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Nunes E, Sirtoli F, Lima E, Minarini G, Gaspar F, Lucas P, Primo C. Instruments for Patient Safety Assessment: A Scoping Review. Healthcare (Basel) 2024; 12:2075. [PMID: 39451490 PMCID: PMC11508098 DOI: 10.3390/healthcare12202075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/19/2024] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Patient safety is an important component of healthcare service quality, and there are numerous instruments in the literature that measure patient safety. This scoping reviewaims to map the instruments/scales for assessing patient safety in healthcare services. METHOD This scoping review follows the JBI methodology. The protocol was registered on the Open Science Framework. Eligibility criteria were defined based on studies that include instruments or scales for assessing patient safety in healthcare services, in any language, and without temporal restrictions. It adhered to all scoping review checklist items [PRISMA-ScR], with searches in the Embase, Lilacs, MedLine, and Scopus databases, as well as the repository of the Brazilian Digital Library of Theses and Dissertations. Two independent reviewers performed selection and data extraction in July 2023. RESULTS Of the 4019 potential titles, 63 studies reported on a total of 47 instruments/scales and 71 dimensions for patient safety assessment. The most-described dimensions were teamwork, professional satisfaction, safety climate, communication, and working conditions. CONCLUSION The diversity of instruments and dimensions for patient safety assessment characterizes the multidimensionality and scope of patient safety. However, it hinders benchmarking between institutions and healthcare units.
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Affiliation(s)
- Elisabete Nunes
- Nursing Research, Innovation, and Development Centre of Lisbon [CIDNUR], Escola Superior de Enfermagem de Lisboa, Avenida Professor Egas Moniz, 1600-190 Lisboa, Portugal; (E.L.); (F.G.); (P.L.); (C.P.)
| | - Fernanda Sirtoli
- Centro de Ciências da Saúde, Campus de Maruípe, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1.468, Vitória 29047-105, ES, Brazil; (F.S.); (G.M.)
| | - Eliane Lima
- Nursing Research, Innovation, and Development Centre of Lisbon [CIDNUR], Escola Superior de Enfermagem de Lisboa, Avenida Professor Egas Moniz, 1600-190 Lisboa, Portugal; (E.L.); (F.G.); (P.L.); (C.P.)
- Centro de Ciências da Saúde, Campus de Maruípe, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1.468, Vitória 29047-105, ES, Brazil; (F.S.); (G.M.)
| | - Greyce Minarini
- Centro de Ciências da Saúde, Campus de Maruípe, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1.468, Vitória 29047-105, ES, Brazil; (F.S.); (G.M.)
| | - Filomena Gaspar
- Nursing Research, Innovation, and Development Centre of Lisbon [CIDNUR], Escola Superior de Enfermagem de Lisboa, Avenida Professor Egas Moniz, 1600-190 Lisboa, Portugal; (E.L.); (F.G.); (P.L.); (C.P.)
| | - Pedro Lucas
- Nursing Research, Innovation, and Development Centre of Lisbon [CIDNUR], Escola Superior de Enfermagem de Lisboa, Avenida Professor Egas Moniz, 1600-190 Lisboa, Portugal; (E.L.); (F.G.); (P.L.); (C.P.)
| | - Cândida Primo
- Nursing Research, Innovation, and Development Centre of Lisbon [CIDNUR], Escola Superior de Enfermagem de Lisboa, Avenida Professor Egas Moniz, 1600-190 Lisboa, Portugal; (E.L.); (F.G.); (P.L.); (C.P.)
- Centro de Ciências da Saúde, Campus de Maruípe, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1.468, Vitória 29047-105, ES, Brazil; (F.S.); (G.M.)
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Kim SY, Ko Y, Sim BH, Yoon YO, Jang C. Refinement and Validation of the Team Effectiveness Scale for Nursing Units. Risk Manag Healthc Policy 2024; 17:2385-2396. [PMID: 39416275 PMCID: PMC11481990 DOI: 10.2147/rmhp.s477206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 10/01/2024] [Indexed: 10/19/2024] Open
Abstract
Purpose Understanding that the complexity and dynamic nature of the nursing care setting creates diverse conditions for teamwork is important when developing tools to measure nursing unit team effectiveness. The Team Effectiveness Scale for Nursing Units (TES-NU), based on the Integrated Team Effectiveness Model, was developed without confirmatory factor analysis and only tested on one nursing organization. It needs further research to prove its validity and reliability. This study aims to refine and validate the TES-NU in various nursing organizations. Methods We designed this methodological study to refine the TES-NU by establishing its validity and reliability. The study included 330 clinical nurses from six general hospitals in South Korea, selected via convenience sampling. The TES-NU's refinement process includes item analysis, exploratory factor analysis, confirmatory factor analysis, item analysis, and convergent validity. Results The KMO of 22 preliminary items was 0.89, the cumulative variance of the five factors was 67.58%, and the commonality was >0.40. Confirmatory factor analysis indicated the revised model fit well with better indices: CMIN/DF = 1.687, CFI = 0.936, TLI = 0.924, RMSEA = 0.059, and SRMR = 0.057. We simplified the refined scale to 22 items in 5 subdomains: "head nurses leadership", "job satisfaction", "cohesion", "work performance", and "nurses competence". Convergent validity (r = 0.69, p < 0.001) and reliability (Cronbach's alpha = 0.92) were validated for the revised TES-NU. Conclusion A refined TES-NU has tested their validity and reliability. Nursing managers can use this tool to manage the performance of individual nurses as well as nursing units, which will contribute to improving the work performance of the nursing organization.
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Affiliation(s)
- Se Young Kim
- Department of Nursing, Changwon National University, Changwon, Repulic of Korea
| | - Young Ko
- College of Nursing, Gachon University, Incheon, Republic of Korea
| | - Bong Hee Sim
- Department of Nursing, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Yeon Ok Yoon
- Department of Nursing, Hanyang University Changwon Hanmaeum Hospital, Changwon, Republic of Korea
| | - Chunseon Jang
- Department of Nursing, Sungkyunkwan University Changwon Hospital, Changwon, Republic of Korea
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Etherington C, Boet S, Chen I, Duffy M, Mamas MA, Bader Eddeen A, Bateman BT, Sun LY. Association Between Surgeon/Anesthesiologist Sex Discordance and 1-year Mortality Among Adults Undergoing Noncardiac Surgery: A Population-based Retrospective Cohort Study. Ann Surg 2024; 279:563-568. [PMID: 37791498 DOI: 10.1097/sla.0000000000006111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To investigate the association between surgeon-anesthesiologist sex discordance and patient mortality after noncardiac surgery. BACKGROUND Evidence suggests different practice patterns exist among female and male physicians. However, the influence of physician sex on team-based practices in the operating room and subsequent patient outcomes remains unclear in the context of noncardiac surgery. METHODS We conducted a population-based, retrospective cohort study of adult Ontario residents who underwent index, inpatient noncardiac surgery between January 2007 and December 2017. The primary exposure was physician sex discordance (ie, the surgeon and anesthesiologist were of the opposite sex). The primary outcome was 1-year mortality. The association between physician sex discordance and patient outcomes was modeled using multivariable Cox proportional hazard regression with adjustment for relevant physician, patient, and hospital characteristics. RESULTS Of 541,209 patients, 158,084 (29.2%) were treated by sex-discordant physician teams. Physician sex discordance was associated with a lower rate of mortality at 1 year [5.2% vs. 5.7%; adjusted HR: 0.95 (0.91-0.99)]. Patients treated by teams composed of female surgeons and male anesthesiologists were more likely to be alive at 1 year than those treated by all-male physician teams [adjusted HR: 0.90 (0.81-0.99)]. CONCLUSIONS Noncardiac surgery patients had a lower likelihood of 1-year mortality when treated by sex-discordant surgeon-anesthesiologist teams. The likelihood of mortality was further reduced if the surgeon was female. Further research is needed to explore the underlying mechanisms of these observations and design strategies to diversify operating room teams to optimize performance and patient outcomes.
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Affiliation(s)
- Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Innie Chen
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Melissa Duffy
- Department of Educational Studies, University of South Carolina, Columbia, SC
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Staffordshire, UK
| | | | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Louise Y Sun
- Institute for Clinical Evaluative Sciences, ON, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Pasquer A, Ducarroz S, Lifante JC, Skinner S, Poncet G, Duclos A. Operating room organization and surgical performance: a systematic review. Patient Saf Surg 2024; 18:5. [PMID: 38287316 PMCID: PMC10826254 DOI: 10.1186/s13037-023-00388-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Organizational factors may influence surgical outcomes, regardless of extensively studied factors such as patient preoperative risk and surgical complexity. This study was designed to explore how operating room organization determines surgical performance and to identify gaps in the literature that necessitate further investigation. METHODS We conducted a systematic review according to PRISMA guidelines to identify original studies in Pubmed and Scopus from January 1, 2000 to December 31, 2019. Studies evaluating the association between five determinants (team composition, stability, teamwork, work scheduling, disturbing elements) and three outcomes (operative time, patient safety, costs) were included. Methodology was assessed based on criteria such as multicentric investigation, accurate population description, and study design. RESULTS Out of 2625 studies, 76 met inclusion criteria. Of these, 34 (44.7%) investigated surgical team composition, 15 (19.7%) team stability, 11 (14.5%) teamwork, 9 (11.8%) scheduling, and 7 (9.2%) examined the occurrence of disturbing elements in the operating room. The participation of surgical residents appeared to impact patient outcomes. Employing specialized and stable teams in dedicated operating rooms showed improvements in outcomes. Optimization of teamwork reduced operative time, while poor teamwork increased morbidity and costs. Disturbances and communication failures in the operating room negatively affected operative time and surgical safety. CONCLUSION While limited, existing scientific evidence suggests that operating room staffing and environment significantly influences patient outcomes. Prioritizing further research on these organizational drivers is key to enhancing surgical performance.
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Affiliation(s)
- Arnaud Pasquer
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France.
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, 5 Place d' Arsonval, 69003, Lyon, France.
