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Baldwin CA, Krumm AM, Sy A, Thomas J, Jones A, Ward EK. Nursing peer feedback: Optimizing our relationships with human resources and collective bargaining organizations. Nurs Outlook 2024; 72:102238. [PMID: 39029447 DOI: 10.1016/j.outlook.2024.102238] [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: 11/02/2023] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/21/2024]
Abstract
Nursing leaders have recognized the need for consistent mechanisms to promote and sustain nursing professionalism. Peer-to-peer feedback and peer review are widely effective for nurse professionalism and self-regulation, patient care outcomes, and retention. Unprofessional behavior has been noted as widespread in health care and the effects on patients, clinicians, and organizations have been well-documented. Approximately 10% of the registered nurses in the United States belong to a collective bargaining unit (CBU) or union. This article will describe how a peer feedback program to address unprofessional behavior was implemented in a Magnet nursing practice with CBU representation.
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Affiliation(s)
- Cynthia A Baldwin
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN.
| | - Alice M Krumm
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Annette Sy
- Nursing Administration, Keck Medicine of University of Southern California, Los Angeles, CA
| | - Jessica Thomas
- Nursing Administration, Keck Medicine of University of Southern California, Los Angeles, CA
| | - Awa Jones
- Nursing Administration, Keck Medicine of University of Southern California, Los Angeles, CA
| | - Emily K Ward
- Department of Nursing Services & Patient Care, University of Iowa Health Care, Iowa City, IA
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Doub TW, Hickson GB, Casey VF, McHugh DF, Nonken P, Catron TF, Domenico HJ, Pichert JW, Cooper WO. An Effective Program to Reduce Malpractice Claims and Payments in a Large Orthopaedic Practice. J Bone Joint Surg Am 2024; 106:1286-1292. [PMID: 38662807 DOI: 10.2106/jbjs.23.00973] [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: 07/18/2024]
Abstract
BACKGROUND High reliability in health care requires a balance between intentionally designed systems and individual professional accountability. One element of accountability includes a process for addressing clinicians whose practices are associated with a disproportionate share of patient complaints. This study aimed to evaluate the impact of the Patient Advocacy Reporting System (PARS), a tiered intervention model to reduce patient complaints about clinicians. METHODS A retrospective cohort study was conducted involving a southeastern U.S. orthopaedic group practice. The study assessed the implementation of the PARS program and subsequent malpractice claims from 2004 to 2020. RESULTS The implementation of PARS was associated with an 83% reduction in malpractice claims cost per high-risk clinician after intervention (p = 0.05; Wilcoxon rank sum test). The overall practice group experienced an 87% reduction in mean annual claims cost per clinician (p = 0.007; segmented regression). The successful adoption required essential elements such as PARS champions, peer messengers, an Office of Patient Affairs, and a clear statement of practice values and professionalism expectations at the time of onboarding. CONCLUSIONS The PARS program was successfully adopted within a surgical specialty group as a part of ongoing risk prevention and management efforts. The period following PARS was associated with a retrospectively measured reduction in malpractice claim costs. The PARS program can be effectively implemented in a large, single-specialty orthopaedic practice setting and, although not necessarily causal, was, in our case, associated with a period of reduced malpractice claim costs. CLINICAL RELEVANCE We have learned in previous research that there are clear links between professionalism and patient outcomes (e.g., surgical complications), but agree that the focus here on medical malpractice is not directly clinical.
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Affiliation(s)
- Thomas W Doub
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Thomas F Catron
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry J Domenico
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James W Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William O Cooper
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
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Crowe L, Riley CM. Bad behavior in healthcare: an insidious threat to patients, staff, and organizations. Curr Opin Cardiol 2024; 39:331-337. [PMID: 38547019 DOI: 10.1097/hco.0000000000001139] [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: 06/05/2024]
Abstract
PURPOSE OF REVIEW 'Bad' or unprofessional behavior (UPB) destroys communication, teamwork, and professional wellbeing, presenting a significant threat to patients and staff. Understanding what constitutes 'bad' or UPB and creating broad accountability for its cessation is imperative to patient-centered care and the survival of the multidisciplinary health workforce. RECENT FINDINGS Despite organizational and legislative commitments to provide well tolerated work environments, UPB is endemic in healthcare and continues to harm patients, staff, and organizations. Historically, categories of UPB have been researched separately which dilutes the problem. Typically, these behaviors cluster, are interchangeable, and are committed by same perpetrators. Women, junior staff, and minority groups remain the most prevalent targets. Even low intensity UPBs among health staff dramatically impacts risk to patient lives, limits quality care, and destroys staff wellbeing. Targeted interventions must address all five roles impacted by UPBs: the target, patients, bystanders, the perpetrator, and the organization to effectively eliminate UPBs. Organizational leaders must demonstrate and uphold organizational values and be swift in addressing UPB to limit the impact on teams and patients. SUMMARY UPB in the healthcare setting presents a multifactorial threat to patients, staff, and organizations. To ensure the delivery of high-quality patient care, and the wellbeing of the health workforce it is crucial to understand the insidious impact of UPB and target interventions across all five roles.
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Affiliation(s)
- Liz Crowe
- Royal Brisbane and Women's Hospital, School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine M Riley
- Children's National Hospital, Division of Cardiac Critical Care, Washington, District of Columbia, USA
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Cooper WO, Hickson GB, Dmochowski RR, Domenico HJ, Barr FE, Emory CL, Gilbert J, Hartman GE, Lozon MM, Martinez W, Noland J, Webber SA. Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers. JAMA Netw Open 2024; 7:e2415331. [PMID: 38842804 PMCID: PMC11157352 DOI: 10.1001/jamanetworkopen.2024.15331] [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] [Received: 02/16/2024] [Accepted: 04/04/2024] [Indexed: 06/07/2024] Open
Abstract
Importance Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members. Objective To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers. Design, Setting, and Participants This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022. Exposure Submitted reports concerning communication, professional responsibility, medical care, and professional integrity. Main Outcomes and Measures Physicians' total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report. Results The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, -7.1 percentage points; 95% CI, -7.7 to -6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, -2.4 percentage points, 95% CI, -3.2 to -1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians. Conclusions and Relevance In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.
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Affiliation(s)
- William O. Cooper
- Departments of Pediatrics and Health Policy, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald B. Hickson
- Department of Pediatrics, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry J. Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Cynthia L. Emory
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jill Gilbert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gary E. Hartman
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Marie M. Lozon
- Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor
| | - William Martinez
- Department of Medicine, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janesta Noland
- Department of Pediatrics, Stanford University School of Medicine, California and Stanford Medicine Children’s Health, Palo Alto, California
| | - Steven A. Webber
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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McGurgan P, Calvert K, Celenza A, Nathan EA, Jorm C. The Schweitzer effect: The fundamental relationship between experience and medical students' opinions on professional behaviours. MEDICAL TEACHER 2024; 46:782-791. [PMID: 38048408 DOI: 10.1080/0142159x.2023.2284660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE We examined whether medical students' opinions on the acceptability of a behaviour were influenced by previously encountering a similar professionally challenging situation, assessed the magnitude of effect of 'experience' compared to other demographic factors which influence medical students' opinions, and evaluated whether opinions regarding some situations/behaviours were more susceptible to 'experience' bias? METHODS Confidential, on-line survey for medical students distributed to Australian and New Zealand (AUS/NZ) medical schools. Students submitted de-identified demographic information, provided opinions on the acceptability of a wide range of student behaviours in professionally challenging situations, and whether they had encountered similar situations. RESULTS 3171 students participated from all 21 Aus/NZ medical schools (16% of registered students). Medical students reported encountering many of the professionally challenging situations, with varying opinions on what was acceptable behaviour. The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar situation. The professional dilemmas most significantly influenced by previous experience typically related to behaviours that students could witness in clinical environments, and often involved breaches of trust. CONCLUSIONS Our results demonstrate the relationship between experience and medical students' opinions on professional behaviour- the 'Schweitzer effect'. When students encounter poor examples of professional behaviour, especially concerning trust breaches, it significantly influences their perception of the behaviour. These results highlight the importance of placing students in healthcare settings with positive professional role modelling/work cultures.
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Affiliation(s)
- Paul McGurgan
- Division of Obstetrics and Gynaecology, UWA Medical School, Perth, Australia
| | - Katrina Calvert
- Dept. of Post-Graduate Medical Education (PGME), K.E.M.H., Perth, Australia
| | - Antonio Celenza
- Division of Emergency Medicine, UWA Medical School, Perth, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, UWA Medical School, Perth, Australia
| | - Christine Jorm
- School of Public Health, University of Sydney, Australia
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Mann DR, Thomas CS, Parrado RH, Rives GT, Talley CL. Future Surgical Leaders: Resident Perception Of Longitudinal Leadership And Non-Technical Skills Curriculum. JOURNAL OF SURGICAL EDUCATION 2024; 81:696-701. [PMID: 38402094 DOI: 10.1016/j.jsurg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE A paucity of formal leadership training programs exists for residents, and outcomes of those are limited in reporting. Based on a robust needs assessment, our program created a longitudinal cohort curriculum, Future Surgical Leaders, for residents and fellows of all levels to provide training in nontechnical skills. Our objective was to evaluate surgical resident short-term outcomes and satisfaction with the Future Surgical Leaders (FSL) curriculum. DESIGN Participants were sent a brief survey after each session of the curriculum from October 2020 to February 2022. The data was compiled after seventeen months of delivery. Likert Scale responses and text comments were analyzed with a 2-sample t-test and 2-way analysis of variance. SETTING Academic tertiary institution. PARTICIPANTS General surgery residents. RESULTS Survey response rate from 54 sessions among all postgraduate year levels was 73%. Overall, 96% of residents/fellows either "agreed" or "strongly agreed" that the topics of the FSL curriculum were important to learn during surgical training. Only 24% of learners knew "a lot" or "a great deal" about the topics prior to the session which rose to 73% afterwards (p < 0.01). Each postgraduate year class showed statistically significant increase in knowledge. About 80% of learners wanted to investigate these topics further. Open comment questions identified themes requesting delivery of specific sessions earlier in residency training and positive overall attitudes toward the FSL curriculum. CONCLUSIONS FSL is a satisfactory means of teaching leadership skills to surgical residents. Residents recognize the need to develop leadership skills prior to entering practice and want to learn more. The FSL curriculum may be considered for application at other surgical training programs.
