Patient safety; Nordic cooperation; Sweden
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-113722 (URN)10.1007/s00103-014-2074-5 (DOI)000347152100004 ()25430735 (PubMedID)
Available from: 2015-01-30 Created: 2015-01-29 Last updated: 2018-01-11
Doupi, P., Svaar, H., Bjorn, B., Deilkas, E., Nylen, U. & Ruthberg, H. (2015). Use of the Global Trigger Tool in patient safety improvement efforts: Nordic experiences. Cognition, Technology & Work, 17(1), 45-54
Open this publication in new window or tab >>Use of the Global Trigger Tool in patient safety improvement efforts: Nordic experiences
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2015 (English)In: Cognition, Technology & Work, ISSN 1435-5558, E-ISSN 1435-5566, Vol. 17, no 1, p. 45-54Article in journal (Refereed) Published
Abstract [en]

The Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement is a method for retrospective patient record review based on the use of triggers-signals of potential adverse events that have caused patient harm. The method has the purpose of patient safety measurement and monitoring among adult inpatient populations and has been increasingly popular among Nordic countries. Use of the GTT in the Nordic area has been part of broader legal and policy actions and initiatives supportive of patient safety promotion and is being used to establish also national level estimates of patient safety incidents. Limitations of the method are its dependency on quality of documentation and the varying inter-rater reliability observed in many studies. Strengths of the GTT are its ability to detect larger numbers, as well as different types of adverse events when compared to other incident detection methods, hence it is a good addition to the palette of means for organizational patient safety monitoring. Research on reliability, usefulness and implementation approaches of the GTT, including its automation, is ongoing in the Nordic countries and is expected to generate useful input for the international patient safety community.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keywords
Patient safety monitoring; Hospitals; Global Trigger Tool; Electronic patient record; Nordic countries
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-114982 (URN)10.1007/s10111-014-0302-2 (DOI)000348933500005 ()
Available from: 2015-03-10 Created: 2015-03-06 Last updated: 2017-12-04
Rutberg, H., Borgstedt Risberg, M., Sjödahl, R., Nordqvist, P., Valter, L. & Nilsson, L. (2014). Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method. BMJ Open, 4(5), 004879
Open this publication in new window or tab >>Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method
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2014 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 5, p. 004879-Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe the level, preventability and categories of adverse events (AEs) identified by medical record review using the Global Trigger Tool (GTT). To estimate when the AE occurred in the course of the hospital stay and to compare voluntary AE reporting with medical record reviewing. Design: Two-stage retrospective record review. Setting: 650-bed university hospital. Participants: 20 randomly selected medical records were reviewed every month from 2009 to 2012. Primary and secondary outcome measures: AE/1000 patient-days. Proportion of AEs found by GTT found also in the voluntary reporting system. AE categorisation. Description of when during hospital stay AEs occur. Results: A total of 271 AEs were detected in the 960 medical records reviewed, corresponding to 33.2 AEs/1000 patient-days or 20.5% of the patients. Of the AEs, 6.3% were reported in the voluntary AE reporting system. Hospital-acquired infections were the most common AE category. The AEs occurred and were detected during the hospital stay in 65.5% of cases; the rest occurred or were detected within 30 days before or after the hospital stay. The AE usually occurred early during the hospital stay, and the hospital stay was 5 days longer on average for patients with an AE. Conclusions: Record reviewing identified AEs to a much larger extent than voluntary AE reporting. Healthcare organisations should consider using a portfolio of tools to gain a comprehensive picture of AEs. Substantial costs could be saved if AEs were prevented.

Place, publisher, year, edition, pages
BMJ Publishing Group: Open Access / BMJ Journals, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108944 (URN)10.1136/bmjopen-2014-004879 (DOI)000336976900075 ()
Available from: 2014-07-15 Created: 2014-07-13 Last updated: 2017-12-05
Danielsson, M., Nilsen, P., Öhrn, A., Rutberg, H., Fock, J. & Carlfjord, S. (2014). Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study.. BMC nursing, 13(1), 39
Open this publication in new window or tab >>Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study.
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2014 (English)In: BMC nursing, ISSN 1472-6955, Vol. 13, no 1, p. 39-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patient safety culture emerges from the shared assumptions, values and norms of members of a health care organization, unit, team or other group with regard to practices that directly or indirectly influence patient safety. It has been argued that organizational culture is an amalgamation of many cultures, and that subcultures should be studied to develop a deeper understanding of an organization's culture. The aim of this study was to explore subcultures among registered nurses and nurse assistants in Sweden in terms of their assumptions, values and norms with regard to practices associated with patient safety.

METHODS: The study employed an exploratory design using a qualitative method, and was conducted at two hospitals in southeast Sweden. Seven focus group interviews and two individual interviews were conducted with registered nurses and seven focus group interviews and one individual interview were conducted with nurse assistants. Manifest content analysis was used for the analysis.

