Work system design for patient safety: the SEIPS model

In the paper

“They also emphasized coordination issues related to patient information.”

In the paper

“Likewise, it was easier to understand comments on the staff questionnaire concerning the work space.”

In the paper

“They commented about the low quality of communication with patients regarding preoperative preparation (for example, understanding of instructions) and postoperative recovery (for example, inconsistencies in providers' instructions).”

In the paper

“For instance, unavailability of patient related information sometimes can lead to cancellations of surgeries on the day they are scheduled.”

In the paper

“A review of the floor plans helped the research team further understand the reasons for these concerns.”

In the paper

“Staff offered suggestions to remedy this problem through redesign of forms and changes in policy and job design.”

In the paper

“Here staff conveyed the inherent inefficiencies of tracking down information that should have been previously provided.”

In the paper

“For instance, concern was expressed by staff regarding the lack of privacy for patients and high noise levels.”

In the paper

“This gave us greater insight concerning the expectations for the various positions as well as how each centre was organized according to the various tasks.”

In the paper

“In this case the plans provided an understanding of the work flow and offered a greater appreciation for the confidentiality issues identified during the patient shadowing.”

In the paper

“We suggest that the work system model applied to patient safety complements and expands Donabedian's framework.”

In the paper

“Changes to any aspect of the work system will, depending on how the change or improvement is designed and implemented, either negatively or positively affect the work and clinical processes and the consequent patient, employee, and organizational outcomes.”

In the paper

“The discipline of human factors emphasizes interactions between people and their environment that contribute to performance, safety and health, and quality of working life, and the goods or services produced.13 14”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites 13 14

In the paper

“In Donabedian's model, the structure includes the organizational structure (work system model component = organization); the material resources (work system model components = environment, technology/tools); and the human resources (work system model components = care provider, tasks).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.

In the paper

“Overall, the work system in which care is provided affects both the work and clinical processes, which in turn influence the patient, employee, and organizational outcomes of care.”

In the paper

“our SEIPS model does not highlight any single element of the work system.”

In the paper

“According to the work system model, a person (the person could be a care provider, another employee of a healthcare institution such as a biomedical engineer, a unit clerk, or the patient) performs a range of tasks using various tools and technologies.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [5][6][7]

In the paper

“Donabedian 20 concludes that direct relationships may exist between structure, process and outcome.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [20] 20. Donabedian A. The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press, 1980.

In the paper

“This reflects the fact that most of the focus of the SPO model centres on the providers and their relationship with the processes and outcome(s)-that is, quality is assessed by the way in which care is provided by an individual or care team as well as the outcome of the care.”

In the paper

“Donabedian's two other means of assessing quality include evaluating the process(es) of care (how provider tasks and clinical processes are both organized and performed) and evaluating the outcome(s) of care (assessing the clinical results and impacts of and patient satisfaction with the care provided).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.

In the paper

“The implication is, therefore, that aspects of the structure may be of lesser consequence.”

In the paper

“According to Donabedian's model, poor quality, in turn, results by not following what is defined as the appropriate or correct means of performing a task (poor process).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.

In the paper

“In Donabedian's model, however, there is a clear statement that ''we must begin … with the performance of physicians and other health care providers''.19”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.

In the paper

“The performance of these tasks occurs within a certain physical environment and under specific organizational conditions.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [5][6][7]

In the paper

“It is important to recognize that a healthcare work system often includes both healthcare providers and the patient being cared for.”

In the paper

“The fact that the SEIPS model explains how the design of a system can impact patients, employees, and the organization has its roots in the theory of healthy work organizations (HWOs).”

In the paper

“The work system model also allows linkage of the various elements of the structure in the SPO model-that is, the organizational structure and material and human resources.”

In the paper

“It proposes the work system model as an expansion of the structure by addressing elements of the work system model such as the physical environment, organizational culture and climate, error reporting and analysis, and work design that are so much a part of the current patient safety focus.”

In the paper

“The SEIPS model specifies feedback loops from processes to work system and from outcomes to work system.”

In the paper

“Any healthcare work system can therefore involve multiple individuals such as healthcare providers and patients.”

In the paper

“However, it has been noted that physician professionalism also fosters a ''culture of blame'' when things go wrong because, if physicians are responsible for the entire medical process, then they are also exclusively to blame for poor quality care.26”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [26] 26. Leape LL. Error in medicine. JAMA 1994;272:1851-7.

In the paper

“Professionals such as physicians, nurses, pharmacists, and other licensed healthcare providers are bound by ethical mandates to serve in their clients' best interests.25”

What the sources say

• ?Not checked — no full text of the sourcecites [25] 25. ABIM Foundation. ACP-ASIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002;136:243-6. source

In the paper

“For instance, a care process can be considered as a series of steps or tasks performed by an individual or a team of individuals using various technologies and tools; the care process may involve various locations, therefore different physical environments.”