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Affiliation(s)
- David R Mann
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Christopher S Thomas
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Raphael H Parrado
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - G Tyler Rives
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Cynthia L Talley
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
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McMullan RD, Churruca K, Hibbert P, Li L, Ash R, Urwin R, Pavithra A, Westbrook JI. Co-worker unprofessional behaviour and patient safety risks: an analysis of co-worker reports across eight Australian hospitals. Int J Qual Health Care 2024; 36:mzae030. [PMID: 38597879 PMCID: PMC11025673 DOI: 10.1093/intqhc/mzae030] [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: 09/17/2023] [Revised: 02/16/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
A key component of professional accountability programmes is online reporting tools that allow hospital staff to report co-worker unprofessional behaviour. Few studies have analysed data from these systems to further understand the nature or impact of unprofessional behaviour amongst staff. Ethos is a whole-of-hospital professional accountability programme that includes an online messaging system. Ethos has now been implemented across multiple Australian hospitals. This study examined reported unprofessional behaviour that staff indicated created a risk to patient safety. This study included 1310 Ethos submissions reporting co-worker unprofessional behaviour between 2017 and 2020 across eight Australian hospitals. Submissions that indicated the behaviour increased the risk to patient safety were identified. Descriptive summary statistics were presented for reporters and subjects of submissions about unprofessional behaviour. Logistic regression was applied to examine the association between each unprofessional behaviour (of the six most frequently reported in the Ethos submissions) and patient safety risk reported in the submissions. The descriptions in the reports were reviewed and the patient safety risks were coded using a framework aligned with the World Health Organization's International Classification for Patient Safety. Of 1310 submissions about unprofessional behaviour, 395 (30.2%) indicated that there was a risk to patient safety. Nurses made the highest number of submissions that included a patient safety risk [3.47 submissions per 100 nursing staff, 95% confidence interval (CI): 3.09-3.9] compared to other professional groups. Medical professionals had the highest rate as subjects of submissions for unprofessional behaviour with a patient safety risk (5.19 submissions per 100 medical staff, 95% CI: 4.44-6.05). 'Opinions being ignored' (odds ratio: 1.68; 95% CI: 1.23-2.22; P < .001) and 'someone withholding information which affects work performance' were behaviours strongly associated with patient safety risk in the submissions (odds ratio: 2.50; 95% CI: 1.73-3.62; P < .001) compared to submissions without a patient safety risk. The two main types of risks to patient safety described were related to clinical process/procedure and clinical administration. Commonly reported events included staff not following policy or protocol; doctors refusing to review a patient; and interruptions and inadequate information during handover. Our findings indicate that unprofessional behaviour was associated with risks to patient safety. Co-worker reports about unprofessional behaviour have significant value as they can be used by organizations to better understand how unprofessional behaviour can disrupt work practices and lead to risks to patient safety.
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Affiliation(s)
- Ryan D McMullan
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Kate Churruca
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Peter Hibbert
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Ling Li
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Ruby Ash
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Rachel Urwin
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Antoinette Pavithra
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Johanna I Westbrook
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
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Freedman B, Li WW, Liang Z, Hartin P, Biedermann N. The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38515008 DOI: 10.1111/jan.16111] [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: 09/14/2023] [Revised: 12/15/2023] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
AIM Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety. METHODS A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies. DATA SOURCES Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023. RESULTS The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety. CONCLUSION Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility. REPORTING METHOD This report adheres to PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.
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Affiliation(s)
- Benjamin Freedman
- James Cook University, Townsville, Queensland, Australia
- Townsville University Hospital, Douglas, Townsville, Australia
| | - Wendy Wen Li
- James Cook University, Townsville, Queensland, Australia
| | - Zhanming Liang
- James Cook University, Townsville, Queensland, Australia
| | - Peter Hartin
- James Cook University, Townsville, Queensland, Australia
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Cha JS, Athanasiadis DI, Peng Y, Wu D, Anton NE, Stefanidis D, Yu D. Objective Nontechnical Skills Measurement Using Sensor-based Behavior Metrics in Surgical Teams. HUMAN FACTORS 2024; 66:729-743. [PMID: 35610959 DOI: 10.1177/00187208221101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The purpose of this study was to identify objective measures that predict surgeon nontechnical skills (NTS) during surgery. BACKGROUND NTS are cognitive and social skills that impact operative performance and patient outcomes. Current methods for NTS assessment in surgery rely on observation-based tools to rate intraoperative behavior. These tools are resource intensive (e.g., time for observation or manual labeling) to perform; therefore, more efficient approaches are needed. METHOD Thirty-four robotic-assisted surgeries were observed. Proximity sensors were placed on the surgical team and voice recorders were placed on the surgeon. Surgeon NTS was assessed by trained observers using the NonTechnical Skills for Surgeons (NOTSS) tool. NTS behavior metrics from the sensors included communication, speech, and proximity features. The metrics were used to develop mixed effect models to predict NOTSS score and in machine learning classifiers to distinguish between exemplar NTS scores (highest NOTSS score) and non-exemplar scores. RESULTS NTS metrics were collected from 16 nurses, 12 assistants, 11 anesthesiologists, and four surgeons. Nineteen behavior features and overall NOTSS score were significantly correlated (12 communication features, two speech features, five proximity features). The random forest classifier achieved the highest accuracy of 70% (80% F1 score) to predict exemplar NTS score. CONCLUSION Sensor-based measures of communication, speech, and proximity can potentially predict NOTSS scores of surgeons during robotic-assisted surgery. These sensing-based approaches can be utilized for further reducing resource costs of NTS and team performance assessment in surgical environments. APPLICATION Sensor-based assessment of operative teams' behaviors can lead to objective, real-time NTS measurement.
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Affiliation(s)
- Jackie S Cha
- Department of Industrial Engineering, Clemson University, SC, USA
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | | | - Yuhao Peng
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - David Wu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Nicholas E Anton
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, In, USA
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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: 0] [Impact Index Per Article: 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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Porter TH, Rathert C, Ishqaidef G, Simmons DR. System justification theory as a foundation for understanding relations among toxic health care workplaces, bullying, and psychological safety. Health Care Manage Rev 2024; 49:59-67. [PMID: 38019464 DOI: 10.1097/hmr.0000000000000391] [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: 11/29/2023]
Abstract
BACKGROUND Toxic work environments and bullying are rampant in health care organizations. The Joint Commission asserted that bullying is a threat to patient safety, and furthermore, it implied that bullying affects clinician psychological safety. However, after decades of trying to reduce bullying, it persists. PURPOSE The purpose of this study was to determine if system justification (SJ) theory can help explain the persistence of bullying in health care organizations. SJ theory posits that people are motivated to justify the systems with which they are embedded, even if those systems are dysfunctional or unfair. METHOD A cross-sectional survey of health care workers ( n = 302) was used to test a moderated mediation model to examine relations between instrumental work climate perceptions and psychological safety, as mediated by SJ and moderated by experiences of workplace bullying. RESULTS Analysis revealed that SJ fully mediated negative relations between instrumental climate and psychological safety; because of SJ the instrumental climate no longer had a direct negative association with psychological safety. Furthermore, bullying was found to play a moderating role in the instrumental climate-SJ relationship. CONCLUSION This study found some support for the role of SJ in perpetuating instrumental workplaces and workplace bullying in health care. PRACTICE IMPLICATIONS Some scholars have proposed that a focus on disrupting workplace contexts that trigger SJ in workers could help break patterns of behavior that enable toxic work environments and bullying to persist.
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Mathis MR, Janda AM, Yule SJ, Dias RD, Likosky DS, Pagani FD, Stakich-Alpirez K, Kerray FM, Schultz ML, Fitzgerald D, Sturmer D, Manojlovich M, Krein SL, Caldwell MD. Nontechnical Skills for Intraoperative Team Members. Anesthesiol Clin 2023; 41:803-818. [PMID: 37838385 PMCID: PMC10703542 DOI: 10.1016/j.anclin.2023.03.013] [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] [Indexed: 10/16/2023]
Abstract
Nontechnical skills, defined as the set of cognitive and social skills used by individuals and teams to reduce error and improve performance in complex systems, have become increasingly recognized as a key contributor to patient safety. Efforts to characterize, quantify, and teach nontechnical skills in the context of perioperative care continue to evolve. This review article summarizes the essential behaviors for safety, described in taxonomies for nontechnical skills assessments developed for intraoperative clinical team members (eg, surgeons, anesthesiologists, scrub practitioners, perfusionists). Furthermore, the authors describe emerging methods to advance understanding of the impact of nontechnical skills on perioperative outcomes.
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Affiliation(s)
- Michael R Mathis
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Allison M Janda
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Steven J Yule
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Roger D Dias
- Department of Emergency Medicine, Brigham & Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Korana Stakich-Alpirez
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Fiona M Kerray
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Megan L Schultz
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - David Fitzgerald
- Department of Clinical Sciences, Medical University of South Carolina College of Health Professions, A 151 Rutledge Avenue, Charleston, SC 29403, USA
| | - David Sturmer
- Department of Perfusion, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Milisa Manojlovich
- School of Nursing, University of Michigan, 426 N Ingalls Street, Ann Arbor, MI 48104, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Matthew D Caldwell
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Rhee AJ. Just Culture: How Do We Address Risky and Unprofessional Behaviors that Lead to Errors? Anesthesiol Clin 2023; 41:731-738. [PMID: 37838380 DOI: 10.1016/j.anclin.2023.05.002] [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] [Indexed: 10/16/2023]
Abstract
Unprofessional behavior in the procedural arena is associated with worse patient outcomes. This is thought to be due to breakdowns in communication structures and team dynamics. Behavioral issues are often uncovered during the investigation of serious event reports. Understanding differences in behavior deviations enables leadership to best address each type with an appropriate response. This allows institutions to address reckless behavior and unprofessionalism, while concomitantly creating a culture that fosters trust to promote self-reporting and sharing of information. These are characteristics of high-reliability organizations that produce sustained excellence in patient outcomes.