RESULTS: Seven patient safety culture domains (i.e. categories of assumptions, values and norms) that included practices associated with patient safety were found: responsibility, competence, cooperation, communication, work environment, management and routines. The domains corresponded with three system levels: individual, interpersonal and organizational levels. The seven domains consisted of 16 subcategories that expressed different aspects of the registered nurses and assistants nurses' patient safety culture. Half of these subcategories were shared.

CONCLUSIONS: Registered nurses and nurse assistants in Sweden differ considerably with regard to patient safety subcultures. The results imply that, in order to improve patient safety culture, efforts must be tailored to both registered nurses' and nurse assistants' patient safety-related assumptions, values and norms. Such efforts must also take into account different system levels. The results of the present study could be useful to facilitate discussions about patient safety within and between different professional groups.

National Category
Clinical Medicine Nursing
Identifiers
urn:nbn:se:liu:diva-115378 (URN)10.1186/s12912-014-0039-5 (DOI)25435809 (PubMedID)
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2018-12-19
Nygren, M., Roback, K., Öhrn, A., Rutberg, H., Rahmqvist, M. & Nilsen, P. (2013). Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils. BMC Health Services Research, 13(52)
Open this publication in new window or tab >>Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils
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2013 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 52Article in journal (Refereed) Published
Abstract [en]

Background

National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council’s patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future.

Methods

The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council’s patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety.

Results

The response rate to the questionnaire was 79%. The conditions that had the highest number of responses in complete agreement were “patients’ involvement is important for patient safety” and “patient safety work has good support from the county council’s management”. Factors that were considered most important for achieving the current level of patient safety were root cause and risk analyses, incident reporting and the Swedish Patient Safety Law. An organizational culture that encourages reporting and avoids blame was considered most important for improved patient safety in the future, closely followed by improved communication between health care practitioners and patients.

Conclusion

Health care professionals with important positions in the Swedish county councils’ patient safety work believe that conditions for this work are somewhat constrained. They attribute the current levels of patient safety to a broad range of factors and believe that many different solutions can contribute to enhanced patient safety in the future, suggesting that this work must be multifactorial.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keywords
Patient safety, Patient involvement, Communication, Safety culture, Root cause analysis, Risk analysis, Incident reporting
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90200 (URN)10.1186/1472-6963-13-52 (DOI)000315330200001 ()
Note

Funding Agencies|Swedish Association of Local Authorities and Regions (SALAR)||

Available from: 2013-03-28 Created: 2013-03-21 Last updated: 2017-12-06Bibliographically approved
Roback, K., Nygren, M., Öhrn, A., Rutberg, H. & Nilsen, P. (2012). Strategier för säker och ännu säkrare vård: Enkätstudie om landstingens patientsäkerhetsarbete. Läkartidningen, 109(45), 2024-2027
Open this publication in new window or tab >>Strategier för säker och ännu säkrare vård: Enkätstudie om landstingens patientsäkerhetsarbete
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2012 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 45, p. 2024-2027Article in journal (Refereed) Published
Abstract [sv]

I en enkät till 216 personer med särskilt ansvar för patientsäkerhet har frågor ställts om vad som har haft betydelse och vad som kommer att ha betydelse för att uppnå en god patientsäkerhet i framtiden.

Händelse- och riskanalyser ansågs ha varit mycket viktigt för att uppnå dagens patientsäkerhetsnivå, liksom rapportering av avvikelser och risker.

Faktorer som ansågs mycket viktiga för att öka patientsäkerheten var främst organisationskultur, kommunikation och utbildning.

Även förbättrad infektionskontroll och standardisering av rutiner samt bättre instruktioner och utbildning avseende medicinsk teknik var viktiga områden.

 

Place, publisher, year, edition, pages
Läkartidningen Förlag, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87753 (URN)
Available from: 2013-01-25 Created: 2013-01-22 Last updated: 2017-12-06
Öhrn, A., Elfström, J., Tropp, H. & Rutberg, H. (2012). What can we learn from patient claims?: Analysing of patient injuries following orthopaedic surgery. Patient Safety in Surgery, 6(2), 1-6
Open this publication in new window or tab >>What can we learn from patient claims?: Analysing of patient injuries following orthopaedic surgery
2012 (English)In: Patient Safety in Surgery, ISSN 1754-9493, Vol. 6, no 2, p. 1-6Article in journal (Refereed) Published
Abstract [en]

Background: Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden.

Methods: In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare".

Results: A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55%) were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%). The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**), with 168 adverse events of 17,507 hospitals discharges (1%). One in five (36 of 168; 21.4%) injured patient was seriously disabled or died.

Conclusions: We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.

Keywords
Insurance Claim Review, Medical Errors, Orthopaedics, Patient Safety, Patient Admission, Safety Management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72590 (URN)10.1186/1754-9493-6-2 (DOI)
Note

On the day of the defence date the status of this article was "Manuscript".

Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2014-09-11Bibliographically approved
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