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France.
| | - Simon Ducarroz
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
| | - Jean Christophe Lifante
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
- Department of Endocrine Surgery, Hospices Civils de Lyon, Lyon, France
| | - Sarah Skinner
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
| | - Gilles Poncet
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, 5 Place d' Arsonval, 69003, Lyon, France
- INSERM, UMR 1052-UMR5286, UMR 1032 Lyon Cancer Research Center, Faculté Laennec, Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Antoine Duclos
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
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Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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Ostroff C, Benincasa C, Rae B, Fahlbusch D, Wallwork N. Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention. PLoS One 2023; 18:e0295271. [PMID: 38033091 PMCID: PMC10688855 DOI: 10.1371/journal.pone.0295271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Incivility in surgery is prevalent and negatively impacts effectiveness and staff well-being. The purpose of this study was to a) examine relationships between incivility, team dynamics, and well-being outcomes, and b) explore a low-cost intervention of 'eye' signage in operating theater areas to reduce incivility in surgical teams. A mixed methods design was used in an orthopedic hospital. Surveys of incivility, teamwork, and well-being were administered three months apart in a small private hospital. An intervention of signage with eyes was placed in the theater area after administration of the first survey, using a pretest-posttest design. Participants also responded to an open-ended question about suggestions for improvements at the end of the survey which was then thematically analyzed. At the individual level (n = 74), incivility was statistically significantly related to team dynamics which in turn was significantly related to burnout, stress, and job attitudes. At the aggregate level, reported incivility was statistically significantly lower after the 'eye' sign intervention. Thematic analysis identified core issues of management behaviors, employee appreciation, communication, and work practices. Incivility in surgical teams has significant detrimental associations with burnout, stress, and job attitudes, which occurs through its impact on decreased team dynamics and communication. A simple intervention that evokes perceptions of being observed, such as signage of eyes in theater areas, has the potential to decrease incivility at least in the short term, demonstrating that incivility is amenable to being modified. Additional research on targeted interventions to address incivility are needed to improve teamwork and staff well-being.
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Affiliation(s)
- Cheri Ostroff
- University of South Australia Centre for Workplace Excellence, Adelaide, Australia
| | - Chelsea Benincasa
- University of South Australia Rosemary Bryant AO Research Centre, Adelaide, Australia
| | - Belinda Rae
- University of South Australia Centre for Workplace Excellence, Adelaide, Australia
| | - Douglas Fahlbusch
- University of South Australia Clinical and Health Sciences, Adelaide, Australia
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Krecko LK, Stalter LN, Quamme SRP, Steege LM, Zelenski AB, Greenberg CC, Jung S. Discussion-based interprofessional education: A positive step toward promoting shared understanding between surgical residents and nurses. J Interprof Care 2023; 37:974-989. [PMID: 37161400 PMCID: PMC10636242 DOI: 10.1080/13561820.2023.2206434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2-6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Lily N Stalter
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sudha R Pavuluri Quamme
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Caprice C Greenberg
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah Jung
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Tanaka MJ, Prasad R, Miller LA, Fleck MM, Stiles B, Boyne CJ, Nguyen THE. Team Approach: Improving Orthopaedic Operating Room Efficiency. JBJS Rev 2023; 11:01874474-202308000-00004. [PMID: 37549236 DOI: 10.2106/jbjs.rvw.23.00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The cost of surgical care accounts for almost one-third of all health care spending in the United States. Within health care spending, the operating room (OR) is one of the largest health care costs during a perioperative episode of care. Efficiency in the OR has been associated with increased productivity, safety, and quality of care. However, multiple sources of delays can contribute to inefficiency, and improving efficiency in the OR requires a systematic approach to identify and address each issue. We report on the case of a process improvement initiative implemented in a large academic institution to improve OR efficiency in outpatient orthopaedic cases, and we discuss the lessons learned through this program. Optimizing workflow in the OR requires a multidisciplinary team approach consisting of clinician leaders with common goals and open discussion regarding the needs of each team member, including circulating nurses, surgical nurses/technologists, and anesthesiologists. Our experience highlights the importance of practical, clinician-driven changes that are supported by administrative engagement, resources for staffing and equipment, and institutional flexibility, which are required to implement systemic changes to address and improve efficiency in the OR.
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Affiliation(s)
- Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rashmi Prasad
- Department of Anesthesia, Johns Hopkins University, Baltimore, Maryland
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Escher C, Rystedt H, Creutzfeldt J, Meurling L, Hedman L, Felländer-Tsai L, Kjellin A. All professions can benefit - a mixed-methods study on simulation-based teamwork training for operating room teams. Adv Simul (Lond) 2023; 8:18. [PMID: 37460943 PMCID: PMC10351117 DOI: 10.1186/s41077-023-00257-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/09/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Operating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants' reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace. METHODS In a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team. Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years. Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis. RESULTS All occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one's profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration. CONCLUSION Simulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.
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Affiliation(s)
- Cecilia Escher
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden.
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - Hans Rystedt
- Simulator Centre West, Region Västra Götaland, Gothenburg, Sweden
| | - Johan Creutzfeldt
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Lisbet Meurling
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Leif Hedman
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Li Felländer-Tsai
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ann Kjellin
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Boet S, Etherington C, Andreas C, Denis-LeBlanc M. Professional Coaching as a Continuing Professional Development Intervention to Address the Physician Distress Epidemic. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:126-132. [PMID: 37249344 DOI: 10.1097/ceh.0000000000000450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
ABSTRACT Physician distress and burnout are reaching epidemic proportions, threatening physicians' capacities to develop and maintain competencies in the face of the increasingly demanding and complex realities of medical practice in today's world. In this article, we suggest that coaching should be considered both a continuing professional development intervention as well as an integral part of a balanced and proactive solution to physician distress and burnout. Unlike other interventions, coaching is intended to help individuals gain clarity in their life, rather than to treat a mental health condition or to provide advice, support, guidance, or knowledge/skills. Certified coaches are trained to help individuals discover solutions to complex problems and facilitate decision-making about what is needed to build and maintain capacity and take action. Across many sectors, coaching has been shown to enhance performance and reduce vulnerability to distress and burnout, but it has yet to be systematically implemented in medicine. By empowering physicians to discover and implement solutions to challenges, regain control over their lives, and act according to their own values, coaching can position physicians to become leaders and advocates for system-level change, while simultaneously prioritizing their own well-being.
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Affiliation(s)
- Sylvain Boet
- Dr. Boet: Professor, Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada, Assistant Dean, Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, Scientist, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada, Institut du Savoir Montfort, Ottawa, Ontario, Canada, and Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr: Etherington: Senior Research Associate, Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada. Dr. Andreas: Associate Faculty, Crux Coaching, Cranbrook, British Columbia, Canada. Dr. Denis-LeBlanc: Vice Dean, Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, Department of Family Medicine, Hôpital Montfort, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, and Institut du Savoir Montfort, Ottawa, Ontario, Canada
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Vikan M, Haugen AS, Bjørnnes AK, Valeberg BT, Deilkås ECT, Danielsen SO. The association between patient safety culture and adverse events - a scoping review. BMC Health Serv Res 2023; 23:300. [PMID: 36991426 PMCID: PMC10053753 DOI: 10.1186/s12913-023-09332-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Adverse events (AEs) affect 10% of in-hospital patients, causing increased costs, injuries, disability and mortality. Patient safety culture (PSC) is an indicator of quality in healthcare services and is thus perceived as a proxy for the quality of care. Previous studies show variation in the association between PSC scores and AE rates. The main objective of this scoping review is to summarise the evidence on the association between PSC scores and AE rates in healthcare services. In addition, map the characteristics and the applied research methodology in the included studies, and study the strengths and limitations of the evidence. METHODS We applied a scoping review methodology to answer the broad research questions of this study, following the PRISMA-ScR checklist. A systematic search in seven databases was conducted in January 2022. The records were screened independently against eligibility criteria using Rayyan software, and the extracted data were collated in a charting form. Descriptive representations and tables display the systematic mapping of the literature. RESULTS We included 34 out of 1,743 screened articles. The mapping demonstrated a statistical association in 76% of the studies, where increased PSC scores were associated with reduced AE rates. Most of the studies had a multicentre design and were conducted in-hospital in high-income countries. The methodological approaches to measuring the association varied, including missing reports on the tools` validation and participants, different medical specialties, and work unit level of measurements. In addition, the review identified a lack of eligible studies for meta-analysis and synthesis and demonstrated a need for an in-depth understanding of the association, including context complexity. CONCLUSIONS We found that the vast majority of studies report reduced AE rates when PSC scores increase. This review demonstrates a lack of studies from primary care and low- and- middle-income countries. There is a discrepancy in utilised concepts and methodology, hence there is a need for a broader understanding of the concepts and the contextual factors, and more uniform methodology. Longitudinal prospective studies with higher quality can enhance efforts to improve patient safety.
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Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Arvid Steinar Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Berit Taraldsen Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- University of South-Eastern Norway, Drammen, Norway
| | | | - Stein Ove Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Bushara O, Abahuje E, Amro A, Tesorero K, Diaz C, Johnson J, Shapiro M, Ko B, Bilimoria KY, Stey AM. Is the Implementation of an Interprofessional Communication Smart Phone Application Associated With Improved Survival Among Critically Ill Surgical Patients? J Surg Res 2023; 283:179-187. [PMID: 36410234 DOI: 10.1016/j.jss.2022.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/15/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients admitted to intensive care units (ICUs) have high rates of mortality and morbidity. Improved communication between providers within ICUs may reduce morbidity. The goal of this study is to leverage a natural experiment of the temporally staggered implementation of a smart phone application for interprofessional communication to quantify the association with postoperative mortality and morbidity among critically ill surgical patients. METHODS We conducted an observational case-control study and utilized a difference-in-difference model to determine the impact of temporally staggered implementation of an interprofessional communication smart phone application on mortality, postoperative hyperglycemia, malnutrition, venous thromboembolism (VTE), and surgical site infections. Our study included patients who underwent surgical procedures and were admitted to the ICU at one of three hospitals (one academic medical center, hospital A, and two community hospitals, hospitals B and C) in a single health system between March 2018 and April 2021. RESULTS Our cohort consisted of 1457 patients, of which 1174 were hospitalized at hospital A and 283 at hospitals B and C. In the full cohort, 80 (5.6%) patients died during ICU admission. Difference-in-difference analysis demonstrated a relative difference in mortality of 4.8% [1.1%-8.5%] (P = 0.04) at hospitals B and C compared to hospital A after the implementation of the application. Our model demonstrated a 2.5% difference in VTEs [1.1%-3.8%], P = 0.03. There were no significant reductions in hyperglycemia, malnutrition, or surgical site infection. CONCLUSIONS The implementation of an interprofessional communication smart phone application is associated with reduced mortality and VTE incidence among critically ill surgical patients across three diverse hospitals.