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Affiliation(s)
- Amanda J Rhee
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 3rd Floor-Room L3-12, Box # 1238, New York, NY 10029, USA.
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14
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Barry CL, Coombs J, Buchs S, Kim S, Grant T, Henry T, Parente J, Spackman J. Professionalism in Physician Assistant Education as a Predictor of Future Licensing Board Disciplinary Actions. J Physician Assist Educ 2023; 34:278-282. [PMID: 37467183 PMCID: PMC10653293 DOI: 10.1097/jpa.0000000000000515] [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: 07/21/2023]
Abstract
PURPOSE The purpose of this study was to evaluate associations between postgraduate disciplinary actions (PGDA) by state licensing boards and physician assistant (PA) school documented professionalism violations (DPV) and academic probation. METHODS This was a retrospective cohort study comprising PA graduates from 2001 to 2011 at 3 institutions (n = 1364) who were evaluated for the main outcome of PGDA and independent variable of DPV and academic probation. Random-effects multiple logistic regression and accelerated failure time parametric survival analysis were used to investigate the association of PGDA with DPV and academic probation. RESULTS Postgraduate disciplinary action was statistically significant and positively associated with DPV when unadjusted (odds ratio [OR] = 5.15; 95% CI: 1.62-16.31; P = .01) and when adjusting for age, sex, overall PA program GPA (GPA), and Physician Assistant National Certifying Exam Score (OR = 5.39; 95% CI: 1.54-18.85; P = .01) (fully adjusted). Academic probation increased odds to 8.43 times (95% CI: 2.85-24.92; P < .001) and 9.52 times (95% CI: 2.38-38.01; P < .001) when fully adjusted. CONCLUSION Students with professionalism violation or academic probation while in the PA school had significant higher odds of receiving licensing board disciplinary action compared with those who did not. Academic probation had a greater magnitude of effect and could represent an intersection of professionalism and academic performance.
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Affiliation(s)
- Carey L Barry
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer Coombs
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Shalon Buchs
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Sooji Kim
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Travis Grant
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Trenton Henry
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jason Parente
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jared Spackman
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
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Aunger JA, Maben J, Abrams R, Wright JM, Mannion R, Pearson M, Jones A, Westbrook JI. Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review. BMC Health Serv Res 2023; 23:1326. [PMID: 38037093 PMCID: PMC10687856 DOI: 10.1186/s12913-023-10291-3] [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: 09/13/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Unprofessional behaviours (UB) between healthcare staff are rife in global healthcare systems, negatively impacting staff wellbeing, patient safety and care quality. Drivers of UBs include organisational, situational, team, and leadership issues which interact in complex ways. An improved understanding of these factors and their interactions would enable future interventions to better target these drivers of UB. METHODS A realist review following RAMESES guidelines was undertaken with stakeholder input. Initial theories were formulated drawing on reports known to the study team and scoping searches. A systematic search of databases including Embase, CINAHL, MEDLINE and HMIC was performed to identify literature for theory refinement. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories. RESULTS We included 81 reports (papers) from 2,977 deduplicated records of grey and academic reports, and 28 via Google, stakeholders, and team members, yielding a total of 109 reports. Five categories of contributor were formulated: (1) workplace disempowerment; (2) harmful workplace processes and cultures; (3) inhibited social cohesion; (4) reduced ability to speak up; and (5) lack of manager awareness and urgency. These resulted in direct increases to UB, reduced ability of staff to cope, and reduced ability to report, challenge or address UB. Twenty-three theories were developed to explain how these contributors work and interact, and how their outcomes differ across diverse staff groups. Staff most at risk of UB include women, new staff, staff with disabilities, and staff from minoritised groups. UB negatively impacted patient safety by impairing concentration, communication, ability to learn, confidence, and interpersonal trust. CONCLUSION Existing research has focused primarily on individual characteristics, but these are inconsistent, difficult to address, and can be used to deflect organisational responsibility. We present a comprehensive programme theory furthering understanding of contributors to UB, how they work and why, how they interact, whom they affect, and how patient safety is impacted. More research is needed to understand how and why minoritised staff are disproportionately affected by UB. STUDY REGISTRATION This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .
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Affiliation(s)
- Justin Avery Aunger
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- NIHR Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, UK.
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Judy M Wright
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Aled Jones
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Urwin R, Pavithra A, McMullan RD, Churruca K, Loh E, Moore C, Li L, Westbrook JI. Hospital staff reports of coworker positive and unprofessional behaviours across eight hospitals: who reports what about whom? BMJ Open Qual 2023; 12:e002413. [PMID: 37963673 PMCID: PMC10649603 DOI: 10.1136/bmjoq-2023-002413] [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: 05/11/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Workplace behaviours of healthcare staff impact patient safety, staff well-being and organisational outcomes. A whole-of-hospital culture change programme, Ethos, was implemented by St. Vincent's Health Australia across eight hospitals. Ethos includes a secure online submission system that allows staff across all professional groups to report positive (Feedback for Recognition) and negative (Feedback for Reflection) coworker behaviours. We analysed these submissions to determine patterns and rates of submissions and identify the coworker behaviours reported. METHOD All Ethos submissions between 2017 and 2020 were deidentified and analysed. Submissions include structured data elements (eg, professional role of the reporter and subjects, event and report dates) and a narrative account of the event and coworker behaviours. Descriptive statistics were calculated to assess use and reporting patterns. Coding of the content of submissions was performed to classify types of reported coworker behaviours. RESULTS There were a total of 2504 Ethos submissions, including 1194 (47.7%) Recognition and 1310 (52.3%) Reflection submissions. Use of the submission tool was highest among nurses (20.14 submissions/100 nursing staff) and lowest among non-clinical services staff (5.07/100 non-clinical services staff). Nurses were most frequently the subject of Recognition submissions (7.56/100 nurses) while management and administrative staff were the least (4.25/100 staff). Frequently reported positive coworker behaviours were non-technical skills (79.3%, N=947); values-driven behaviours (72.5%, N=866); and actions that enhanced patient care (51.3%, N=612). Medical staff were the most frequent subjects of Reflection submissions (12.59/100 medical staff), and non-clinical services staff the least (4.53/100 staff). Overall, the most frequently reported unprofessional behaviours were being rude (53.8%, N=705); humiliating or ridiculing others (26%, N=346); and ignoring others' opinions (24.6%, N=322). CONCLUSION Hospital staff across all professional groups used the Ethos messaging system to report both positive and negative coworker behaviours. High rates of Recognition submissions demonstrate a strong desire of staff to reward and encourage positive workplace behaviours, highlighting the importance of culture change programmes which emphasise these behaviours. The unprofessional behaviours identified in submissions are consistent with behaviours previously reported in surveys of hospital staff, suggesting that submissions are a reliable indicator of staff experiences.
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Affiliation(s)
- Rachel Urwin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Antoinette Pavithra
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ryan D McMullan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Erwin Loh
- St Vincent's Health Australia Ltd Fitzroy, Fitzroy, Victoria, Australia
| | - Carolyn Moore
- St Vincent's Health Australia Ltd Fitzroy, Fitzroy, Victoria, Australia
| | - Ling Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Maben J, Aunger JA, Abrams R, Wright JM, Pearson M, Westbrook JI, Jones A, Mannion R. Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist review. BMC Med 2023; 21:403. [PMID: 37904186 PMCID: PMC10617100 DOI: 10.1186/s12916-023-03102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Unprofessional behaviour (UB) between staff encompasses various behaviours, including incivility, microaggressions, harassment, and bullying. UB is pervasive in acute healthcare settings and disproportionately impacts minoritised staff. UB has detrimental effects on staff wellbeing, patient safety and organisational resources. While interventions have been implemented to mitigate UB, there is limited understanding of how and why they may work and for whom. METHODS This study utilised a realist review methodology with stakeholder input to improve understanding of these complex context-dependent interventions. Initial programme theories were formulated drawing upon scoping searches and reports known to the study team. Purposive systematic searches were conducted to gather grey and published global literature from databases. Documents were selected if relevant to UB in acute care settings while considering rigour and relevance. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories. RESULTS Of 2977 deduplicated records, 148 full text reports were included with 42 reports describing interventions to address UB in acute healthcare settings. Interventions drew on 13 types of behaviour change strategies and were categorised into five types of intervention (1) single session (i.e. one off); (2) multiple session; (3) single or multiple sessions combined with other actions (e.g. training sessions plus a code of conduct); (4) professional accountability and reporting programmes and; (5) structured culture change interventions. We formulated 55 context-mechanism-outcome configurations to explain how, why, and when these interventions work. We identified twelve key dynamics to consider in intervention design, including importance of addressing systemic contributors, rebuilding trust in managers, and promoting a psychologically safe culture; fifteen implementation principles were identified to address these dynamics. CONCLUSIONS Interventions to address UB are still at an early stage of development, and their effectiveness to reduce UB and improve patient safety is unclear. Future interventions should incorporate knowledge from behavioural and implementation science to affect behaviour change; draw on multiple concurrent strategies to address systemic contributors to UB; and consider the undue burden of UB on minoritised groups. STUDY REGISTRATION This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .
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Affiliation(s)
- Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Justin Avery Aunger
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
- NIHR Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Judy M Wright
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Aled Jones
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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18
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Bagot KL, McInnes E, Mannion R, McMullan RD, Urwin R, Churruca K, Hibbert P, Westbrook JI. Middle manager responses to hospital co-workers' unprofessional behaviours within the context of a professional accountability culture change program: a qualitative analysis. BMC Health Serv Res 2023; 23:1012. [PMID: 37726731 PMCID: PMC10510259 DOI: 10.1186/s12913-023-09968-6] [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: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The critical role that middle managers play in enacting organisational culture change designed to address unprofessional co-worker behaviours has gone largely unexplored. We aimed to explore middle managers' perspectives on i) whether they speak up when they or their team members experience unprofessional behaviours (UBs); ii) how concerns are handled; iii) the outcomes; and iv) the role of a professional accountability culture change program (known as Ethos) in driving change. METHODS Qualitative, constructivist approach. Five metropolitan hospitals in Australia which had implemented Ethos. Purposive sampling was used to invite middle-level managers from medicine, nursing, and non-clinical support services. Semi-structured interviews conducted remotely. Inductive, reflexive thematic and descriptive thematic analyses undertaken using NVivo. RESULTS Thirty interviews (approximately 60 min; August 2020 to May 2021): Nursing (n = 12), Support Services (n = 10), and Medical (n = 8) staff, working in public (n = 18) and private (n = 12) hospitals. One-third (n = 10) had a formal role in Ethos. All middle managers (hearers) had experienced the raising of UBs by their team (speakers). Themes representing reasons for ongoing UBs were: staying silent but active; history and hierarchy; and double-edged swords. The Ethos program was valued as a confidential, informal, non-punitive system but required improvements in profile and effectiveness. Participants described four response stages: i) determining if reports were genuine; ii) taking action depending on the speaker's preference, behaviour factors (type, frequency, impact), if the person was known/unknown; iii) exploring for additional information; and iv) addressing either indirectly (e.g., change rosters) or directly (e.g., become a speaker). CONCLUSIONS Addressing UBs requires an organisational-level approach beyond supporting staff to speak up, to include those hearing and addressing UBs. We propose a new hearer's model that details middle managers' processes after a concern is raised, identifying where action can be taken to minimise avoidant behaviours to improve hospital culture, staff and patient safety.
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Affiliation(s)
- K L Bagot
- Nursing Research Institute -St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Fitzroy, VIC, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia
| | - E McInnes
- Nursing Research Institute -St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Fitzroy, VIC, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - R Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - R D McMullan
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - R Urwin
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - K Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - P Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - J I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
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19
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Dambrino RJ, Domenico HJ, Graves JA, Buntin MJB, Martinez W, Rosenbloom ST, Cooper WO. Unsolicited Patient Complaints Following the 21st Century Cures Act Information-Blocking Rule. JAMA HEALTH FORUM 2023; 4:e233244. [PMID: 37773508 PMCID: PMC10543134 DOI: 10.1001/jamahealthforum.2023.3244] [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: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 10/01/2023] Open
Abstract
Importance The 21st Century Cures Act includes an information-blocking rule (IBR) that requires health systems to provide patients with immediate access to their health information in the electronic medical record upon request. Patients accessing their health information before they receive an explanation from their health care team may experience confusion and may be more likely to share unsolicited patient complaints (UPCs) with their health care organization. Objective To evaluate the quantity of UPCs about physicians before and after IBR implementation and to identify themes in UPCs that may identify patient confusion, fear, or anger related to the release of information. Design, Setting, and Participants This retrospective cohort study was conducted with an interrupted time-series analysis of UPCs spanning January 1, 2020, to June 30, 2022. The data were obtained from a single academic medical center, Vanderbilt University Medical Center, at which the IBR was implemented on January 20, 2021. Data analysis was performed from January 11 to July 15, 2023. Exposure Implementation of the IBR on January 20, 2021. Main Outcomes and Measures The primary outcome was the monthly rate of UPCs before and after IBR implementation. A qualitative analysis was performed for UPCs received after IBR implementation. The Wilcoxon rank-sum test was used to compare monthly complaints between the pre- and post-IBR groups. The Pearson χ2 test was used to compare proportions of complaints by UPC category between time periods. Results The medical center received 8495 UPCs during the study period: 3022 over 12 months before and 5473 over 18 months after institutional IBR implementation. There was no difference in the monthly proportions of UPCs per 1000 patient encounters before (median, 0.81 [IQR, 0.75-0.88]) and after (median, 0.83 [IQR, 0.77-0.89]) IBR implementation (difference in medians, -0.02 [95% CI, -0.12 to 0.07]; P =.86). Segmented regression analysis revealed no difference in monthly UPCs (β [SE], 0.03 [0.09]; P =.72). Conclusions and Relevance In this cohort study, implementation of the Cures Act IBR was not associated with an increase in monthly rates of UPCs. These findings suggest that review of UPCs identified as IBR-specific complaints may allow clinicians and organizations to prepare patients that their test and procedure results may be available before clinicians are able to review them and respond.
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Affiliation(s)
- Robert J. Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry J. Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John A. Graves
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda J. B. Buntin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Carey Business School, Johns Hopkins University, Baltimore, Maryland
| | - William Martinez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William O. Cooper
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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20
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Kovoor JG, Gupta AK, Bacchi S, Stretton B, Padbury RT. 'Hurry up' syndrome harms surgical patients and staff. ANZ J Surg 2023; 93:1756-1757. [PMID: 37458228 DOI: 10.1111/ans.18593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Joshua G Kovoor
- Flinders Medical Centre, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Stephen Bacchi
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
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21
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Kendrick DE, Thelen AE, Chen X, Gupta T, Yamazaki K, Krumm AE, Bandeh-Ahmadi H, Clark M, Luckoscki J, Fan Z, Wnuk GM, Ryan AM, Mukherjee B, Hamstra SJ, Dimick JB, Holmboe ES, George BC. Association of Surgical Resident Competency Ratings With Patient Outcomes. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:813-820. [PMID: 36724304 DOI: 10.1097/acm.0000000000005157] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Accurate assessment of clinical performance is essential to ensure graduating residents are competent for unsupervised practice. The Accreditation Council for Graduate Medical Education milestones framework is the most widely used competency-based framework in the United States. However, the relationship between residents' milestones competency ratings and their subsequent early career clinical outcomes has not been established. It is important to examine the association between milestones competency ratings of U.S. general surgical residents and those surgeons' patient outcomes in early career practice. METHOD A retrospective, cross-sectional study was conducted using a sample of national Medicare claims for 23 common, high-risk inpatient general surgical procedures performed between July 1, 2015, and November 30, 2018 (n = 12,400 cases) by nonfellowship-trained U.S. general surgeons. Milestone ratings collected during those surgeons' last year of residency (n = 701 residents) were compared with their risk-adjusted rates of mortality, any complication, or severe complication within 30 days of index operation during their first 2 years of practice. RESULTS There were no associations between mean milestone competency ratings of graduating general surgery residents and their subsequent early career patient outcomes, including any complication (23% proficient vs 22% not yet proficient; relative risk [RR], 0.97, [95% CI, 0.88-1.08]); severe complication (9% vs 9%, respectively; RR, 1.01, [95% CI, 0.86-1.19]); and mortality (5% vs 5%; RR, 1.07, [95% CI, 0.88-1.30]). Secondary analyses yielded no associations between patient outcomes and milestone ratings specific to technical performance, or between patient outcomes and composites of operative performance, professionalism, or leadership milestones ratings ( P ranged .32-.97). CONCLUSIONS Milestone ratings of graduating general surgery residents were not associated with the patient outcomes of those surgeons when they performed common, higher-risk procedures in a Medicare population. Efforts to improve how milestones ratings are generated might strengthen their association with early career outcomes.
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Affiliation(s)
- Daniel E Kendrick
- D.E. Kendrick is assistant professor, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Angela E Thelen
- A.E. Thelen is research fellow, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Xilin Chen
- X. Chen is research analyst, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Tanvi Gupta
- T. Gupta is research analyst, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kenji Yamazaki
- K. Yamazaki is senior data analyst, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Andrew E Krumm
- A.E. Krumm is assistant professor, Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Hoda Bandeh-Ahmadi
- H. Bandeh-Ahmadi is project manager, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Clark
- M. Clark is a biostatistician, Consulting for Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, Michigan
| | - John Luckoscki
- J. Luckoscki is research fellow, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Zhaohui Fan
- Z. Fan is research analyst, Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Greg M Wnuk
- G.M. Wnuk is program manager, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew M Ryan
- A.M. Ryan is professor, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bhramar Mukherjee
- B. Mukherjee is professor and chair, Division of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Stanley J Hamstra
- S.J. Hamstra is professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin B Dimick
- J.B. Dimick is professor and chair, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Eric S Holmboe
- E.S. Holmboe is chief research, Milestone Development, and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Brian C George
- B.C. George is director, Center for Surgical Training and Research, and assistant professor, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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22
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Churruca K, Westbrook J, Bagot KL, McMullan RD, Urwin R, Cunningham N, Mitchell R, Hibbert P, Sunderland N, Loh E, Taylor N. Retrospective analysis of factors influencing the implementation of a program to address unprofessional behaviour and improve culture in Australian hospitals. BMC Health Serv Res 2023; 23:584. [PMID: 37287017 DOI: 10.1186/s12913-023-09614-1] [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: 07/13/2022] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Unprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos, implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers. METHOD Data relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers. RESULTS Four enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool ('Design quality and packaging'), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos ('Goals and Feedback', 'Access to Knowledge and Information'). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers. CONCLUSION Aspects of the inner setting (e.g., 'Leadership Engagement', 'Tension for Change') had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia.
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia
| | - Kathleen L Bagot
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Daniel Mannix Building, Brunswick Street, Fitzroy, Australia
| | - Ryan D McMullan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia
| | | | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Neroli Sunderland
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia
| | - Erwin Loh
- St Vincent's Health Australia, Melbourne, Australia
| | - Natalie Taylor
- School of Population Health, University of New South Wales, Sydney, Australia
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23
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Schillhammer CK. Editorial Commentary: Meditation Results From Mindfulness and Results in Improved Surgical Performance: 10 Minutes per Day, the Apps Are Free, Why Not Try? Arthroscopy 2023; 39:1271-1272. [PMID: 37019538 DOI: 10.1016/j.arthro.2022.11.004] [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] [Received: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 04/07/2023]
Abstract
Meditation is a practice that is thousands of years old and has proponents across the spectrum, from artists to athletes. Meditation is not synonymous with mindfulness but is instead a technique to reach the state of mindfulness. Mindfulness itself can be simply described as the state of bringing one's attention to the present moment. Attaining mindfulness allows a surgeon to maintain focus and avoid allowing outside stimuli to affect performance. Attaining mindfulness does not eliminate feelings of anger or frustration but allows a surgeon to respond to such emotions thoughtfully. Surgeons who respond mindlessly to frustration exhibit poor behavior, worse surgical outcomes, and increased exposure to liability. Today, daily mindfulness is attainable in an efficient manner using modern, application (app)-based technology, and positive effects of mindfulness on surgical and clinical performance have been reported across multiple specialties. Practicing mindfulness daily for 10 minutes, including the day of surgery, could improve performance. Mindfulness matters, the apps are free, so why not try?