In the paper

“A system redesign approach to changing physician behavior may not only be a more effective approach, but may be better accepted by physicians than traditional organizational efforts to improve quality using incentives.27”

What the sources say

• ?Not checked — no full text of the sourcecites [27] 27. Flynn EA, Barker KN, Pepper GA, et al. Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities. Am J Health- System Pharm 2002;59:436-46. source

In the paper

“Poor processes and outcomes can be triggers for system redesign: the need would then arise to identify negative work system elements that affect processes and the quality and safety of care, as well as employee and organizational outcomes.”

In the paper

“The patient is also involved in patient care processes and is the ''recipient'' of good or bad outcomes of the care process.”

In the paper

“HWOs are organizations that have both good organizational outcomes and a healthy and safe workforce.31 32”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites 31 32

In the paper

“From this viewpoint, the patient is an ''input'' into the SEIPS model.”

In the paper

“Some negative elements in a work system that are hard to change may be overcome by focusing on some other positive elements.”

In the paper

“Conversely, patient safety activities place greater emphasis on the system in which practitioners work and less on individual performance.21”

What the sources say

• ?Not checked — no full text of the sourcecites [21] 21. Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. JAMA 1995;274:35-43. source

In the paper

“However, the PICC line intervention may not decrease the nurse's workload but add to the workload as more and more patients require PICC line insertion rather than central venous catheter insertions.”

In the paper

“Our model emphasizes the linkages between patient outcomes and employee/organizational outcomes.”

In the paper

“In the SEIPS model the individual is at the centre of the work system.”

In the paper

“These system redesigns support rather than conflict with the physician's role as a professional.”

In the paper

“The implication is that outcomes (both patient and employee/organizational, as proposed by the SEIPS model) are related and that they also are associated with structure aspects of the SPO model.”

In the paper

“These feedback loops represent pathways to design or redesign the work system.”

In the paper

“The care process is also affected by multiple organizational characteristics such as the need for coordination and collaboration among the healthcare providers involved in the process.”

In the paper

“Donabedian's model focuses on care process(es)-that is, how care is provided, delivered and managed.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.

In the paper

“Likewise, a bad outcome is associated with the poor performance of an individual (or a group of individuals).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.

In the paper

“For instance, a care process can be considered as a series of steps or tasks performed by an individual or a team of individuals using various technologies and tools; the care process may involve various locations, therefore different physical environments.”

In the paper

“Firstly, if the individual in the work system is a healthcare provider, tasks performed by the individual often involve the patient-for example, surgical tasks.”

In the paper

“Using the SEIPS model with the patient at the centre of the work system model can help to identify deficiencies in the healthcare system that can impair the patient's capacity to receive high quality safe care, and therefore contribute to the design of systems and processes for delivering patient centred care.”

In the paper

“Involvement of physicians in the system redesign process is critical to both the success of the system and to physician acceptance of the new system.26”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [26] 26. Leape LL. Error in medicine. JAMA 1994;272:1851-7.

In the paper

“The SEIPS model expands the concept of process to include not only care processes but also other processes that support the care process such as maintenance, housekeeping and supply chain management.”

In the paper

“6thers have also emphasized the important relationship between patient outcomes and employee/organizational outcomes.15 33”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites 15 33

In the paper

“It can be used proactively to guide system design and hazard analysis, or reactively to guide patient or employee injury investigations.”

In the paper

“The design of work systems affects patient safety as well as employee and organizational outcomes.”

In the paper

“It is descriptive, not prescriptive.”

In the paper

“This can be considered as a limitation of the model because it does not provide specific guidance as to the critical elements; but it can also be a strength because the model is generic and adaptable to the particular context or situation.”

In the paper

“The individual is at the centre of the work system and can be a healthcare provider, a healthcare team, or the patient.”

In the paper

“However, it provides a framework on how to think about the different aspects of a work system, their interactions, and possible outcomes.”

In the paper

“The professional model assumes that providers have the ultimate authority to define and carry out the core tasks of providing medical care.42”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [42] 42. Freidson E. Profession of medicine: a study of the sociology of applied knowledge. New York: Harper & Row, 1970.

In the paper

“Recognizing potential resistance and obtaining strong support from key opinion leaders 43 is essential to effective implementation of the SEIPS model.”

What the sources say

• ?Not checked — no full text of the sourcecites [43] 43. Flynn KE, Smith MA, Davis MK. From physician to consumer: the effectiveness of strategies to manage health care utilization. Med Care Res Rev 2002;59:455-81. source

In the paper

“It can also guide patient safety researchers toward developing research questions and understanding what variables to measure for a particular study.”

In the paper

“Because the professional status of providers is linked so strongly to their autonomy, they may resist system efforts to manage the process of medical care as infringing on their autonomy and degrading their professional status.”

In the paper

“This can be considered as a limitation of the model because it does not provide specific guidance as to the critical elements; but it can also be a strength because the model is generic and adaptable to the particular context or situation.”

In the paper

“We have shown that the SEIPS model can be applied in many different ways to patient safety challenges.”

In the paper

“It is critical to understand how resistance to a systems approach may limit effective implementation of the SEIPS model in practice.”

In the paper

“The design of work systems influences processes which, in turn, affect outcomes.”

In the paper

“The SEIPS model is useful for providing a view of the whole system instead of focusing on only one aspect of the work system and treating that aspect in isolation.”

In the paper

“They also influence each other.”