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Patient Safety: Practice Change Project


The concept of patient safety is a vital part of nursing that is, however, sometimes excluded from the staff’s discussions about organizational culture. In the example of Hospital Hope, the differences between the actual and hypothetical scenarios are apparent in the responses of the nurses and hospital leaders to the problem of Mrs. Jackson and other patients (Sammer & James, 2011). In the original situation, the woman’s issues were not analyzed or regarded as a part of a larger systemic issue that impacts the health of all patients. In the scenario describing a positive outcome, the leadership of governing board members, executive leadership, managers, and nurses was the central factor that helped Hospital Hope to initiate and complete a practice change project. Furthermore, the framework used by the authors to design the program of change can be implemented in other facilities needing improvement.

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Important Factor

The two described scenarios differ in one major aspect – the response of the hospital’s leadership to the problems of Mrs. Jackson and other patients. In both cases, the hospital experiences issues with its culture of patient safety. Nonetheless, while the organization in the first example treats hospital-acquired conditions as an inherent part of treatment, the hypothetical Hospital Hope begins questioning its quality of care (Sammer & James, 2011). The first action towards change is initiated by the Governing Board of the hospital that conducts surveys to learn about the staff’s opinion about the culture of patient safety in the Surgical Intensive Care Unit (SICU). Then, a similar commitment to practice improvement is expressed by nurse managers of the SICU. They embraced the changes and worked to engage other nurses and staff in developing steps to acknowledge and address patients’ safety concerns.

In turn, the nurses shared their expertise, additional knowledge, and information that they recently obtained from various courses to contribute to the processes happening in Hospital Hope. In this case, they acted as leaders by demonstrating their interest in advancing the awareness of others and inspiring colleagues to reach their potential and contribute to the growth of the organization (Sammer & James, 2011). One can see that all levels of the hospital’s employees were not only complicit with the proposed change but actively supported all processes and suggestions to further it. Therefore, it is possible to assume that leadership was the central factor that drove the development of Hospital Hope and became the basis of the framework introduced by the authors.

To understand the importance of leadership in Hospital Hope, one can examine the original scenario where Mrs. Jackson’s health issues were disregarded as a concern for patient safety. In this case, the board members, managers, and nurses did not react to the situation, failing to consider the pitfalls in the organizational culture (Sammer & James, 2011). Moreover, nurses did not contact higher levels of management about the issue, and nothing was reported to the board members. As an outcome, the lack of leadership qualities on all levels of the hospital led to the patient being neglected. As no one was interested in researching the problem or taking steps for improvement and engaging others, the poor quality of patient safety remained unchanged.

Framework for Practice Change

A model for practice improvement is essential because it helps leaders to see which particular steps and activities have to be prioritized to achieve the best results. The framework described by Sammer and James (2011) seems to be a detailed and comprehensive approach to improving the practice. This approach is useful in the described scenario because its activities correspond with the objectives that have to be reached to strengthen the culture of safety. Thus, one’s proposed framework for change has to be based on the specific mission that the hospital has. The first step to develop the framework is to describe how it will be used in the organization – the direction of activities, their effectiveness, and factors that may contribute to or impede the progress. Then, the vision, mission, and objectives of the program need to be outlined for all members to understand why and how the change will be reached.

Following these steps, one has to identify which components of the framework will determine the model’s success. For instance, the approach discussed by Sammer and James (2011) includes such major elements as teamwork, evidence-based practice, communication, leadership, learning, just culture, and a patient-centered focus. These concepts are broken down into actions that support each factor, encouraging change. Similarly, the framework in my facility would have the same processes and resemble the approach outlined in the examined study. The model by Edwards (2017) is similar, suggesting collaboration, nonpunitive culture, accountability, mindfulness, process improvement, organizational factors, and self-assessment as vital segments in the framework. Both models highlight the role of cooperation and positive reinforcement – two aspects that have to appear in every model.


The leadership expressed by all workers in Hospital Hope was the driving factor for change in the organization. Staff, managers, and executive leadership participated in the program and provided their time and experience to both complete steps outlined by the model and encourage others to do the same. In a similar situation, the framework presented in the study can be used to inspire change. It is vital to individualize this model for a specific facility by outlining the mission and objectives of the organization and the program that it will complete.

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Edwards, M. T. (2017). An organizational learning framework for patient safety. American Journal of Medical Quality, 32(2), 148-155.

Sammer, C., & James, B. (2011). Patient safety culture: The nursing unit leader’s role. Online Journal of Issues in Nursing, 16(3). Web.

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