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24
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Forsythe RO, Van Herzeele I, Zayed H, Argyriou A, Stavroulakis K, Saratzis A. International Cross-Sectional Survey of Bullying, Undermining, and Harassment in the Vascular Workplace. Eur J Vasc Endovasc Surg 2023; 65:748-755. [PMID: 36871928 DOI: 10.1016/j.ejvs.2023.02.075] [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: 09/07/2022] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Bullying, undermining behaviour, and harassment (BUH) may exist in healthcare settings, impacting on patient care. The aim of this international study was to evaluate the characteristics of BUH experienced by physicians treating vascular diseases at various career stages. METHODS This was an anonymous international structured non-validated cross-sectional survey distributed via relevant professional societies in collaboration with the Research Collaborative in Peripheral Artery Disease. The survey was disseminated through societies' newsletters, emails, and social media. Data were collected online, allowing free text entries alongside structured multiple choice questions based on previous surveys. Demographics, geographical information, and data relating to stage and training environment were collected. RESULTS Of 587 respondents from 28 countries, 86% were working in vascular surgery, mostly at a university hospital (56%); 81% were aged between 31 and 60 years, 57% were working as a consultant, and 23% as a resident. Respondents were mostly white (83%), male (63%), heterosexual (94%), and without disability (96%). Overall, 253 (43%) reported experiencing BUH personally, 75% had witnessed BUH toward colleagues, and 51% witnessed these in the last 12 months. Female sex and non-white ethnicity were associated with BUH (53% vs. 38% and 57% vs. 40% respectively; p < .001 in both cases). While working as a consultant, 171 (50%) reported experiencing BUH, more often among females, non-heterosexuals, those who were not working in their country of birth, and non-white people. Specialty and hospital type were not associated with BUH. CONCLUSION BUH remains a major problem in the vascular workplace. Female sex, non-heterosexuality, and non-white ethnicity are associated with BUH at various career stages.
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Affiliation(s)
- Rachael O Forsythe
- Centre for Cardiovascular Science, University of Edinburgh and Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Hany Zayed
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Angeliki Argyriou
- Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | | | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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25
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Lewis C. The impact of interprofessional incivility on medical performance, service and patient care: a systematic review. Future Healthc J 2023; 10:69-77. [PMID: 37786504 PMCID: PMC10538688 DOI: 10.7861/fhj.2022-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
The stressful nature of the medical profession is a known trigger for aggression or abuse among healthcare staff. Interprofessional incivility, defined as low-intensity negative interactions with ambiguous or unclear intent to harm, has recently become an occupational concern in healthcare. While incivility in nursing has been widely investigated, its prevalence among physicians and its impact on patient care are poorly understood. This review summarises current understanding of the effects of interprofessional incivility on medical performance, service and patient care. A structured search and screening of literature returned 13 studies of diverse origin, methodology, quality, size and population type. The consensus is that interprofessional incivility is common among physicians and nurses and has both psychological and clinical outcomes, resulting in stress, compromised patient safety and poor quality of care. Junior staff are affected more often than consultants, with higher rates in radiology, general surgery, neurosurgery and cardiology. Incivility also undermines medical team performance, particularly in perioperative settings. In patient care, incivility is associated with complications, medical errors, mortality, and compromised patient safety and quality of care. Patients whose surgeons have a record of incivility can be at higher risk of complications. The impact of incivility on medical performance, service and patient care appears systemic and must be addressed accordingly. This analysis was limited by the methodological weaknesses of the included studies, which highlights the need for more high-quality empirical research. This would benefit the NHS and other stakeholders when designing targeted interventions. In particular, establishing quantitative methods for identifying and measuring incivility will be crucial for improving our understanding of the phenomenon.
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Williams BW, Welindt D. Assisting physicians who exhibit disruptive behavior: Understanding the costs, contributors, and corrections. Australas Psychiatry 2023; 31:132-135. [PMID: 36749186 DOI: 10.1177/10398562231156477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this article is to discuss the etiology, prevalence, impact, and management of disruptive behavior in physicians. These various aspects will be examined at both the individual and system level, to provide appropriate perspective and detail effective approaches to address these behaviors. METHOD Clinical experience and review of the authors' and other researchers' findings provide consensus on numerous key aspects of physician disruptive behavior. RESULTS Physicians demonstrating disruptive behavior are often distressed. The behavior should be understood as arising from biopsychosocial contributors, knowledge gaps, insight, and systems factors. These contributors are inclusive and may interact with each other. CONCLUSIONS A comprehensive approach is required which can include assessment/reassessment tools, individualized programming (therapy, coaching, instruction), deliberate practice, medical follow-up, and system intervention. Complications include the diversity of disruptive behaviors, the many contributory factors therein, disagreement about methodology/measurement, and the role of the system.
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Affiliation(s)
- Betsy W Williams
- Clinical Program Director, Professional Renewal Center®, Lawrence, KS, USA.,Director of Education, Wales Behavioral Assessment, Lawrence, KS, USA; Clinical Associate Professor, Department of Psychiatry, School of Medicine, University of Kansas, Lawrence, KS, USA
| | - Dillon Welindt
- Department of Psychology, 3265University of Oregon, Eugene, OR, USA
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McMichael B, Kemp M, Engler T, Bamdad M, Perrone E, Kwakye G, Mohr D, Palazzolo W, Sonnenday C, Sandhu G. The Michigan Action Progress System (MAPS): Enhancing a Culture of Professionalism, Accountability, and Psychological Safety. JOURNAL OF SURGICAL EDUCATION 2023; 80:7-10. [PMID: 36216770 DOI: 10.1016/j.jsurg.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/22/2022] [Accepted: 08/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To prioritize trainee well-being, promote professionalism, and allow individuals to raise concerns without fear of retribution, one surgical department created an innovative process by which individuals can raise concerns and obtain subsequent support. DESIGN AND SETTING The University of Michigan Department of Surgery implemented the Michigan Action Progress System (MAPS) in February 2021. PARTICIPANTS General Surgery residents, faculty, and staff voluntarily participate in MAPS. RESULTS Since implementation, there have been 26 entries into MAPS. Petitioners included students (10, 38%), residents and fellows (7, 27%), staff (1, 4%), faculty (1, 4%), and anonymous petitioners (7, 27%). Concerns regarding racism (1, 4%), bullying (11, 52%), gender discrimination (1, 4%), and other incidents (8, 38%) were addressed though MAPS. CONCLUSIONS We have successfully implemented an innovative system that focuses on the needs of the user, consolidates handling of concerns, and emphasizes transparency, documentation, education, and improvement to promote a culture of professionalism and accountability.
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Affiliation(s)
| | - Michael Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Tedi Engler
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michaela Bamdad
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Erin Perrone
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - David Mohr
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Chris Sonnenday
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Fiester A, Yuan C. Ethical Issues in Using Behavior Contracts to Manage the "Difficult" Patient and Family. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:50-60. [PMID: 34590938 DOI: 10.1080/15265161.2021.1974974] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Long used as a tool for medical compliance and adhering to treatment plans, behavior contracts have made their way into the in-patient healthcare setting as a way to manage the "difficult" patient and family. The use of this tool is even being adopted by healthcare ethics consultants (HECs) in US hospitals as part of their work in navigating conflict at the bedside. Anecdotal evidence of their increasing popularity among clinical ethicists, for example, can be found at professional bioethics meetings and conversations and idea-sharing among practitioners on HEC social media. While there are a handful of papers gesturing toward a bioethical critique of behavior contracts of various types, the use of behavior contracts in the context of interpersonal conflict has not been vetted by bioethicists to determine their ethical legitimacy or efficacy. In this paper, we highlight a set of ethical concerns that we believe must be addressed before continuing or widespread implementation of behavior contracts to manage the "difficult" patient or family.
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Implementation of Peer Messengers to Deliver Feedback: An Observational Study to Promote Professionalism in Nursing. Jt Comm J Qual Patient Saf 2023; 49:14-25. [PMID: 36400699 DOI: 10.1016/j.jcjq.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Co-Worker Observation System (CORS) is a tool and a process to address disrespectful behavior through feedback from trained peer messengers. First used by physicians and advanced practice providers (APPs), CORS has been shown to decrease instances of unprofessional behaviors among physicians and APPs. The research team assessed the feasibility and fidelity of implementing CORS for staff nurses. METHODS CORS was implemented at three academic medical centers using a project bundle with 10 essential implementation elements. Reports of unprofessional behavior among staff nurses that were submitted through the institution's electronic reporting system were screened through natural language processing software, coded by trained CORS coders using the Martinez taxonomy, and referred to a trained peer messenger to share the observations with the nurse. A mixed methods, observational design assessed feasibility and fidelity. RESULTS A total of 590 reports from three sites were identified by the Center for Patient and Professional Advocacy from September 1, 2019, through August 31, 2021. Most reports included more than one problematic behavior, each of which was coded. Of the peer messages, 76.5% were successfully documented using the debriefing survey as complete, 2.2% as awaiting messenger feedback, and 0.2% as awaiting messenger assignments (total of 78.9 % considered delivered). A total of 21.1% were not shared; 4.7% of reports were intentionally not shared because the issue stemmed from a new system or policy implementation (4.0%) or because of known factors affecting the nurse (0.7%). CONCLUSION CORS can be implemented with staff nurses efficiently when nursing infrastructure is adequate.
