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Gutgeld-Dror M, Laor N, Karnieli-Miller O. Assertiveness in physicians' interpersonal professional encounters: A scoping review. MEDICAL EDUCATION 2024; 58:392-404. [PMID: 37725417 DOI: 10.1111/medu.15222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/04/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Good relationships between physicians, patients, families and the healthcare team are essential for high-quality care. Medical encounters are sometimes challenging. They may include conflicts, requiring physicians to be assertive: that is to share and protect their needs, rights and values while preserving those of others. Whereas assertiveness has been studied in patients and nursing staff (those with less power in healthcare), physicians' assertiveness, which must be mindful of these power differences, lacks a comprehensive review. Thus, this scoping review focuses on assertive communication in physicians' encounters. METHODS A literature search of four online databases: MEDLINE, Embase, PsycINFO and WoS, seeking articles on physicians' assertiveness as a communication style published until February 2022. The Joanna Briggs Institute approach and the Preferred Reporting Items for Systematic Reviews checklist underpinned the review protocol. RESULTS We identified 1513 articles relating to assertiveness, reviewed 153 full-text articles and selected 22 for full review, 68% from the last decade. The articles focused mainly on assertive communication and relationships with medical staff, with 54% focusing on bottom-up power relations. In 40% of the articles, no clear definition of assertiveness was included. Definitions included had varied focus: on self, on the other or both. Overall, assertiveness measures varied widely, precluding a methodical comparison. CONCLUSIONS Despite the growing interest in physicians' assertiveness, a clearer definition and in-depth exploration of assertiveness are needed alongside development of valid measures of assertiveness appropriate to physicians. Based on the review, we offer a relational definition of assertiveness as the capacity to communicate one's views, concerns, rights and needs while respecting others and preserving therapeutic, collegial and educational professional alliances. This definition may serve to expand research in the field while offering a professional alternative to problematic communication styles-passive and self-denying or paternalistic and aggressive -that obfuscate and thus undermine physician-patient relationships.
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Affiliation(s)
- Maayan Gutgeld-Dror
- Department of Medical Education, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Cohen-Harris Resilience Centre, OTI The Israeli Autism Association, Tel Aviv, Israel
| | - Nathaniel Laor
- Cohen-Harris Resilience Centre, OTI The Israeli Autism Association, Tel Aviv, Israel
- Department of Psychiatry, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child Study Center, Yale University, New Haven, Connecticut, USA
| | - Orit Karnieli-Miller
- Department of Medical Education, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barlow M, Morse KJ, Watson B, Maccallum F. Identification of the barriers and enablers for receiving a speaking up message: a content analysis approach. Adv Simul (Lond) 2023; 8:17. [PMID: 37415244 DOI: 10.1186/s41077-023-00256-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Within healthcare, the barriers and enablers that influence clinicians' ability to speak up are well researched. However, despite the receiver of the message being identified as a key barrier to a speaker voicing a concern, there have been very few receiver-focused studies. As a result, little is known about the barriers and enablers that influence message reception. Understanding these can help inform speaking up training and ultimately enhance patient safety through more effective clinical communication. OBJECTIVES To identify enabling or inhibiting factors that influence the receiver's reception and response to a speaking up message, and if the identified barriers and enablers are related to speaker or receiver characteristics. DESIGN AND METHODS Twenty-two interdisciplinary simulations were video recorded and transcribed. Simulation participants formed the patient discharge team and were receivers of a speaking up message, delivered by a nurse at the patient's bedside. How the message was delivered (verbose or abrupt wording), was manipulated and counterbalanced across the simulations. Within the post simulation debriefs, barriers and enablers of being a receiver of a message were explored using content analysis. SETTING/PARTICIPANTS This study took place in a large Australian tertiary healthcare setting. Participants were qualified clinicians of varying disciplines and specialties. RESULTS A total of 261 barriers and 285 enablers were coded. Results showed that how the message was delivered (differing tone, phases, and manner) influenced what receivers identified as barriers and enablers. Additionally, the receiver's own cognitive processes, such as making positive attributions of the speaker and attempting to build rapport and collegiality, better enabled message reception and response. Receiver behaviour was negatively impacted by listening to fix, rather than understand, and not knowing in the moment how to manage their own reactions and appropriately frame a response. CONCLUSION The debriefings identified key barriers and enablers to receiving a speaking up message that differ from those previously identified for senders of the speaking up message. Current speaking up programs are predominately speaker centric. This study identified that both speaker and receiver behaviour influenced message reception. Therefore, training must place equal attention on both the speaker and receiver and be inclusive of experiential conversational rehearsal of both positive and challenging encounters.