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Affiliation(s)
- Omar Bushara
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Egide Abahuje
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ali Amro
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Carmen Diaz
- Kellogg School of Business, Northwestern University, Chicago, Illinois
| | - Julie Johnson
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Shapiro
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bona Ko
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne M Stey
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Li L, Wu HH, Huang CH, Zou Y, Li XY. Key drivers of promoting patient safety culture from the perspective of medical staff at a tertiary hospital in China. TQM JOURNAL 2022. [DOI: 10.1108/tqm-02-2022-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PurposeUnderstanding the antecedents of patient safety culture among medical staff is essential if hospital managers are to promote explicit patient safety policies and strategies. The factors that influence patient safety culture have received little attention. The authors aim to investigate the antecedents of patient safety culture (safety climate) in relation to medical staff to develop a comprehensive approach to improve patient safety and the quality of medical care in China.Design/methodology/approachThe Chinese version of the Safety Attitudes Questionnaire (CSAQ) was used to examine the attitudes toward patient safety among physicians and nurses. This medical staff was asked to submit the intra-organizational online survey via email. A total of 1780 questionnaires were issued. The final useable questionnaires were 256, yielding a response rate of 14.38%. One-way analysis of variance (ANOVA) was employed to test if different sex, supervisor/manager, age, working experience, and education result in different perceptions. Confirmatory factor analysis (CFA) was used to verify the structure of the data. Then linear regression with forward selection was performed to obtain the essential dimension(s) that affect the safety culture (safety climate).FindingsThe CFA results showed that 26 CSAQ items measured 6 safety-related dimensions. The linear regression results indicated that working conditions, teamwork climate, and job satisfaction had significant positive effects on safety culture (safety climate).Practical implicationsHospital managers should put increased effort into essential elements of patient-oriented safety culture, such as working conditions, teamwork climate, and job satisfaction to develop appropriate avenues to improve the quality of delivered medical services as well as the safety of patients.Originality/valueThis study focused on the contribution that the antecedents of patient safety culture (safety climate) make with reference to the perspective of medical staff in a tertiary hospital in China.
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Wang SJ, Chang YC, Hu WY, Shih YH, Yang CH. Improving Patient Safety Culture During the COVID-19 Pandemic in Taiwan. Front Public Health 2022; 10:889870. [PMID: 35903386 PMCID: PMC9315290 DOI: 10.3389/fpubh.2022.889870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimPatient safety culture attitude is strongly linked to patient safety outcomes. Since the onset of the COVID-19 pandemic in early 2020, pandemic prevention has become the priority of hospital staff. However, few studies have explored the changes in patient safety culture among hospital staff that have occurred during the pandemic. The present study compared the safety attitudes, emotional exhaustion (EE), and work–life balance (WLB) of hospital staff in the early (2020) and late (2021) stages of the COVID-19 pandemic and explored the effects of EE and WLB on patient safety attitudes in Taiwan.Materials and MethodsIn this cross-sectional study, the Joint Commission of Taiwan Patient Safety Culture Survey, including the six-dimension Safety Attitudes Questionnaire (SAQ) and EE and WLB scales, were used for data collection.ResultsThis study included a total of 706 hospital employees from a district hospital in Taipei City. The respondents' scores in each SAQ sub-dimension (except for stress recognition) increased non-significantly from 2020 to 2021, whereas their EE and WLB scores improved significantly (P < 0.05 and P < 0.01, respectively). The results of hierarchical regression analysis indicated that although a respondent's WLB score could predict their scores in each SAQ sub-dimension (except for stress recognition), EE was the most important factor affecting the respondents' attitudes toward patient safety culture during the later stage of the COVID-19 pandemic.ConclusionIn the post-pandemic, employees' attitudes toward safety climate, job satisfaction, and perception of Management changed from negative to positive. Additionally, both EE and WLB are key factors influencing patient safety culture. The present study can be used as a reference for hospital managers to formulate crisis response strategies.
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Affiliation(s)
- Shu Jung Wang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yun Chen Chang
- School of Nursing and Graduate Institute of Nursing, China Medical University, Taichung, Taiwan
- *Correspondence: Yun Chen Chang
| | - Wen Yu Hu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- Wen Yu Hu
| | - Yang Hsin Shih
- Superintendent Office, Central Clinic & Hospital, Taipei, Taiwan
| | - Ching Hsu Yang
- Department of Emergency Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
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Bäker A, Maisano F, Mestres CA. Enabling leaders of multispecialty teams via cross-training. BMJ LEADER 2022; 7:45-51. [PMID: 37013874 DOI: 10.1136/leader-2021-000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
BackgroundTeamwork across medical specialties improves patient outcomes. However, it also places an additional strain on team leaders, who must mediate between the medical specialties while at the same time belonging to one of them. We examine whether a cross-training incorporating communication and leadership skills can enhance multispecialty teamwork in Heart Teams and enable Heart Team leaders.MethodIn a prospective observational study, the authors surveyed physicians working in multispecialty Heart Teams worldwide, who participated in a cross-training course. Survey responses were collected at the beginning of the course and 6 months later, after course completion. Furthermore, for a subsample of participants, external assessments of course participants’ communication and presentation skills at the beginning and at the end of the training were elicited. The authors conducted mean comparison tests and difference-in-difference analysis.ResultsSixty-four physicians were surveyed. A total of 547 external assessments were collected. The cross-training significantly improved participant-rated teamwork across medical specialties, and communication and presentation skills as rated by participants and external assessors who were blind to the time structure or training context.ConclusionThe study highlights how a cross-training can enable leaders of multispecialty teams in their leadership role by raising awareness of other specialties’ skills and knowledge. Cross-training combined with communication skills training is an effective measure to improve collaboration in Heart Teams.
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Affiliation(s)
- Agnes Bäker
- School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Business Administration, University of Zurich, Zurich, Switzerland
| | | | - Carlos A Mestres
- University Hospital Zurich, Zurich, Switzerland
- Department of Cardiothoracic Surgery, University of the Free State, Bloemfontein, South Africa
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Mrayyan MT. Predictors and outcomes of patient safety culture: a cross-sectional comparative study. BMJ Open Qual 2022; 11:e001889. [PMID: 35798501 PMCID: PMC9263941 DOI: 10.1136/bmjoq-2022-001889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Developing a safety culture in hospitals improves patient safety-related initiatives. Limited recent knowledge about patient safety culture (PSC) exists in the healthcare context. AIMS This study assessed nurses' reporting on the predictors and outcomes of PSC and the differences between the patient safety grades and the number of events reported across the components of PSC. METHODS A cross-sectional comparative research design was conducted. The Strengthening the Reporting of Observational Studies in Epidemiology (https://www.strobe-statement.org/index.php?id=available-checklists) guided the study. The researcher recruited a convenience sample of 300 registered nurses using the hospital survey on patient safety culture, with a response rate of 75%. RESULTS Nurses reported PSC to be 'moderate'. Areas of strength in PSC were non-punitive responses to errors and teamwork within units. Areas that needed improvements were the supervisor's/manager's expectations and actions in promoting safety and communication openness. Some significant correlations were reported among PSC components. Significant differences in means were observed for patient safety grades in six out of the ten PSC components and one outcome item. Organisational learning/continuous improvement, hospital handoffs and transitions, years of experience in the current hospital, the supervisor's/manager's expectations and actions in promoting safety and gender predicted PSC. Of the outcomes, around half of the sample reported a 'very good' patient safety grade, and 'no events' or 'one to two events' only were reported, and nurses 'agreed' on the majority of items, which indicates a positive perception about the overall PSC in the hospitals. In addition, nurses 'most of the time' reported the events when they occurred. PSC components correlated significantly and moderately with PSC outcomes. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE PSC was moderate with an overall positive nurses' perceptions. PSC's strengths should be maintained, and areas of improvement should be prioritised and immediately tackled. Assessing PSC is the first step in improving hospitals' overall performance and quality of services, and improving patient safety practices is essential to improving PSC and clinical outcomes.
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Affiliation(s)
- Majd T Mrayyan
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
- Advanced Nursing Department, Faculty of Nursing, Isra University, Amman, Jordan
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Bedürfnisorientierte Arbeitswelten im Krankenhaus: Entwicklung und Akzeptanz des HEMI-Architekturkonzepts. GIO-GRUPPE-INTERAKTION-ORGANISATION-ZEITSCHRIFT FUER ANGEWANDTE ORGANISATIONSPSYCHOLOGIE 2022. [DOI: 10.1007/s11612-022-00629-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDieser Beitrag in der Zeitschrift Gruppe. Interaktion. Organisation (GIO), Themenheft New Work – Inspirierende, kooperationsfördernde Arbeitsumgebungen beschreibt die Entwicklung und wissenschaftliche Prüfung eines Architekturkonzepts zur evidenzbasierten Gestaltung innovativer und bedürfnisorientierter Arbeitswelten im Krankenhaus. Das Konzept basiert auf einer berufsunabhängigen Neubewertung der Krankenhausumgebung und definiert fünf Umgebungskategorien und architektonische Qualitäten: (H) hands on/off (Arbeiten mit oder ohne direktem Patientenkontakt), (E) eyes on/off (Arbeiten mit oder ohne indirektem Patientenkontakt), (M) mind on (konzentrierte Arbeiten), mind off (Entspannung und Regeneration) und (I) interact on/off (Arbeiten mit oder ohne Kontakt zu Kollegen). Die Kategorien lassen Rückschlüsse auf den psycho-emotionalen Stress und die kognitive Beanspruchung der Mitarbeitenden zu und bestimmen die auf diese reagierende architektonische Gestaltung. Im Unterschied zum bisherigen deutschen Krankenhausentwurf durchbricht das (HEMI) Architekturkonzept veraltete Organisationsstrukturen, geht architekturpsychologisch auf die steigende Belastung der Mitarbeitenden ein und formuliert räumliche Lösungen. Die Akzeptanz der zentralen Arbeitswelt, die das Konzept u. a. vorsieht und die in einer bundesweiten Befragung an Klinikärztinnen und -ärzten durchgeführt wurde, ist hoch und abhängig von Alter‑, Einkommen und Dienstjahren.