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Health care professionals' perceptions of unprofessional behaviour in the clinical workplace. PLoS One 2023; 18:e0280444. [PMID: 36656827 PMCID: PMC9851503 DOI: 10.1371/journal.pone.0280444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Unprofessional behaviour undermines organizational trust and negatively affects patient safety, the clinical learning environment, and clinician well-being. Improving professionalism in healthcare organizations requires insight into the frequency, types, sources, and targets of unprofessional behaviour in order to refine organizational programs and strategies to prevent and address unprofessional behaviours. OBJECTIVE To investigate the types and frequency of perceived unprofessional behaviours among health care professionals and to identify the sources and targets of these behaviours. METHODS Data was collected from 2017-2019 based on a convenience sample survey administered to all participants at the start of a mandatory professionalism course for health care professionals including attending physicians, residents and advanced practice providers (APPs) working at one academic hospital in the United States. RESULTS Out of the 388 participants in this study, 63% experienced unprofessional behaviour at least once a month, including failing to respond to calls/pages/requests (44.3%), exclusion from decision-making (43.0%) and blaming behaviour (39.9%). Other monthly experienced subtypes ranged from 31.7% for dismissive behaviour to 4.6% for sexual harassment. Residents were more than twice as likely (OR 2.25, p<0.001)) the targets of unprofessional behaviour compared to attending physicians. Female respondents experienced more discriminating behaviours (OR 2.52, p<0.01). Nurses were identified as the most common source of unprofessional behaviours (28.1%), followed by residents from other departments (21%). CONCLUSIONS Unprofessional behaviour was experienced frequently by all groups, mostly inflicted on these groups by those outside of the own discipline or department. Residents were most frequently identified to be the target and nurses the source of the behaviours. This study highlights that unprofessional behaviour is varied, both regarding types of behaviours as well as targets and sources of such behaviours. This data is instrumental in developing training and remediation initiatives attuned to specific professional roles and specific types of professionalism lapses.
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Putnam EM, Baetzel AE, Leis A. Paediatric anaesthesiology education: simulation-based 'attending boot camp' for fellows shows feasibility and value in the early years of attendings' careers. BJA OPEN 2022; 4:100115. [PMID: 37588785 PMCID: PMC10430843 DOI: 10.1016/j.bjao.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/14/2022] [Indexed: 08/18/2023]
Abstract
Background Established simulation-based 'boot camps' utilise adult learning theory to engage and teach technical and non-technical skills to medical graduates transitioning into residency or fellowship. However, the transition from trainee to the attending role has not been well studied. The primary aim of this study was to design and execute a simulation-based educational day, exposing senior trainees in paediatric anaesthesia to commonly encountered challenges and teaching critical technical skills relevant to their new role. Secondary aims included assessment of its value and relevance in early years of graduated fellows' new careers as attendings. Methods An 'attending boot camp' day comprised the following: two crisis simulations, an otolaryngologist-taught cadaver cricothyroidotomy laboratory, and a difficult conversations workshop. There was a debriefing after each section. Data were collected using end-of-day and early-career e-mail surveys for five consecutive fellow cohorts from 2016 to 2020. Results Forty fellows participated; overall feedback was positive. The end-of-day surveys revealed planned changes in practice for 89% (25/28) of fellows, and 54% (15/28) highlighted communication skills as 'most beneficial'. Early-career follow-up surveys found 96% (23/24) identified increased confidence in skill acquisition because of the day; 79% (19/24) experienced scenarios in real life similar to those simulated. The qualitative analysis revealed four high-value themes: delegation, leadership, clinical skills, and difficult communication. Conclusions The transition from senior trainee to attending physician remains under-researched. A tailored simulation-based 'attending boot camp' was feasible and valued and may be useful in bridging this transition. Participants identified leadership practice, life-saving technical skills, and difficult communication practice as valuable and relevant in their early careers.
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Affiliation(s)
- Elizabeth M. Putnam
- Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor, MI, USA
- Department of Learning Health Sciences, and University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Anne E. Baetzel
- Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Aleda Leis
- Department of Epidemiology, University of Michigan Health Systems, Ann Arbor, MI, USA
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Mahmoud A, Shanmuganathan K, Chandrakumar C, Stimler B, Jeyaseelan L. Bullying in trauma and orthopaedics: a survey of staff in orthopaedic departments in the UK. Br J Hosp Med (Lond) 2022; 83:1-10. [DOI: 10.12968/hmed.2022.0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background/aims An orthopaedic department requires good teamwork and communication to function. This is undermined by bullying and harassment, which may affect the victim's health and career. Methods A 26-item questionnaire was sent to all delegates who registered for a free orthopaedic webinar teaching series via email and social media. This study includes the responses from all those who had worked in a UK orthopaedic department. Results There were 168 respondents from varying backgrounds; 17.9% had experienced bullying or harassment in their orthopaedic department, while 36.3% had witnessed it. Women and people from ethnic minority backgrounds suffered 10.2% and 6.9% higher rates of bullying than their male or white counterparts respectively. Conclusions The results demonstrate that despite attempts to reduce bullying in orthopaedics, it remains prevalent, and particularly affects women and those from ethnic minority backgrounds. Orthopaedic departments must adapt to reflect changes in society.
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Affiliation(s)
- Arin Mahmoud
- Trauma and Orthopaedic Department, Royal London Hospital, London, UK
| | | | | | - Batya Stimler
- Trauma and Orthopaedic Department, Royal London Hospital, London, UK
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Parker AS, Mwachiro MM, Kirui JR, Many HR, Mwachiro EB, Parker RK. A Semistructured Interview for Surgical Residency Targeting Nontechnical Skills. JOURNAL OF SURGICAL EDUCATION 2022; 79:e213-e219. [PMID: 36030183 DOI: 10.1016/j.jsurg.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/05/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We review the development, implementation, and initial outcomes of a semistructured interview process to assess the nontechnical skills of surgical residency applicants. DESIGN In 2018, we restructured our residency selection interview process. Through semistructured faculty interviews, we sought to evaluate candidates along seven nontechnical skills (grit, ownership, rigor, teamwork, presence, impact, and organizational alignment). We plotted each candidate's scores on a radar plot for graphical representation and calculated the plot area of each candidate. We retrospectively evaluated 3 years of data, comparing the nontechnical skill scores of matriculants into the training program to those of nonmatriculants. SETTING Tenwek Hospital is a 361-bed tertiary teaching and referral hospital in rural western Kenya with a 5-year general surgery residency program. PARTICIPANTS Thirty-one applicants were interviewed over 3 years. Thirteen matriculated into the program. RESULTS Scores for grit, (4.8 vs 3.9; p = 0.0004), impact (4.2 vs 3.5; p = 0.014), ownership (4.2 vs 3.6; p = 0.01), and organizational alignment (4.3 vs 3.8; p = 0.008) were significantly higher in matriculants. CONCLUSIONS This semistructured interview process provides a robust and beneficial mechanism for assessing applicants' nontechnical skills, which may allow for the matriculation of more well-rounded candidates into surgical residency and, ultimately, surgical practice.
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Affiliation(s)
- Andrea S Parker
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
| | | | | | - Heath R Many
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, University of Tennessee Medical Center, Knoxville, Tennessee
| | | | - Robert K Parker
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
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Peckston DC, Urwin R, McMullan R, Westbrook J. Student and clinician perceptions of medical student mistreatment: a cross-sectional vignette survey. BMJ Open 2022; 12:e061253. [PMID: 36104130 PMCID: PMC9476143 DOI: 10.1136/bmjopen-2022-061253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The mistreatment of medical students remains pervasive in medical education. Understanding the extent to which clinicians and students recognise mistreatment can assist in creating targeted interventions that reduce mistreatment. The objective of this study was to use clinical vignettes to assess perceptions of medical student mistreatment among medical students and clinical faculty at an Australian university. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study used a survey of medical students and clinical faculty in a Doctor of Medicine (MD) programme at Macquarie University in Sydney, Australia. Data were collected via an online survey between 13 July and 27 July 2020. OUTCOME MEASURES Fourteen clinical vignettes were developed based on commonly reported themes of mistreatment. An additional control vignette was also included, and these 15 vignettes were distributed via email to all 169 MD students and 42 teaching faculty at this teaching site. Participants were asked to rate whether the vignettes portrayed mistreatment on a 5-point Likert scale (strongly disagree to strongly agree). RESULTS Respondents included 83 MD students and 34 clinical faculty. On average, students perceived mistreatment in 9 of 14 vignettes and faculty in 8 of 14 vignettes. Faculty and student perceptions aligned in themes of sexual abuse, physical abuse and in the control vignette depicting a constructive teaching style. Perceptions differed significantly between faculty and students (p<0.05) for five vignettes across the themes of gender discrimination, requests of students to perform non-educational tasks, humiliation, specialty choice discrimination and requests to perform a task beyond the student's capacity. CONCLUSION Agreement on what constitutes appropriate behaviour is crucial to ensuring that a culture of mistreatment can be replaced with one of kindness, equity and respect. This study demonstrated the successful use of vignettes to compare perceptions of mistreatment, with faculty and student perceptions differing across a variety of themes.
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Affiliation(s)
- Dane Christopher Peckston
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ryan McMullan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Rivard SJ, Kemp MT, Sandhu G, Heximer AC, Hughes T, Byrnes ME. "Why would you want to do that?"Surgical Interns Reflect on Discouragement From Entering Surgical Fields. JOURNAL OF SURGICAL EDUCATION 2022; 79:1150-1158. [PMID: 35662535 DOI: 10.1016/j.jsurg.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/20/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Decreasing numbers of medical students are choosing to pursue surgical careers. This study highlights individual experiences of surgical interns receiving discouragement from pursuing surgery as a career. METHODS We interviewed 24 incoming surgical interns from 7 institutions and 7 surgical subspecialties about their experiences with discouragement from surgery. RESULTS All surgical interns discussed experiencing discouragement from pursuing surgery as a career. Family, friends, the general public, and medical professionals, including surgeons, served as sources of discouragement. Reasons for discouragement fell into 3 main themes: The Surgeon and Surgical Culture, The Sacrifices, and The Sexism. Despite its pervasiveness, participants reconciled the discouragement received. DISCUSSION Discouragement from surgery is pervasive and centered around surgeon stereotypes and perceptions of surgical culture, significant personal sacrifices required, and traditional gender-related expectations. These results highlight the importance of individual surgeons' comments on student experience and can be used to improve the perception of surgery amongst prospective interns.
