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Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study
  1. Leahora Rotteau1,
  2. Dalia Othman2,
  3. Richard Dunbar-Yaffe3,
  4. Chris Fortin4,
  5. Katharyn Go5,
  6. Amanda Mayo1,6,
  7. Jordan Pelc7,
  8. Jesse Wolfstadt8,
  9. Meiqi Guo9,
  10. Christine Soong1,10
  1. 1Centre for Quality Improvment and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
  2. 2Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
  3. 3Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
  4. 4Division of Physical Medicine and Rehabilitation, Sinai Health System, Toronto, Ontario, Canada
  5. 5Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  6. 6Division of Physical Medicine and Rehabilitation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  7. 7Division of Hospital Medicine, Sinai Health System, Toronto, Ontario, Canada
  8. 8Granovsky Gluskin Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada
  9. 9Division of Physical Medicine and Rehabilitation, University Health Network, Toronto, Ontario, Canada
  10. 10Division of General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada
  1. Correspondence to Dr Leahora Rotteau, Centre for Quality Improvment and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario M5S 1A8, Canada; Leahora.Rotteau{at}sunnybrook.ca

Abstract

Background Efforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, we explore physicians’ experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts.

Methods We conducted a qualitative study of the Medical Safety Huddle initiative implemented across six sites. The initiative consisted of short, physician focused and led, weekly meetings aimed at reviewing, anticipating and addressing patient safety issues. We conducted 29 semistructured interviews with leaders and participants. We applied an interpretive thematic analysis to the data using self-determination theory as an analytic lens.

Results The results of the thematic analysis are organised in two themes, (1) relatedness and meaningfulness, and (2) progress and autonomy, representing two forms of intrinsic motivation for engagement that we found were leveraged through participation in the initiative. First, participation enabled a sense of community and a ‘safe space’ in which professionally relevant safety issues are discussed. Second, participation in the initiative created a growing sense of ability to have input in one’s work environment. However, limited collaboration with other professional groups around patient safety and the ability to consistently address reported concerns highlights the need for leadership and organisational support for physician engagement.

Conclusion The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles’ implementation must align with the organisation’s multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.

  • Patient safety
  • Qualitative research
  • Hospital medicine

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Footnotes

  • MG and CS are joint senior authors.

  • Contributors All authors contributed to the conceptualisation and planning of this study and to the development of the manuscript. LR was responsible for data collection and coding and had a lead role in data analysis and manuscript preparation.

    LR is responsible for the overall content as the guarantor.

    MG and CS supported data analysis and manuscript writing.

  • Funding This study was funded by Mount Sinai-University Health Network Academic Medical Organization Innovation Fund (MSU-19-030).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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