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Doorey AJ, Turi ZG, Lazzara EH, Casey M, Kolm P, Garratt KN, Weintraub WS. Safety gaps in medical team communication: Closing the loop on quality improvement efforts in the cardiac catheterization lab. Catheter Cardiovasc Interv 2022; 99:1953-1962. [PMID: 35419927 DOI: 10.1002/ccd.30189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022]
Abstract
Closed-loop communication (CLC) is a fundamental aspect of effective communication, critical in the cardiac catheterization laboratory (cath lab) where physician orders are verbal. Complete CLC is typically a hospital and national mandate. Deficiencies in CLC have been shown to impair quality of care. Single center observational study, CLC for physician verbal orders in the cath lab were assessed by direct observation during a 5-year quality improvement effort. Performance feedback and educational efforts were used over this time frame to improve CLC, and the effects of each intervention assessed. Responses to verbal orders were characterized as complete (all important parameters of the order repeated, the mandated response), partial, acknowledgment only, or no response. During the first observational period of 101 cases, complete CLC occurred in 195 of 515 (38%) medication orders and 136 of 235 (50%) equipment orders. Complete CLC improved over time with various educational efforts, (p < 0.001) but in the final observation period of 117 cases, complete CLC occurred in just 259 of 328 (79%) medication orders and 439 of 581 (76%) equipment orders. Incomplete CLC was associated with medication and equipment errors. CLC of physician verbal orders was used suboptimally in this medical team setting. Baseline data indicate that physicians and staff have normalized weak, unreliable communication methods. Such lapses were associated with errors in order implementation. A subsequent 5-year quality improvement program resulted in improvement but a sizable minority of unacceptable responses. This represents an opportunity to improve patient safety in cath labs.
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Affiliation(s)
- Andrew J Doorey
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA.,Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zoltan G Turi
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Elizabeth H Lazzara
- Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA
| | - Molly Casey
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Paul Kolm
- MedStar Washington Health Research Institute, Washington, District of Columbia, USA
| | - Kirk N Garratt
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA
| | - William S Weintraub
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA.,MedStar Washington Health Research Institute, Washington, District of Columbia, USA.,Division of Cardiology, Georgetown University, Washington, District of Columbia, USA
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Tschan F, Keller S, Semmer NK, Timm-Holzer E, Zimmermann J, Huber SA, Wrann S, Hübner M, Banz V, Prevost GA, Marschall J, Candinas D, Demartines N, Weber M, Beldi G. Effects of structured intraoperative briefings on patient outcomes: multicentre before-and-after study. Br J Surg 2021; 109:136-144. [PMID: 34850862 PMCID: PMC10401893 DOI: 10.1093/bjs/znab384] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/29/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Operations require collaboration between surgeons, anaesthetia professionals, and nurses. The aim of this study was to determine whether intraoperative briefings influence patient outcomes. METHODS In a before-and-after controlled trial (9 months baseline; 9 months intervention), intraoperative briefings were introduced in four general surgery centres between 2015 and 2018. During the operation, the responsible surgeon (most senior surgeon present) briefed the surgical team using the StOP? protocol about: progress of the operation (Status), next steps (Objectives), possible problems (Problems), and encouraged asking questions (?). Differences between baseline and intervention were analysed regarding surgical-site infections (primary outcome), mortality, unplanned reoperations, and duration of hospital stay (secondary outcomes), using inverse probability of treatment (IPT) weighting based on propensity scores. RESULTS In total, 8256 patients underwent surgery in the study. Endpoint data were available for 7745 patients (93.8 per cent). IPT-weighted and adjusted intention-to-treat analyses showed no differences in surgical-site infections between baseline and intervention (9.8 versus 9.6 per cent respectively; adjusted difference (AD) -0.15 (95 per cent c.i. -1.45 to 1.14) per cent; odds ratio (OR) 0.92, 95 per cent c.i. 0.83 to 1.15; P = 0.797), but there were reductions in mortality (1.6 versus 1.1 per cent; AD -0.54 (-1.04 to -0.03) per cent; OR 0.60, 0.39 to 0.92; P = 0.018), unplanned reoperations (6.4 versus 4.8 per cent; AD -1.66 (-2.69 to -0.62) per cent; OR 0.72, 0.59 to 0.89; P = 0.002), and fewer prolonged hospital stays (21.6 versus 19.8 per cent; AD -1.82 (-3.48 to -0.15) per cent; OR 0.87, 0.77 to 0.98; P = 0.024). CONCLUSION Short intraoperative briefings improve patient outcomes and should be performed routinely.
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Affiliation(s)
- Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Sandra Keller
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Berne, Berne, Switzerland
| | - Eliane Timm-Holzer
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Jasmin Zimmermann
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon A Huber
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon Wrann
- Department of Surgery, Triemli Hospital, Zurich, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Gian Andrea Prevost
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland.,Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, University Hospital Berne, Berne, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Markus Weber
- Department of Surgery, Triemli Hospital, Zurich, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
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20
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Marrast L, Congliaro J, Doonachar A, Rogers A, Block L, LaVine N, Fornari A. Developing a team-based assessment strategy: direct observation of interprofessional team performance in an ambulatory teaching practice. MEDEDPUBLISH 2021. [DOI: 10.12688/mep.17422.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: High functioning interprofessional teams may benefit from understanding how well (or not so well) a team is functioning and how teamwork can be improved. A team-based assessment can provide team insight into performance and areas for improvement. Though individual assessment via direct observation is common, few residency programs in the United States have implemented strategies for interprofessional team (IPT) assessments. Methods: We piloted a program evaluation via direct observation for a team-based assessment of an IPT within one Internal Medicine residency program. Our teams included learners from medicine, pharmacy, physician assistant and psychology graduate programs. To assess team performance in a systematic manner, we used a Modified McMaster-Ottawa tool to observe three types of IPT encounters: huddles, patient interactions and precepting discussions with faculty. The tool allowed us to capture team behaviors across various competencies: roles/responsibilities, communication with patient/family, and conflict resolution. We adapted the tool to include qualitative data for field notes by trained observers that added context to our ratings. Results: We observed 222 encounters over four months. Our results support that the team performed well in measures that have been iteratively and intentionally enhanced – role clarification and conflict resolution. However, we observed a lack of consistent incorporation of patient-family preferences into IPT discussions. Our qualitative results show that team collaboration is fostered when we look for opportunities to engage interprofessional learners. Conclusions: Our observations clarify the behaviors and processes that other IPTs can apply to improve collaboration and education. As a pilot, this study helps to inform training programs of the need to develop measures for, not just individual assessment, but also IPT assessment.
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Mossburg SE, Dennison Himmelfarb C. The Association Between Professional Burnout and Engagement With Patient Safety Culture and Outcomes: A Systematic Review. J Patient Saf 2021; 17:e1307-e1319. [PMID: 29944601 DOI: 10.1097/pts.0000000000000519] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In the last 20 years, there have been numerous successful efforts to improve patient safety, although recent research still shows a significant gap. Researchers have begun exploring the impact of individual level factors on patient safety culture and safety outcomes. This review examines the state of the science exploring the impact of professional burnout and engagement on patient safety culture and safety outcomes. METHODS A systematic search was conducted in CINAHL, PubMed, and Embase. Studies included reported on the relationships among burnout or engagement and safety culture or safety outcomes. RESULTS Twenty-two studies met inclusion criteria. Ten studies showed a relationship between both safety culture and clinical errors with burnout. Two of 3 studies reported an association between burnout and patient outcomes. Fewer studies focused on engagement. Most studies exploring engagement and safety culture found a moderately strong positive association. The limited evidence on the relationship between engagement and errors depicts inconsistent findings. Only one study explored engagement and patient outcomes, which failed to find a relationship. CONCLUSIONS The burnout/safety literature should be expanded to a multidisciplinary focus. Mixed results of the relationship between burnout and errors could be due to a disparate relationship with perceived versus observed errors. The engagement/safety literature is immature, although high engagement seems to be associated with high safety culture. Extending this science into safety outcomes would be meaningful, especially in light of the recent focus on an abundance-based approach to safety.
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Affiliation(s)
- Sarah E Mossburg
- From the Johns Hopkins University School of Nursing, Baltimore, Maryland
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Mansour D, Sayeed Z, Padela MT, McCarty S, Tonnos F, Silas D, Mostafa G, Yassir WK. Accountable Operating Room Teams. Orthopedics 2021; 44:e463-e470. [PMID: 34292838 DOI: 10.3928/01477447-20210618-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With Medicare reimbursement diminishing and the aging population consuming more health care, hospitals continue to push for reforms to improve the efficiency of health care delivery, decrease consumption, and elevate the quality of care. Operating rooms command a large share of hospital resources but are also major revenue generators. Surgical care has evolved to become more efficient and accountable. Defining the characteristics of an accountable operating room team has been more elusive and inconsistent. This review defines the characteristics of accountable operating room teams and recommends measures by which to evaluate them. [Orthopedics. 2021;44(4):e463-e470.].
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Richard A, Pfeiffer Y, Schwappach DDL. Development and Psychometric Evaluation of the Speaking Up About Patient Safety Questionnaire. J Patient Saf 2021; 17:e599-e606. [PMID: 28858000 DOI: 10.1097/pts.0000000000000415] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Speaking up about safety concerns by staff is important to prevent medical errors. Knowledge about healthcare workers' speaking up behaviors and perceived speaking up climate is useful for healthcare organizations (HCOs) to identify areas for improvement. The aim of this study was to develop a short questionnaire allowing HCOs to assess different aspects of speaking up among healthcare staff. METHODS Healthcare workers (n = 523) from 2 Swiss hospitals completed a questionnaire covering various aspects of speak up-related behaviors and climate. Psychometric testing included descriptive statistics, correlations, reliabilities (Cronbach α), principal component analysis, and t tests for assessing differences in hierarchical groups. RESULTS Principal component analysis confirmed the structure of 3 speaking up behavior-related scales, that is, frequency of perceived concerns (concern scale, α = 0.73), withholding voice (silence scale, α = 0.76), and speaking up (speak up scale, α = 0.85). Concerning speak up climate, principal component analysis revealed 3 scales (psychological safety, α = 0.84; encouraging environment, α = 0.74; resignation, α = 0.73). The final survey instrument also included items covering speaking up barriers and a vignette to assess simulated behavior. A higher hierarchical level was mostly associated with a more positive speak up-related behavior and climate. CONCLUSIONS Patient safety concerns, speaking up, and withholding voice were frequently reported. With this questionnaire, we present a tool to systematically assess and evaluate important aspects of speaking up in HCOs. This allows for identifying areas for improvement, and because it is a short survey, to monitor changes in speaking up-for example, before and after an improvement project.