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Affiliation(s)
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Tasha Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mary E Byrnes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Perera GN, Hey LA, Chen KB, Morello MJ, McConnell BM, Ivy JS. Checklists in Healthcare: Operational Improvement of Standards using Safety Engineering - Project CHOISSE - A framework for evaluating the effects of checklists on surgical team culture. APPLIED ERGONOMICS 2022; 103:103786. [PMID: 35617733 DOI: 10.1016/j.apergo.2022.103786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 03/10/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
The CHOISSE multi-stage framework for evaluating the effects of electronic checklist applications (e-checklists) on surgical team members' perception of their roles, performance, communication, and understanding of checklists is introduced via a pilot study. A prospective interventional cohort study design was piloted to assess the effectiveness of the framework and the sociotechnical effects of the e-checklist. A Delphi process was used to design the stages of the framework based on literature and expert consensus. The CHOISSE framework was applied to guide the implementation and evaluation of e-checklists on team culture for ten pilot teams across the US over a 24-week period. The pilot results revealed more engagement by surgeons than non-surgeons, and significant increases in surgeons' perception of communication and engagement during surgery with a small sample. Mixed methods analysis of the data and lessons learned were used to identify iterative improvements to the CHOISSE framework and to inform future studies.
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Affiliation(s)
- Gimantha N Perera
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA.
| | - Lloyd A Hey
- Hey Clinic for Scoliosis and Spine Care, Duke Raleigh Hospital, NC, USA
| | - Karen B Chen
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA
| | - Madeline J Morello
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA
| | - Brandon M McConnell
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA; Center for Additive Manufacturing and Logistics, North Carolina State University, Raleigh, NC, USA
| | - Julie S Ivy
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA
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Abstract
Surgeons are famously decisive, assertive, and confident. Unfortunately, we also often have a reputation for being blunt, harsh, and unprofessional. Unprofessional behaviors are unacceptable, and we believe that they are a symptom of surgeon distress and burnout. Unprofessional behaviors should be prevented, but equally importantly, so should the stressors that drive them. This is critically important for the future of our profession.
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Maben J, Aunger JA, Abrams R, Pearson M, Wright JM, Westbrook J, Mannion R, Jones A. Why do acute healthcare staff engage in unprofessional behaviours towards each other and how can these behaviours be reduced? A realist review protocol. BMJ Open 2022; 12:e061771. [PMID: 35788075 PMCID: PMC9255388 DOI: 10.1136/bmjopen-2022-061771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Unprofessional behaviours encompass many behaviours including bullying, harassment and microaggressions. These behaviours between healthcare staff are problematic; they affect people's ability to work, to feel psychologically safe at work and speak up and to deliver safe care to patients. Almost a fifth of UK National Health Service staff experience unprofessional behaviours in the workplace, with higher incidence in acute care settings and for staff from minority backgrounds. Existing analyses have investigated the effectiveness of strategies to reduce these behaviours. We seek to go beyond these, to understand the range and causes of such behaviours, their negative effects and how mitigation strategies may work, in which contexts and for whom. METHODS AND ANALYSIS This study uses a realist review methodology with stakeholder input comprising a number of iterative steps: (1) formulating initial programme theories drawing on informal literature searches and literature already known to the study team, (2) performing systematic and purposive searches for grey and peer-reviewed literature on Embase, CINAHL and MEDLINE databases as well as Google and Google Scholar, (3) selecting appropriate documents while considering rigour and relevance, (4) extracting data, (5) and synthesising and (6) refining the programme theories by testing the theories against the newly identified literature. ETHICS AND DISSEMINATION Ethical review is not required as this study is a secondary research. An impact strategy has been developed which includes working closely with key stakeholders throughout the project. Step 7 of our project will develop pragmatic resources for managers and professionals, tailoring contextually-sensitive strategies to reduce unprofessional behaviours, identifying what works for which groups. We will be guided by the 'Evidence Integration Triangle' to implement the best strategies to reduce unprofessional behaviours in given contexts. Dissemination will occur through presentation at conferences, innovative methods (cartoons, videos, animations and/or interactive performances) and peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021255490.
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Affiliation(s)
- Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Justin Avery Aunger
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Judy M Wright
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Cooper WO, Hickson GB. Balancing Rights and Responsibilities of Key Stakeholders in Addressing Reports of Disrespect Experienced by Patients. Chest 2022; 162:1140-1144. [DOI: 10.1016/j.chest.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/11/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022] Open
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Dmochowski RR, Cooper WO, Hickson GB. Professionalism, Leadership, and a Pilfered Apple. Jt Comm J Qual Patient Saf 2022; 48:419-423. [DOI: 10.1016/j.jcjq.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
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Obuseh M, Yu D, DeLaurentis P. Detecting Unusual Intravenous Infusion Alerting Patterns with Machine Learning Algorithms. Biomed Instrum Technol 2022. [PMID: 35749264 DOI: 10.2345/1943-5967-56.2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To detect unusual infusion alerting patterns using machine learning (ML) algorithms as a first step to advance safer inpatient intravenous administration of high-alert medications. MATERIALS AND METHODS We used one year of detailed propofol infusion data from a hospital. Interpretable and clinically relevant variables were feature engineered, and data points were aggregated per calendar day. A univariate (maximum times-limit) moving range (mr) control chart was used to simulate clinicians' common approach to identifying unusual infusion alerting patterns. Three different unsupervised multivariate ML-based anomaly detection algorithms (Local Outlier Factor, Isolation Forest, and k-Nearest Neighbors) were used for the same purpose. Results from the control chart and ML algorithms were compared. RESULTS The propofol data had 3,300 infusion alerts, 92% of which were generated during the day shift and seven of which had a times-limit greater than 10. The mr-chart identified 15 alert pattern anomalies. Different thresholds were set to include the top 15 anomalies from each ML algorithm. A total of 31 unique ML anomalies were grouped and ranked by agreeability. All algorithms agreed on 10% of the anomalies, and at least two algorithms agreed on 36%. Each algorithm detected one specific anomaly that the mr-chart did not detect. The anomaly represented a day with 71 propofol alerts (half of which were overridden) generated at an average rate of 1.06 per infusion, whereas the moving alert rate for the week was 0.35 per infusion. DISCUSSION These findings show that ML-based algorithms are more robust than control charts in detecting unusual alerting patterns. However, we recommend using a combination of algorithms, as multiple algorithms serve a benchmarking function and allow researchers to focus on data points with the highest algorithm agreeability. CONCLUSION Unsupervised ML algorithms can assist clinicians in identifying unusual alert patterns as a first step toward achieving safer infusion practices.
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Affiliation(s)
- Marian Obuseh
- Marian Obuseh is a PhD student in the School of Industrial Engineering at Purdue University in West Lafayette, IN.
| | - Denny Yu
- Denny Yu, PhD, is an assistant professor in the School of Industrial Engineering at Purdue University in West Lafayette, IN
| | - Poching DeLaurentis
- Poching DeLaurentis, PhD, was a research scientist in the Regenstrief Center for Healthcare Engineering at Purdue University in West Lafayette, IN, at the time this study was conducted
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Culture and collaboration between the clinician-scientist and veterinary specialist: An essential interprofessional partnership in the translational sciences. Lab Anim (NY) 2022; 51:95-97. [DOI: 10.1038/s41684-022-00944-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hicks S, Stavropoulou C. The Effect of Health Care Professional Disruptive Behavior on Patient Care: A Systematic Review. J Patient Saf 2022; 18:138-143. [PMID: 33395017 DOI: 10.1097/pts.0000000000000805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disruptive behavior among health care professionals can adversely affect patient care. These behaviors undermine cultures of safety, exposing patients to preventable risk. Existing evidence associates disruptive behaviors with a negative effect at the organizational level and on the health care professional, but the effect on patient care has been less well documented. OBJECTIVES This study aimed to identify and synthesize the empirical evidence of health care professional disruptive behaviors on the following outcome measures of patient care: clinical outcomes, patient safety, patient satisfaction, or quality of care. METHODS A systematic literature review was conducted. Between June 6 and July 23, 2019, 6 databases were searched for published empirical studies that examined disruptive behaviors and patient outcomes. Excluded from this pool were studies that did not make associations with patient care. Studies were analyzed using thematic analysis. RESULTS Twenty-five studies met the inclusion criteria and were included in the review. The prevalence and type of disruptive behavior varied, but it consistently contributed to a reduction in the quality and safety of patient care. The effects on patient care was manifested through adverse incidents, neglect of care needs, never events, and complaints. Disruptive behaviors significantly impaired the safety culture leading to reduced patient safety, evidenced by worse clinical outcomes. CONCLUSIONS Disruptive behaviors among health care professionals are a significant threat to patient safety and quality of care. Organizations must harness the benefits of awareness programs, policy, and interventions to generate a culture change where these behaviors are not accepted, thereby protecting patients from preventable harm.
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Affiliation(s)
- Sophia Hicks
- From the City, University of London, London, United Kingdom
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Abstract
OBJECTIVE To determine whether trauma patients managed by an admitting or consulting service with a high proportion of physicians exhibiting patterns of unprofessional behaviors are at greater risk of complications or death. SUMMARY BACKGROUND DATA Trauma care requires high-functioning interdisciplinary teams where professionalism, particularly modeling respect and communicating effectively, is essential. METHODS This retrospective cohort study used data from nine level I trauma centers that participated in a national trauma registry linked with data from a national database of unsolicited patient complaints. The cohort included trauma patients admitted January 1, 2012 through December 31, 2017. The exposure of interest was care by one or more high-risk services, defined as teams with a greater proportion of physicians with high numbers of patient complaints. The study outcome was death or complications within 30 days. RESULTS Among the 71,046 patients in the cohort, 9,553 (13.4%) experienced the primary outcome of complications or death, including 1,875 of 16,107 patients (11.6%) with 0 high-risk services, 3,788 of 28,085 patients (13.5%) with one high-risk service, and 3,890 of 26,854 patients (14.5%) with 2+ high-risk services (p < .001). In logistic regression models adjusting for relevant patient, injury, and site characteristics, patients who received care from one or more high-risk services were at 24.1% (95% CI 17.2% to 31.3%; P < 0.001) greater risk of experiencing the primary study outcome. CONCLUSIONS Trauma patients who received care from at least one service with a high proportion of physicians modeling unprofessional behavior were at an increased risk of death or complications.
