Evidence map›Paper›PMID 39935719›Full record

ArticleGlobal journal on quality and safety in healthcare2025

Strengthening Reliability and Sustainability: Integrating Training Within Industry (TWI) in a Quality Improvement Collaborative.

Paulo Borem, Rafaela Moraes de Moura, Helena Barreto Dos Santos, Guilherme Cesar Silva Dias Santos, Patrícia Dos Santos Bopsin, Beatriz Ramos, Andrea Keiko Fujinami Gushken, Samara de Campos Braga, Edileusa Novaes Piusi, Priscila Martini Bernardi Garzella and 10 more

Abstract read
In one paragraph

Article in Global journal on quality and safety in healthcare, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Paulo BoremInstitute for Healthcare Improvement, Boston, MA, USA.
Rafaela Moraes de MouraHospital Moinhos de Vento, Porto Alegre, Brazil.
Helena Barreto Dos SantosHospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Guilherme Cesar Silva Dias SantosBP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Patrícia Dos Santos BopsinHospital Israelita Albert Einstein, São Paulo, Brazil.
Beatriz RamosHospital Sírio-Libanês, São Paulo, Brazil.
Andrea Keiko Fujinami GushkenHcor, São Paulo, Brazil.
Samara de Campos BragaHcor, São Paulo, Brazil.
Edileusa Novaes PiusiHospital Sírio-Libanês, São Paulo, Brazil.
Priscila Martini Bernardi GarzellaHospital Israelita Albert Einstein, São Paulo, Brazil.
Lais Silvestre Bizerra BaltazarBP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Karen Cristina da Conceição Dias SilvaHospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Teilor Ricardo Dos SantosHospital Moinhos de Vento, Porto Alegre, Brazil.
Marco Antonio Saavedra BravoHospital Sírio-Libanês, São Paulo, Brazil.
Ademir Jose PetenateInstitute for Healthcare Improvement, Boston, MA, USA.
Cristiane Maria Reis CristaldaMinistério da Saúde, Brasília, Brazil.
Luciana Yumi UeMinistério da Saúde, Brasília, Brazil.
Claudia Garcia de BarrosHospital Israelita Albert Einstein, São Paulo, Brazil.
Sebastian VernalHospital Moinhos de Vento, Porto Alegre, Brazil.ORCID https://orcid.org/0000-0001-8589-0089
Saúde em Nossas Mãos collaborative study group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Integrating process improvement tools into healthcare has shown promising results, yet the application of "training within industry" (TWI) still needs to be explored in this context. This study focuses on implementing job instruction (JI), one of the three components of TWI, within a large breakthrough series collaborative (BTS) in a middle-income country. Methods: We evaluated the deployment of JI during a nationwide initiative aimed at reducing three critical healthcare-associated infections (HAIs)-central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI)-across 189 Brazilian public intensive care units (ICUs). Our quality improvement (QI) project outlines the integration of JI to enhance the reliability of care bundles and empower frontline teams to reduce variation, one fundamental condition to maintain ongoing improvements. Results: The implementation strategy included structured JI training for the hub's leaders, which facilitated the gradual adoption and customization of JI and visual management techniques into daily ICU care. We detailed the four stages of JI training, the content of each session, and how they were incorporated into the existing BTS framework alongside visual management tools. The mean compliance to prevention bundles exceeded 90%, and the project results reached an overall reduction of 44%, 52%, and 54% for CLABSI, VAP, and CAUTI, respectively. Conclusion: Our findings suggest that JI can be seamlessly integrated into routine QI activities. This structure promotes consistency in carrying out each aspect of care bundles, preventing HAI and strengthening patient safety.

Indexed as

healthcare-associated infectionsimprovement sciencejob instructionquality controlquality improvement

Identifiers

PMID39935719
PMCPMC11808858

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.