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Waheed A, Presswood E, Scott G. Organisational values of National Health Service trusts in England: semantic analysis and relation to performance indicators. BMJ LEADER 2021; 6:192-198. [DOI: 10.1136/leader-2021-000512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022]
Abstract
BackgroundOrganisational values are widely assumed to have positive effects on performance and staff. National Health Service (NHS) trusts in England have accordingly chosen their own organisational values. However, there has been no survey of the values adopted, and there is little evidence that the choice of values per se has consequences for outcomes. We comprehensively described trusts’ organisational values, using natural language processing to identify common themes. We tested whether the choice of themes was associated with outcomes for patients and staff.MethodsWe collected data on trusts’ values (from their websites), performance (Summary Hospital-level Mortality Indicator (SHMI) statistics, Care Quality Commission (CQC) ratings), sickness absence rates (SAR) and staff opinions (NHS Staff Survey responses). We first characterised values based on lexical properties then progressed to semantic analysis, using Google’s Universal Sentence Encoder, to transform values to high-dimensional embeddings, and k-means clustering of embeddings to semantically cluster values into 12 common themes. We tested for associations between trusts’ use of these themes and outcomes.ResultsOrganisational values were obtained for 221 of 228 NHS trusts, with 985 values in total (480 unique). Semantic clustering identified themes including ‘care’, ‘value respect’ and ‘togetherness’. There was no significant association between themes and SHMI or CQC ratings. However, themes predicted trusts’ SAR (p=0.001, R2=0.159), with use of ‘care’, ‘value respect’, ‘aspirational’ and ‘people’ all significant predictors of increased sickness absence; themes also predicted staff opinions on ‘Equality, diversity and inclusion’ (p=0.011, R2=0.116), but with ‘supportive’ and ‘openness’ predicting more negative responses.ConclusionA trust’s adoption of individualised organisational values does not seem to make a positive difference to its patients or staff. These findings should give NHS managers pause for thought, challenging them to reconsider their reliance on value-defining initiatives, and to seek evidence that a focus on values has measurable benefits on outcomes.
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Affiliation(s)
- Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Laith K Hasan
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Minneapolis, Minnesota
| | - Theodore W Parsons
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
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Truong H, Sullivan AM, Abu-Nuwar MR, Therrien S, Jones SB, Pawlowski J, Parra JM, Jones DB. Operating room team training using simulation: Hope or hype? Am J Surg 2021; 222:1146-1153. [PMID: 33933207 DOI: 10.1016/j.amjsurg.2021.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study sought to determine the long-term impact of multidisciplinary simulated operating room (OR) team training. METHOD Two-wave survey study (immediate post-training survey 2010-2017, follow-up 2018). Differences across time, specialty, and experience with adverse events were assessed using chi-square and t -tests. RESULTS Immediately after training, more than 90% of respondents found simulation scenarios realistic and reported team training would provide safer patient care. However, follow-up participants reported less enthusiasm toward training, with 58% stating they would like to take similar training again. A majority of participants (77%) experienced adverse events after training; those reporting adverse events reported more positive long-term evaluations. CONCLUSIONS Simulated OR team training is initially highly valued by participants and is perceived as contributing to patient safety. Diminution of participant enthusiasm over time suggests that repeat training requirements be reconsidered, and less costly, alternative methods (such as asynchronous learning or virtual reality) should be explored.
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Affiliation(s)
- Hung Truong
- Beth Israel Deaconess Medical Center Division of Bariatric and Minimally Invasive Surgery, United States.
| | - Amy M Sullivan
- Carl J. Shapiro Institute for Research and Education, Beth Israel Deaconess Medical Center, United States; Beth Israel Deaconess Medical Center Department of Medicine, United States.
| | - Mohamad Rassoul Abu-Nuwar
- Beth Israel Deaconess Medical Center Division of Bariatric and Minimally Invasive Surgery, United States.
| | - Stephanie Therrien
- Beth Israel Deaconess Medical Center Division of Bariatric and Minimally Invasive Surgery, United States.
| | | | - John Pawlowski
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care and Pain Medicine, United States.
| | - Jose M Parra
- Carl J. Shapiro Institute for Research and Education, Beth Israel Deaconess Medical Center, United States.
| | - Daniel B Jones
- Beth Israel Deaconess Medical Center Division of Bariatric and Minimally Invasive Surgery, United States.
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Schlak AE, Aiken LH, Chittams J, Poghosyan L, McHugh M. Leveraging the Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020610. [PMID: 33445764 PMCID: PMC7828279 DOI: 10.3390/ijerph18020610] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Burnout remains a persistent issue affecting nurses across the US health system. Limited evidence exists about the direct impact of nurse burnout on patient outcomes. This study explores the relationship between nurse burnout and mortality, failure to rescue, and length of stay, while also considering the effect of a good work environment. METHODS Cross sectional data from nurses and hospitals were used in conjunction with patient claims data. Multivariate logistic regression was used to study the relationship between nurse burnout, patient outcomes, the work environment, and Magnet status. RESULTS Higher odds of patient mortality, failure to rescue, and prolonged length of stay were found in hospitals that had, on average, higher nurse burnout scores. Good work environments were found to attenuate the relationship between nurse burnout and mortality, failure to rescue, and length of stay. Magnet status, another indicator of a good work environment, was found to attenuate the relationship between nurse burnout and mortality and failure to rescue. CONCLUSIONS Improving the work environment remains a solution for hospitals looking to concurrently improve nurse burnout and patient outcomes. Administrators may look to the Magnet recognition program as a blueprint to better support nurses in providing safe, high quality care.
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Affiliation(s)
- Amelia E. Schlak
- Columbia University School of Nursing, New York, NY 10032, USA;
- Correspondence:
| | - Linda H. Aiken
- Center for Health Outcomes and Policy Research, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA; (L.H.A.); (M.M.)
| | - Jesse Chittams
- Biostatistics Analysis Core (BECCA lab), Office of Nursing Research (ONR), University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA;
| | | | - Matthew McHugh
- Center for Health Outcomes and Policy Research, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA; (L.H.A.); (M.M.)
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Hospital Workforce Engagement and Inpatient Mortality Rate: Findings from the English National Health Service Staff Surveys. J Gen Intern Med 2020; 35:3465-3470. [PMID: 33051836 PMCID: PMC7728947 DOI: 10.1007/s11606-020-06045-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Healthcare workforce engagement may represent a proactive approach against provider burnout, a widely prevalent condition that is associated with poor patient outcomes. OBJECTIVE We examine whether workforce engagement is associated with better hospital performance, measured as lower inpatient mortality, in English National Health Services (NHS) acute Trusts. DESIGN Panel study using cross-lagged regression, applying an optimally time-lagged value of the dependent variable as covariate to account for unmeasured Trust characteristics. PARTICIPANTS NHS acute Trusts and respondents to the NHS Staff Surveys, 2012-2018. MAIN MEASURES We measured engagement using three survey questions corresponding to validated engagement factors, and hospital performance using the Summary Hospital-level Mortality Indicator (SHMI). In the first analyses, associations of SHMI (dependent variable) with workforce engagement in the current, prior, and subsequent years were studied to find the optimum lag period for lagged regression analysis. In the subsequent cross-lagged regression analysis, bi-directional associations between SHMI and engagement were studied. Heterogeneity in engagement components across Trusts was studied in detail for the year 2017. KEY RESULTS In the first analyses, current SHMI was negatively associated with engagement in the current year (ß = - 0.044; p = 0.035) more than with the prior year (ß = - 0.037; p = 0.049). In the second analysis, (a) engagement predicted same-year SHMI after controlling for prior-year SHMI (ß = - 0.044; p = 0.035). A 1-unit higher engagement score was associated with 4.4% lower SHMI. (b) SHMI predicted engagement in the same year (ß = - 0.066; p = 0.001) after controlling for prior-year engagement. More in-depth analysis showed high inter-trust heterogeneity on all three engagement factors (I2 > 85%). CONCLUSION Higher workforce engagement predicts lower mortality which in turn predicts engagement. Heterogeneity in workforce well-being suggests an opportunity to foster mutual learning across Trusts.
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Yu J, Lee W, Kim M, Choi S, Lee S, Kim S, Jung Y, Kwak D, Jung H, Lee S, Lee YJ, Hyun SJ, Kang Y, Kim SM, Lee J. Effectiveness of simulation-based interprofessional education for medical and nursing students in South Korea: a pre-post survey. BMC MEDICAL EDUCATION 2020; 20:476. [PMID: 33243233 PMCID: PMC7691096 DOI: 10.1186/s12909-020-02395-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/19/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Effective collaboration and communication among health care team members are critical for providing safe medical care. Interprofessional education aims to instruct healthcare students how to learn with, from, and about healthcare professionals from different occupations to encourage effective collaboration to provide safe and high-quality patient care. The purpose of this study is to confirm the effectiveness of Interprofessional education by comparing students' attitudes toward interprofessional learning before and after simulation-based interprofessional education, the perception of teamwork and collaboration between physicians and nurses, and the self-reported competency differences among students in interprofessional practice. METHODS The survey responses from 37 5th-year medical students and 38 4th-year nursing students who participated in an interprofessional education program were analyzed. The Attitude Towards Teamwork in Training Undergoing Designed Educational Simulation scale, the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration, and the Interprofessional Education Collaborative competency scale were used for this study. The demographic distribution of the study participants was obtained, and the perception differences before and after participation in interprofessional education between medical and nursing students were analyzed. RESULTS After interprofessional education, student awareness of interprofessional learning and self-competency in interprofessional practice improved. Total scores for the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration did not change significantly among medical students but increased significantly among nursing students. Additionally, there was no significant change in the perception of the role of other professions among either medical or nursing students. CONCLUSIONS We observed an effect of interprofessional education on cultivating self-confidence and recognizing the importance of interprofessional collaboration between medical professions. It can be inferred that exposure to collaboration situations through Interprofessional education leads to a positive perception of interprofessional learning. However, even after their interprofessional education experience, existing perceptions of the role of other professional groups in the collaboration situation did not change, which shows the limitations of a one-time short-term program. This suggests that efforts should be made to ensure continuous exposure to social interaction experiences with other professions.