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Orlando MS, Greenberg CC, Pavuluri Quamme SR, Yee A, Faerber AE, King CR. Surgical coaching in obstetrics and gynecology: an evidence-based strategy to elevate surgical education and promote lifelong learning. Am J Obstet Gynecol 2022; 227:51-56. [PMID: 35176285 DOI: 10.1016/j.ajog.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/22/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
The American Board of Medical Specialties, of which the American Board of Obstetrics and Gynecology is a member, released recommendations in 2019 reimagining specialty certification and highlighting the importance of individualized feedback and data-driven advances in clinical practice throughout the physicians' careers. In this article, we presented surgical coaching as an evidence-based strategy for achieving lifelong learning and practice improvement that can help to fulfill the vision of the American Board of Medical Specialties. Surgical coaching involves the development of a partnership between 2 surgeons in which 1 surgeon (the coach) guides the other (the participant) in identifying goals, providing feedback, and facilitating action planning. Previous literature has demonstrated that surgical coaching is viewed as valuable by both coaches and participants. In particular, video-based coaching involves reviewing recorded surgical cases and can be integrated into the physicians' busy schedules as a means of acquiring and advancing both technical and nontechnical skills. Establishing surgical coaching as an option for continuous learning and improvement in practice has the potential to elevate surgical performance and patient care.
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Building organisations, setting minds: exploring how boards of Dutch medical specialist companies address physicians’ professional performance. BMC Health Serv Res 2022; 22:155. [PMID: 35123458 PMCID: PMC8818234 DOI: 10.1186/s12913-022-07512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background Governments worldwide are reforming healthcare systems to achieve high quality and safe patient care while maintaining costs. Self-employed physicians reorganise into novel organisations to meet reconfiguration demands, impacting their work environment and practice. This study explores what strategies these novel organisations use to address physicians’ professional performance and what they encounter when executing these strategies to achieve high quality and safe care. Methods This constructivist exploratory qualitative study used focus groups to answer our research question. Between October 2018 and May 2019, we performed eight focus group sessions with purposively sampled Medical Specialist Companies (MSCs), which are novel physician-led organisations in the Netherlands. In each session, board members of an MSC participated (n = 33). Results MSCs used five strategies to address physicians’ professional performance: 1) actively managing and monitoring performance, 2) building a collective mindset, 3) professionalising selection and onboarding, 4) improving occupational well-being, and 5) harmonising working procedures. The MSC’s unique context determined which strategies and quality and safety topics deserved the most attention. Physicians’ support, trusting relationships with hospital administrators, and the MSC’s organisational maturity seem critical to the quality of the strategies’ execution. Conclusions The five strategies have clear links to physicians’ professional performance and quality and safety. Insight into whether an MSC’s strategies together reflect medical professional or organisational values seems crucial to engage physicians and collaboratively achieve high quality and safe care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07512-6.
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Guo L, Ryan B, Leditschke IA, Haines KJ, Cook K, Eriksson L, Olusanya O, Selak T, Shekar K, Ramanan M. Impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes: a systematic review. BMJ Qual Saf 2022; 31:679-687. [DOI: 10.1136/bmjqs-2021-013955] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/26/2021] [Indexed: 12/12/2022]
Abstract
BackgroundRecent studies suggest that displays of unacceptable behaviour, including bullying, discrimination and harassment, between healthcare workers (HCWs) may impair job performance, and in turn, increase the frequency of medical errors, adverse events and healthcare-related complications. The objective of this systematic review was to summarise the current evidence of the impact of unacceptable behaviour occurring between HCWs on clinical performance and patient outcomes.MethodsWe searched MEDLINE, Embase, PsycINFO and CINAHL from 1 January 1990 to 31 March 2021. The search results were screened by two independent reviewers and studies were included if they were original research that assessed the effects of unacceptable behaviour on clinical performance, quality of care, workplace productivity or patient outcomes. Risk of bias was assessed using tools relevant to the study design and the data were synthesised without meta-analysis.ResultsFrom the 2559 screened studies, 36 studies were included: 22 survey-based studies, 4 qualitative studies, 3 mixed-methods studies, 4 simulation-based randomised controlled trials (RCTs) and 3 other study designs. Most survey-based studies were low quality and demonstrated that HCWs perceived a relationship between unacceptable behaviour and worse clinical performance and patient outcomes. This was supported by a smaller number of higher quality retrospective studies and RCTs. Two of four RCTs produced negative results, possibly reflecting inadequate power or study design limitations. No study demonstrated any beneficial effect of unacceptable behaviour on the study outcomes.ConclusionsDespite the mixed quality of evidence and some inconsistencies in the strengths of associations reported, the overall weight of evidence shows that unacceptable behaviour negatively affects the clinical performance of HCWs, quality of care, workplace productivity and patient outcomes. Future research should focus on the evaluation and implementation of interventions that reduce the frequency of these behaviours.
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Obuseh M, Yu D, DeLaurentis P. Detecting Unusual Intravenous Infusion Alerting Patterns with Machine Learning Algorithms. Biomed Instrum Technol 2022; 56:58-70. [PMID: 35749264 PMCID: PMC9767430 DOI: 10.2345/0899-8205-56.2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To detect unusual infusion alerting patterns using machine learning (ML) algorithms as a first step to advance safer inpatient intravenous administration of high-alert medications. MATERIALS AND METHODS We used one year of detailed propofol infusion data from a hospital. Interpretable and clinically relevant variables were feature engineered, and data points were aggregated per calendar day. A univariate (maximum times-limit) moving range (mr) control chart was used to simulate clinicians' common approach to identifying unusual infusion alerting patterns. Three different unsupervised multivariate ML-based anomaly detection algorithms (Local Outlier Factor, Isolation Forest, and k-Nearest Neighbors) were used for the same purpose. Results from the control chart and ML algorithms were compared. RESULTS The propofol data had 3,300 infusion alerts, 92% of which were generated during the day shift and seven of which had a times-limit greater than 10. The mr-chart identified 15 alert pattern anomalies. Different thresholds were set to include the top 15 anomalies from each ML algorithm. A total of 31 unique ML anomalies were grouped and ranked by agreeability. All algorithms agreed on 10% of the anomalies, and at least two algorithms agreed on 36%. Each algorithm detected one specific anomaly that the mr-chart did not detect. The anomaly represented a day with 71 propofol alerts (half of which were overridden) generated at an average rate of 1.06 per infusion, whereas the moving alert rate for the week was 0.35 per infusion. DISCUSSION These findings show that ML-based algorithms are more robust than control charts in detecting unusual alerting patterns. However, we recommend using a combination of algorithms, as multiple algorithms serve a benchmarking function and allow researchers to focus on data points with the highest algorithm agreeability. CONCLUSION Unsupervised ML algorithms can assist clinicians in identifying unusual alert patterns as a first step toward achieving safer infusion practices.
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Affiliation(s)
- Marian Obuseh
- Marian Obuseh is a PhD student in the School of Industrial Engineering at Purdue University in West Lafayette, IN.
| | - Denny Yu
- Denny Yu, PhD, is an assistant professor in the School of Industrial Engineering at Purdue University in West Lafayette, IN
| | - Poching DeLaurentis
- Poching DeLaurentis, PhD, was a research scientist in the Regenstrief Center for Healthcare Engineering at Purdue University in West Lafayette, IN, at the time this study was conducted
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Spain DA. "Be Worthy". J Trauma Acute Care Surg 2022; 92:4-11. [PMID: 34932038 DOI: 10.1097/ta.0000000000003428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David A Spain
- From the Department of Surgery, Stanford University, Stanford, California
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Etherington C, Kitto S, Burns JK, Adams TL, Birze A, Britton M, Singh S, Boet S. How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis. BMC Health Serv Res 2021; 21:1357. [PMID: 34923992 PMCID: PMC8684702 DOI: 10.1186/s12913-021-07403-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite substantial implications for healthcare provider practice and patient outcomes, gender has yet to be systematically explored with regard to interprofessional operating room (OR) teamwork. We aimed to explore and describe how gender and additional social identity factors shape experiences and perceptions of teamwork in the OR. METHODS This study was a qualitative secondary analysis of semi-structured interviews with OR team members conducted between November 2018 and July 2019. Participants were recruited across hospitals in Ontario, Canada. We conducted both purposive and snowball sampling until data saturation was reached. Transcripts were analyzed thematically by two independent research team members, moving from open to axial coding. RESULTS Sixty-six interviews of OR healthcare professionals were completed: anesthesia (n=17), nursing (n=19), perfusion (n=2), and surgery (n=26). Traditional gender roles, norms, and stereotypes were perceived and experienced by both women and men, but with different consequences. Both women and men participants described challenges that women face in the OR, such as being perceived negatively for displaying leadership behaviours. Participants also reported that interactions and behaviours vary depending on the team gender composition, and that other social identities, such as age and race, often interact with gender. Nevertheless, participants indicated a belief that the influence of gender in the OR may be modified. CONCLUSIONS The highly gendered reality of the OR creates an environment conducive to breakdowns in communuication and patient safety risks in addition to diminishing team morale, psychological safety, and provider well-being. Consequently, until teamwork interventions adequately account for gender, they are unlikely to be optimally effective or sustainable.
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Affiliation(s)
- Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Joseph K Burns
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Tracey L Adams
- Department of Sociology, Social Science Centre, Western University, London, ON, N6A 5C2, Canada
| | - Arija Birze
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Sukhbir Singh
- Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.
- Department of Innovation in Medical Education, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Francophone Affairs, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Faculty of Education, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, ON, K1N 6N5, Canada.
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