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Affiliation(s)
- Jihye Yu
- Office of Medical Education, Ajou University School of Medicine, Suwon, South Korea
| | - Woosuck Lee
- College of Nursing, Taegu Science University, Daegu, South Korea
| | - Miran Kim
- Department of Obstetrics & Gynecology, Ajou University School of Medicine, Suwon, South Korea
| | - Sangcheon Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Sungeun Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Soonsun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Yunjung Jung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Dongwook Kwak
- Department of Obstetrics & Gynecology, Ajou University School of Medicine, Suwon, South Korea
| | - Hyunjoo Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea
| | - Sukyung Lee
- Ajou Center for Clinical Excellence, Ajou University School of Medicine, Suwon, South Korea
| | - Yu-Jin Lee
- College of Nursing, Taegu Science University, Daegu, South Korea
| | - Soo-Jin Hyun
- College of Nursing, Taegu Science University, Daegu, South Korea
| | - Yun Kang
- College of Nursing, Taegu Science University, Daegu, South Korea
| | - So Myeong Kim
- College of Nursing, Taegu Science University, Daegu, South Korea
| | - Janghoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea.
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O'Leary KJ, Manojlovich M, Johnson JK, Estrella R, Hanrahan K, Leykum LK, Smith GR, Goldstein JD, Williams MV. A Multisite Study of Interprofessional Teamwork and Collaboration on General Medical Services. Jt Comm J Qual Patient Saf 2020; 46:667-672. [PMID: 33228852 DOI: 10.1016/j.jcjq.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/08/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Teamwork and collaboration are essential to providing high-quality care. Prior research has found discrepancies between nurses' and physicians' perceptions in operating rooms, ICUs, and labor and delivery units. Less is known about health care professionals' perceptions of teamwork and collaboration on general medical services. METHODS This cross-sectional study included nurses, nurse assistants, and physicians working on general medical services in four mid-sized hospitals. Researchers assessed teamwork climate using the Safety Attitudes Questionnaire and asked respondents to rate the quality of collaboration experienced with their own and other professional categories. RESULTS Data for 380 participants (80 hospitalists, 13 resident physicians, 193 nurses, and 94 nurse assistants) were analyzed. Hospitalists had the highest median teamwork climate score (83.3, interquartile range [IQR] = 72.3-91.1), and nurses had the lowest (78.6, IQR = 69.6-87.5), but the difference was not statistically significant (p = 0.42). Median teamwork climate scores were significantly different across the four sites (highest = 83.3, IQR = 75.0-91.1; lowest = 76.8, IQR = 66.7-88.4; p = 0.003). Ratings of the quality of collaboration differed significantly based on professional category. Specifically, 63.3% (50/79) of hospitalists rated the quality of collaboration with nurses as high or very high, while 48.7% (94/193) of nurses rated the quality of collaboration with hospitalists as high or very high. CONCLUSION This study found significant differences in perceptions of teamwork climate across sites and in collaboration across professional categories on general medical services. Given the importance in providing high-quality care, leaders should consider conducting similar assessments to characterize teamwork and collaboration on general medical services within their own hospitals.
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Bajpai S, Lindeman B. The Trainee's Role in Patient Safety: Training Residents and Medical Students in Surgical Patient Safety. Surg Clin North Am 2020; 101:149-160. [PMID: 33212075 DOI: 10.1016/j.suc.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical education must transition to a more holistic approach by teaching technical and nontechnical skills. Formalized safety curricula can be developed by adopting recommended guidelines and content from national and international organizations, existing validated practices of training programs, frequent simulation exercises, and objective evaluation tools."
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Affiliation(s)
- Swara Bajpai
- Department of Surgery, 1808 7th Avenue South, BDB 202, Birmingham, AL 35294, USA
| | - Brenessa Lindeman
- Endocrine Surgery, General Surgery, Department of Surgical Oncology, BDB 603, Birmingham, AL, USA.
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Abstract
Effective teamwork, both in and out of the operating room, is an essential component of safe and efficient surgical performance. There are multiple available assessment tools for evaluating teamwork and important contributors to teamwork such as safety culture and nontechnical skills. Multiple types of interventions exist to improve and train providers on teamwork, and many have been demonstrated to improve not only teamwork but also patient outcomes. Teamwork strategies can be adapted to different contexts, based on provider needs and resources.
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Affiliation(s)
- Akemi L Kawaguchi
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.246, Houston, TX 77030, USA.
| | - Lillian S Kao
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA
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Clay-Williams R, Taylor N, Ting HP, Arnolda G, Winata T, Braithwaite J. Do quality management systems influence clinical safety culture and leadership? A study in 32 Australian hospitals. Int J Qual Health Care 2020; 32:60-66. [PMID: 32026935 DOI: 10.1093/intqhc/mzz107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/21/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to explore the associations between the organization-level quality arrangements, improvement and implementation and department-level safety culture and leadership measures across 32 large Australian hospitals. DESIGN Quantitative observational study, using linear and multi-level modelling to identify relationships between quality management systems and clinician safety culture and leadership. SETTING Thirty-two large Australian public hospitals. PARTICIPANTS Quality audit at organization level, senior quality manager at each participating hospital, 1382 clinicians (doctors, nurses and allied health professionals). MAIN OUTCOME MEASURES Associations between organization-level quality measures and department-level clinician measures of teamwork climate, safety climate and leadership for acute myocardial infarction (AMI), hip fracture and stroke treatment conditions. RESULTS We received 1332 valid responses from participants. The quality management systems index (QMSI, a questionnaire-based measure of the hospitals' quality management structures) was 'positively' associated with all three department-level scales in the stroke department, with safety culture and leadership in the emergency department, but with none of the three scales in the AMI and hip fracture departments. The quality management compliance index (QMCI, an external audit-based measure of the quality improvement activities) was 'negatively' associated with teamwork climate and safety climate in AMI departments, after controlling for QMSI, but not in other departments. There was no association between QMCI and leadership in any department, after controlling for QMSI, and there was no association between the clinical quality implementation index (CQII, an external audit-based measure of the level of implementation of quality activities) and any of the three department-level scales in any of the four departments, after controlling for both QMSI and QMCI. CONCLUSIONS The influence of organization-level quality management systems on clinician safety culture and leadership varied depending on the hospital department, suggesting that whilst there was some consistency on patient safety attitudes and behaviours throughout the organizations, there were also other factors at play.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
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Feraco AM, Ananth P, Dussel V, Al-Sayegh H, Ma C, Rosenberg AR, Feudtner C, Wolfe J. Parent Perceptions of Team-Delivered Care for Children With Advanced Cancer: A Report From the PediQUEST Study. J Pain Symptom Manage 2020; 60:811-817. [PMID: 32450115 PMCID: PMC7508972 DOI: 10.1016/j.jpainsymman.2020.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/01/2020] [Accepted: 05/14/2020] [Indexed: 01/07/2023]
Abstract
CONTEXT Childhood cancer care is delivered by interprofessional health care teams; however, little is known about how parents perceive overall team-delivered care (TDC). OBJECTIVES We sought to describe parent perceptions of TDC and associated factors, including care rendered by individual clinicians, teamwork, information consistency, and patient and parent characteristics. METHODS Cross-sectional surveys were distributed to parents of 104 children with recurrent/refractory cancer enrolled in a multisite symptom management trial. The primary outcome, TDC, was parent report of care quality delivered by the child's care team during the preceding three months. Likert-scaled items (excellent/very good/good/fair/poor) queried care quality delivered by individual clinicians, perceived teamwork, and other factors. Factors associated with parent perceptions of excellent TDC were identified using Fisher's exact test. RESULTS Eighty-six parents (83%) responded. During the preceding three months, 63% (n = 54) of parents reported excellent TDC. However, only 47% (n = 40) described their care team's teamwork as excellent. Approximately one-quarter (24%) described care rendered by their child's oncologist as less-than-excellent. Among parents who reported psychosocial clinician involvement (71%; n = 60), only 43% described this care as excellent. Individually, excellent care from each clinician type (oncologist, psychosocial clinician, and primary nurse) was associated with excellent TDC (all P ≤ 0.001; no correction for multiple comparisons). CONCLUSION Among parents of children with advanced cancer, more than one-third report less-than-excellent TDC. In addition, less than half report excellent teamwork, and ratings of care rendered by individual clinicians are highly variable. Findings suggest that interventions are needed to enhance interprofessional teamwork in the care of children with advanced cancer.
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Affiliation(s)
- Angela M Feraco
- Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Prasanna Ananth
- Yale School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, and Yale Cancer Center, New Haven, Connecticut, USA
| | - Veronica Dussel
- Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Hasan Al-Sayegh
- Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Clement Ma
- Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abby R Rosenberg
- Seattle Children's Research Institute and University of Washington, Seattle, Washington, USA
| | - Chris Feudtner
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Patient Safety Attitude of Nurses Working in Surgical Units: A Cross-Sectional Study in Turkey. J Perianesth Nurs 2020; 35:671-675. [PMID: 32682667 DOI: 10.1016/j.jopan.2020.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/14/2020] [Accepted: 03/14/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the attitudes of nurses working in surgical units toward patient safety. DESIGN A descriptive and cross-sectional study. METHODS The sample in this study was 207 nurses (92% of all the nurses) working in surgical units in a training and research hospital in Turkey, all of whom agreed to participate in this study between April 30 and June 25, 2019. Study data were collected using a demographic characteristics form and the Patient Safety Attitude Questionnaire. Number, mean, SD, percentage calculations, Kruskal-Wallis test, Mann-Whitney U test, and the Spearman correlation test were used to analyze the study data. FINDINGS The mean total attitude score of the nurses was 176.30 ± 26.92. Nurses who previously received training on patient safety had statistically higher attitude scores than those who did not (U = 3883.000; P = .01). CONCLUSIONS Nurses working in surgical units had a positive attitude toward patient safety, and previous training on patient safety significantly improved their attitude scores. A recommendation is to conduct effective in-service training programs for patient safety in hospitals and to encourage participation by nurses in training programs such as courses and conferences that will result in attitude improvement.
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Seppey R, Oesch A, Viehl CT. Compliance to the Surgical Safety Checklist over time in late and early adopters. J Perioper Pract 2020; 30:57-62. [PMID: 31081732 DOI: 10.1177/1750458919850403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS To compare the compliance of the Surgical Safety Checklist in two groups of users: early (Group A) and late (Group B) adopters, and to detect change over time. METHOD Observational study. We collected all Surgical Safety Checklist protocols in one calendar month period and, eight months later, we repeated collection for another month. Analysis was then performed to compare the compliance in different groups and over time. UNLABELLED There was no statistical difference in the overall compliance between the two groups or between elective and emergency cases. Equally, there was no significant change in compliance over time in Group A. In Group B, however, there was a trend to an improved compliance over time. Compliance to the Surgical Safety Checklist was significantly lower during operations performed by consulting surgeons in comparison to internally employed surgeons.
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Affiliation(s)
- Romain Seppey
- Department of Surgery, Hospital Center Biel/Bienne, Biel/Bienne, Switzerland
| | - Antoine Oesch
- Department of Surgery, Hospital Center Biel/Bienne, Biel/Bienne, Switzerland
| | - Carsten T Viehl
- Department of Surgery, Hospital Center Biel/Bienne, Biel/Bienne, Switzerland
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UC Care Check-A Postoperative Neurosurgery Operating Room Checklist: An Interrupted Time Series Study. J Healthc Qual 2020; 42:224-235. [PMID: 31977363 DOI: 10.1097/jhq.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The effectiveness of neurosurgical operating room (OR) checklists to improve communication, safety attitudes, and clinical outcomes is uncertain. PURPOSE To develop, implement, and evaluate a post-operative neurosurgery operating room checklist. METHODS Four large academic medical centers participated in this study. We developed an evidence-based checklist to be performed at the end of every adult-planned or emergent surgery in which all team members pause to discuss key elements of the case. We used a prospective interrupted time series study design to assess trends in clinical and cost outcomes. Safety attitudes and communication among OR providers were also assessed. RESULTS There were 11,447 neurosurgical patients in the preintervention and 10,973 in the postintervention periods. After implementation, survey respondents perceived that postoperative checklists were regularly performed, important issues were communicated at the end of each case, and patient safety was consistently reinforced. Observed to expected (O/E) overall mortality rates remained less than one, and 30-day readmission rate, length of stay index, direct cost index, and perioperative venous thromboembolism and hematoma rates remained unchanged as a result of checklist implementation. CONCLUSION A neurosurgical checklist can improve OR team communication; however, improvements in safety attitudes, clinical outcomes, and health system costs were not observed.
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Işık I, Gümüşkaya O, Şen S, Arslan Özkan H. The Elephant in the Room: Nurses' Views of Communication Failure and Recommendations for Improvement in Perioperative Care. AORN J 2019; 111:e1-e15. [PMID: 31886544 DOI: 10.1002/aorn.12899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Perioperative communication failures endanger patient safety and may reduce efficiency. The objective of our phenomenological research study was to determine the reasons for and consequences of perioperative communication failures and to seek recommendations for improvement. Fourteen perioperative nurses participated in this study. We conducted in-depth interviews with a semi-structured questionnaire following Colaizzi's seven-step methodology to extract themes. We organized the themes into categories: causes, consequences, and recommendations for preventing communication failure. Some themes for causes were inadequate time for preoperative preparation, lack of personnel, and disruptive behaviors of physicians. Consequences of communication failure were decreased staff retention, avoidance of colleagues, threats to patient safety, and intra-team violence. Two recommendations included enforcing institutional regulations and creating team spirit. The study revealed that nurses believe that institutional regulations should not only be present but enforced. Further, nurses believe that strengthening employees' interpersonal skills is essential to preventing communication issues.
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Racicot BM, Kernan MC, Nicholls ED. Effects of Management Support, Team Member Support, and Job Status on Safety Climate and Employee Attitudes. ORGANIZATION MANAGEMENT JOURNAL 2019. [DOI: 10.1080/15416518.2019.1679075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Bernadette M. Racicot
- Department of Business Administration, University of Delaware, Newark, Delaware, USA
| | - Mary C. Kernan
- Department of Business Administration, University of Delaware, Newark, Delaware, USA
| | - Edward D. Nicholls
- Department of Business Administration, University of Delaware, Newark, Delaware, USA
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Tawfik DS, Scheid A, Profit J, Shanafelt T, Trockel M, Adair KC, Sexton JB, Ioannidis JPA. Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis. Ann Intern Med 2019; 171:555-567. [PMID: 31590181 PMCID: PMC7138707 DOI: 10.7326/m19-1152] [Citation(s) in RCA: 308] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Whether health care provider burnout contributes to lower quality of patient care is unclear. PURPOSE To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship. DATA SOURCES MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019. STUDY SELECTION Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care. DATA EXTRACTION 2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests. DATA SYNTHESIS A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety. LIMITATION Studies were primarily observational; neither causality nor directionality could be determined. CONCLUSION Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates. PRIMARY FUNDING SOURCE Stanford Maternal and Child Health Research Institute.
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Affiliation(s)
- Daniel S Tawfik
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Annette Scheid
- Brigham and Women's Hospital and Harvard Medical School, llBoston, Massachusetts (A.S.)
| | - Jochen Profit
- Stanford University School of Medicine, Stanford, California, and California Perinatal Quality Care Collaborative, Palo Alto, California (J.P.)
| | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Mickey Trockel
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Kathryn C Adair
- Duke University School of Medicine, Duke University Health System, and Duke Patient Safety Center, Durham, North Carolina (K.C.A., J.B.S.)
| | - J Bryan Sexton
- Duke University School of Medicine, Duke University Health System, and Duke Patient Safety Center, Durham, North Carolina (K.C.A., J.B.S.)
| | - John P A Ioannidis
- Stanford University School of Medicine, Stanford University School of Humanities and Sciences, and Meta-Research Innovation Center at Stanford (METRICS), Stanford, California (J.P.I.)
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Dinh JV, Traylor AM, Kilcullen MP, Perez JA, Schweissing EJ, Venkatesh A, Salas E. Cross-Disciplinary Care: A Systematic Review on Teamwork Processes in Health Care. SMALL GROUP RESEARCH 2019. [DOI: 10.1177/1046496419872002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As health care delivery moves toward more complex, team-based systems, the topic of medical teamwork has gained considerable attention and study across disciplines. This systematic review integrates empirical research on teamwork and health care to identify broad trends. We identified and coded 1,818 relevant, English, and peer-reviewed journal articles using a teamwork processes rubric. Several themes emerged. The health care teamwork literature has grown substantially over the past 20 years. Approximately half of the studies were descriptive (rather than interventional or psychometric); the majority relied on quantitative methods. Health care teamwork was also studied in thematically distinct manners. Interpersonal processes were most commonly studied across fields. Of all disciplines, medicine focused most on transition processes, whereas those from team science centered more highly on action processes. There were also finer grained disciplinary differences in content areas of communication and collaboration. Interprofessional journals represent a potential area for interdisciplinary efforts. Implications and future directions are discussed.
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Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019; 9:e028280. [PMID: 31515415 PMCID: PMC6747874 DOI: 10.1136/bmjopen-2018-028280] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate the relationship between teamwork and clinical performance and potential moderating variables of this relationship. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed was searched in June 2018 without a limit on the date of publication. Additional literature was selected through a manual backward search of relevant reviews, manual backward and forward search of studies included in the meta-analysis and contacting of selected authors via email. ELIGIBILITY CRITERIA Studies were included if they reported a relationship between a teamwork process (eg, coordination, non-technical skills) and a performance measure (eg, checklist based expert rating, errors) in an acute care setting. DATA EXTRACTION AND SYNTHESIS Moderator variables (ie, professional composition, team familiarity, average team size, task type, patient realism and type of performance measure) were coded and random-effect models were estimated. Two investigators independently extracted information on study characteristics in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS The review identified 2002 articles of which 31 were included in the meta-analysis comprising 1390 teams. The sample-sized weighted mean correlation was r=0.28 (corresponding to an OR of 2.8), indicating that teamwork is positively related to performance. The test of moderators was not significant, suggesting that the examined factors did not influence the average effect of teamwork on performance. CONCLUSION Teamwork has a medium-sized effect on performance. The analysis of moderators illustrated that teamwork relates to performance regardless of characteristics of the team or task. Therefore, healthcare organisations should recognise the value of teamwork and emphasise approaches that maintain and improve teamwork for the benefit of their patients.
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Affiliation(s)
- Jan B Schmutz
- Department of Communication Studies, Northwestern University, Evanston, Illinois, USA
| | - Laurenz L Meier
- Department of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Ostovari M, Yu D. Impact of care provider network characteristics on patient outcomes: Usage of social network analysis and a multi-scale community detection. PLoS One 2019; 14:e0222016. [PMID: 31498827 PMCID: PMC6733513 DOI: 10.1371/journal.pone.0222016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023] Open
Abstract
Objective We assess healthcare provider collaboration and the impact on patient outcomes using social network analysis, a multi-scale community detection algorithm, and generalized estimating equations. Material and methods A longitudinal analysis of health claims data of a large employer over a 3 year period was performed to measure how provider relationships impact patient outcomes. The study cohort included 4,230 patients with 167 providers. Social network analysis with a multi-scale community detection algorithm was used to identify groups of healthcare providers more closely working together. Resulting measures of provider collaboration were: 1) degree, 2) betweenness, and 3) closeness centrality. The three patient outcome measures were 1) emergency department visit, 2) inpatient hospitalization, and 3) unplanned hospitalization. Relationships between provider collaboration and patient outcomes were assessed using generalized estimating equations. General practitioner, family practice, and internal medicine were labeled as primary care. Cardiovascular, endocrinologists, etc. were labeled as specialists, and providers such as radiology and social workers were labeled as others. Results Higher connectedness (degree) and higher access (closeness) to other providers in the community were significant for reducing inpatient hospitalization and emergency department visits. Patients of specialists (e.g. cardiovascular) and providers specified as others (e.g. social worker) had higher rate of hospitalization and emergency department visits compared to patients of primary care providers. Conclusion Application of social network analysis for developing healthcare provider networks can be leveraged by community detection algorithms and predictive modeling to identify providers’ network characteristics and their impacts on patient outcomes. The proposed framework presents multi-scale measures to assess characteristics of healthcare providers and their impact on patient outcomes. This approach can be used by implementation experts for informed decision-making regarding the design of insurance coverage plans, and wellness promotion programs. Health services researchers can use the study approach for assessment of provider collaboration and impacts on patient outcomes.
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Affiliation(s)
- Mina Ostovari
- Value Institute, Christiana Care Health System, Newark, Delaware, United States of America
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail:
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Javed A, Yasir M, Majid A, Shah HA, Islam EU, Asad S, Khan MW. Evaluating the effects of social networking sites addiction, task distraction, and self-management on nurses' performance. J Adv Nurs 2019; 75:2820-2833. [PMID: 31385324 DOI: 10.1111/jan.14167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/14/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022]
Abstract
AIMS The purpose of this study was to explore the relationship of social networking sites (SNSs) addiction on nurses' performance and how this relationship was mediated by task distraction and moderated by self-management. DESIGN This cross-sectional study is designed to empirically test the relationship of SNSs addiction, task distraction, and self-management with the nurses' performance. METHODS Data were collected by conducting an online survey on nurses across the world using a web-based questionnaire developed through 'Google Docs' and distributed through Facebook from 13 August 2018 - 17 November 2018. The Facebook groups were searched using the selected key terms. In total, 45 groups were found to have relevance to this research; therefore, request was made to the admins of these groups to participate in this research and to post a link in their groups. Only 19 group admins responded positively by uploading a link of the research instrument on their respective group pages and 461 members of these groups participated in the research. RESULTS Results of the data collected from 53 different countries indicated that SNSs addiction results in lowering the nurses' performance. This relationship is further strengthened by task distraction introduced as a mediating variable. The results show that self-management mediates the relationship between SNSs addiction and employees' performance. Moreover, the results of the study confirm that self-management reduces the negative impact of SNSs addiction on nurses' performance. CONCLUSION Social networking sites (SNSs) addiction and task distraction reduce the nurses' performance, whereas self-management enhances nurses' performance. IMPACT This study addresses the problem of using SNSs at the workplace and its potential effect on nurses' performance. Results demonstrate that SNSs addiction reduces the performance which is further decreased by task distraction; however, self-management of nurses can enhance the nurses' performance. The research has numerous theoretical and practical implications for hospital administration, doctors, and nurses.
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Affiliation(s)
- Asad Javed
- Department of Management Sciences, Hazara University, Mansehra, Pakistan
| | - Muhammad Yasir
- Department of Management Sciences, Hazara University, Mansehra, Pakistan
| | - Abdul Majid
- Department of Management Sciences, Hazara University, Mansehra, Pakistan
| | - Hassan Ahmed Shah
- Department of Management Sciences, Khushal Khan Khattak University, Karak, Pakistan
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Sifaki-Pistolla D, Melidoniotis E, Dey N, Chatzea VE. How trust affects performance of interprofessional health-care teams. J Interprof Care 2019; 34:218-224. [PMID: 31390238 DOI: 10.1080/13561820.2019.1631763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interprofessional teamwork in health-care settings is considered a valuable means of enhancing patient management. Literature has highlighted the importance of trust in building effective health-care teams. The present study aimed to investigate and further understand the perceptions of health-care professionals regarding trust and performance within their working team, as well as to assess the association between them and team performance. "TRUST" questionnaire, a valid instrument for measuring the relationship of trust and team performance was distributed to the members of the perioperative teams located in two different hospitals (a University and a General Hospital) in Greece. Two multivariate linear regression models were developed to reveal the significant predictors of high performance per hospital. Among the major findings revealed were 1) trust and performance were closely related 2) slight yet significant variations were observed between the University and the General Hospital and 3) trust level, years of previous experience and number of team members were among the key predictors of effective team performance. This study conveys new knowledge on trust and performance within health-care settings with limited resources and is expected to guide future interventions aiming to enhance team performance.
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Affiliation(s)
- Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Nilanjan Dey
- Department of Computer Science & Engineering, Bengal College of Engineering and Technology, Kolkata, India
| | - Vasiliki-Eirini Chatzea
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Gordon SK, Trovinger S, DeLellis T. Escape from the usual: Development and implementation of an 'escape room' activity to assess team dynamics. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:818-824. [PMID: 31227197 DOI: 10.1016/j.cptl.2019.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/06/2019] [Accepted: 04/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND PURPOSE Today's pharmacists must be "team-ready." While team-based learning is ubiquitous in pharmacy education, little data exists for fostering team-building skills in healthcare education. This study evaluates the effect of an escape room-themed team-building exercise on pharmacy student experiences and perceptions of working in teams using StrengthsFinder 2.0 as a framework. EDUCATIONAL ACTIVITY AND SETTING Second and third professional year pharmacy students were divided into teams of four to five. Each team competed in a puzzle-based simulated "escape room". Students completed pre- and post-surveys regarding perceptions of working in teams and team dynamics after reviewing their StrengthsFinder 2.0 results. Quantitative data were analyzed using descriptive statistics and a related-samples McNemar test for statistical significance. Qualitative data from open-ended questions were analyzed to determine common themes among student answers. FINDINGS Of the 137 enrolled students, 127 participated in the activity and surveys. Sixty percent of teams successfully completed the activity on time. All but one statement ("I am an integral member of the team") showed a statistically significant increase in those strongly agreeing or agreeing pre- to post-exercise. The largest shift was seen for the statement "I enjoy working in a team environment". Thematic analysis of qualitative data revealed that students felt harnessing their individual talents made the teams stronger. SUMMARY This exercise positively impacted student perceptions of working in teams. Further research should determine the effect of pre-requisite team-building exercises on team-based learning outcomes.
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Affiliation(s)
- Sarah K Gordon
- Manchester University College of Pharmacy, Natural & Health Sciences, 10627 Diebold Road, Fort Wayne, IN 46845, United States.
| | - Sara Trovinger
- Manchester University College of Pharmacy, Natural & Health Sciences, 10627 Diebold Road, Fort Wayne, IN 46845, United States.
| | - Teresa DeLellis
- Manchester University College of Pharmacy, Natural & Health Sciences, 10627 Diebold Road, Fort Wayne, IN 46845, United States.
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Senders ZJ, Aeder M, Semrau S, Ammori J. Improving Resident-To-Attending Communication: Implementing a Tool to Facilitate Attending Notification of Critical Patient Events at a Single Academic Institution. Am Surg 2019. [DOI: 10.1177/000313481908500632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ineffective communication between surgical trainees and attending surgeons is a significant contributor to patient harm. The aim of this study was to evaluate a tool to improve resident-to-attending communication regarding changes in patient clinical status. Ten critical patient events were compiled into a list of triggers for direct attending surgeon notification at a single academic institution. Residents and faculty were surveyed to assess communication before and after implementation of the list. Institution of the triggers list was associated with a nonstatistically significant increase in resident-to-attending notification regarding 7 of 10 critical patient events. There was no reported change in frequency of calls associated with the list's implementation. Most residents felt that the list improved patient care and increased their comfort with calling attending surgeons. Comments were generally positive; however, both groups expressed concern that the list could negatively impact resident autonomy and supervision. Implementing a list of triggers for attending notification of critical patient events subjectively improved resident-to-attending communication in an environment with high baseline levels of communication.
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Affiliation(s)
- Zachary J. Senders
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and
| | - Mark Aeder
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and
| | - Susan Semrau
- University Hospitals Cleveland Medical Center, Quality Institute, Cleveland, Ohio
| | - John Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and
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Toffolutti V, Stuckler D. A Culture Of Openness Is Associated With Lower Mortality Rates Among 137 English National Health Service Acute Trusts. Health Aff (Millwood) 2019; 38:844-850. [DOI: 10.1377/hlthaff.2018.05303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Veronica Toffolutti
- Veronica Toffolutti is a postdoctoral researcher in health economics at the Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy (Dondena), Bocconi University, in Milan, Italy, and a honorary fellow of the London School of Hygiene and Tropical Medicine, in the UK
| | - David Stuckler
- David Stuckler is a professor of public analysis and public management at Bocconi University
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Doorey AJ, Turi ZG, Lazzara EH, Mendoza EG, Garratt KN, Weintraub WS. Safety gaps in medical team communication: Results of quality improvement efforts in a cardiac catheterization laboratory. Catheter Cardiovasc Interv 2019; 95:136-144. [PMID: 31025508 DOI: 10.1002/ccd.28298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/28/2019] [Accepted: 04/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess closed-loop communications (readback), a fundamental aspect of effective communication, among cardiovascular teams and assess improvement efforts. BACKGROUND Effective communication within teams is essential to assure safety and optimal outcomes. Readback of verbal physician orders is a hospital and national requirement. METHODS Single-center observational study, where the readback responses to physician verbal orders in the catheterization laboratory were characterized over three distinct time intervals from 2015 to 2017. Performance feedback and focused education on the value of readbacks was provided to the teams in two waves, with subsequent remeasurement. Responses to verbal orders were characterized as complete (all important parameters of the order repeated for verification), partial, acknowledgement only, or no response. Changes in readback performance after quality interventions were assessed. RESULTS During the first-observational period of 101 cases, complete readback occurred in 195 of 515 (38%) medication orders and 136 of 235 (58%) equipment orders. After initial quality improvement efforts, 102 cases were observed. In these, 298 of 480 (62%) medication orders had complete readback, and 210 of 420 (50%) equipment orders had complete readback. After additional quality improvement efforts, 168 cases were observed. In these, 506 of 723 (70%) medication orders had complete readback, and 630 of 1,061 (59%) equipment orders had complete readback. Overall, medication order readback improved over time (correlation = 0.26 [-0.30, -0.21]; p < 0.001), but equipment order readback did not (correlation = 0.02 [-0.07, 0.03]; p = 0.44). CONCLUSIONS Closed-loop communication of physician verbal orders was used infrequently in this medical team setting and proved difficult to fully improve. This is an important safety gap.
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Affiliation(s)
- Andrew J Doorey
- Department of Medicine, Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
| | - Zoltan G Turi
- Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Elizabeth H Lazzara
- Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Erika G Mendoza
- Department of Biological Sciences, Delaware State University, Dover, Delaware
| | - Kirk N Garratt
- Department of Medicine, Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
| | - William S Weintraub
- Department of Medicine, Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware.,Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
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de Santana Lemos C, de Brito Poveda V. Adverse Events in Anesthesia: An Integrative Review. J Perianesth Nurs 2019; 34:978-998. [PMID: 31005390 DOI: 10.1016/j.jopan.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 02/16/2019] [Accepted: 02/23/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE This study conducted an integrative review of the literature in a search for scientific evidence related to the occurrence of perioperative adverse events resulting from anesthesia. DESIGN Integrative review. METHODS The search was performed in the PubMed/MEDLINE, Virtual Health Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases and portals, including studies published in Portuguese, English, or Spanish, from 1997 to 2017. The studies were supposed to assess adverse events associated exclusively with anesthesia care. FINDINGS We selected 21 studies. The main adverse events in anesthesia were respiratory, drug error, cardiology, and neurology. Most of the events were related to human errors, slips, and lapses that resulted in damage to the patient, such as permanent injuries or death. CONCLUSIONS Care planning, efficient communication, and teamwork are critical to prevent adverse events in anesthesia.
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