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Affiliation(s)
- Melanie Barlow
- Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, QLD, Australia.
- School of Psychology, University of Queensland, St. Lucia, QLD, Australia.
| | - Kate J Morse
- College of Nursing & Health Professions, Drexel University, 245 N 15Th Street, Mail Stop 501, 4Th Floor, Room 4606, Philadelphia, PA, 19102, USA
| | - Bernadette Watson
- School of Psychology, University of Queensland, St. Lucia, QLD, Australia
- Department of English and Communication, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St. Lucia, QLD, Australia
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Alanazi S, Wiechula R, Foley D. Followership in nurses working in Saudi Arabian hospitals: A cross-sectional study. Nurs Forum 2022; 57:1289-1298. [PMID: 36052985 PMCID: PMC10088012 DOI: 10.1111/nuf.12793] [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: 05/20/2022] [Revised: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 01/04/2023]
Abstract
AIM To explore the followership styles and their associations with nurses' sociodemographic profiles in Saudi Arabia. BACKGROUND In Saudi Arabia, nurses' role is seen as less important and passive. However, whether they were actually passive followers has not been examined. No previous research has examined nurses' followership styles in Saudi Arabia. METHODS This cross-sectional study used a convenience sample of nurses. The Kelley followership questionnaire-revised was used to determine the prevalence of the five followership styles. Participants' demographic characteristics, which included age, gender, nationality, education level, years of experience, and role, were collected to investigate their associations with followership styles. An online survey was designed and distributed using SurveyMonkey®. Data were analyzed with logistic regression and expressed as odds ratios. RESULTS This study included 355 nurses. Findings revealed that the predominant followership style was exemplary (74%), followed by the pragmatist (19%), conformist (4%), and passive styles (3%). Logistic regression analysis revealed that expatriates, higher education, and a leader role had an independent association with an exemplary followership style. Male gender was associated with a passive style. Younger age, male gender, Saudi Arabian nationality, undergraduate qualification, no previous leadership experience, a follower role, and fewer years of experience increased the odds of having a pragmatist style. CONCLUSION AND IMPLICATIONS Followership styles were influenced by sociodemographic and work-related factors. Young nurses with less experience tend to be pragmatist followers. Nursing managers should integrate followership styles when planning leadership and team development courses to ensure maximum team effectiveness as leadership and followership are interdependent.
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Affiliation(s)
- Sulaiman Alanazi
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Nursing Department, Faculty of Applied Medical Sciences, Jouf University, Jouf, Saudi Arabia
| | - Richard Wiechula
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,The Centre for Evidence-based Practice South Australia (CEPSA): A Joanna Briggs Institute Centre of Excellence, Adelaide, South Australia, Australia
| | - David Foley
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Manojlovich M, Krein SL. We don't talk about communication: why technology alone cannot save clinically deteriorating patients. BMJ Qual Saf 2022; 31:bmjqs-2022-014798. [PMID: 35868850 DOI: 10.1136/bmjqs-2022-014798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Affiliation(s)
| | - Sarah L Krein
- School of Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Sculli GL, Pendley-Louis R, Neily J, Anderson TM, Isaacks DB, Knowles R, Young-Xu Y, Gunnar W. A High-Reliability Organization Framework for Health Care: A Multiyear Implementation Strategy and Associated Outcomes. J Patient Saf 2022; 18:64-70. [PMID: 33044255 DOI: 10.1097/pts.0000000000000788] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Applying high-reliability organization (HRO) principles to health care is complex. No consensus exists as to an effective framework for HRO implementation or the direct impact of adoption. METHODS The Veterans Health Administration (VHA) National Center for Patient Safety established the high-reliability hospital (HRH) model for HRO adoption and piloted HRH in collaboration with the Truman VA Medical Center (Truman) during a 3-year intervention period (January 1, 2016-December 31, 2018). High-reliability hospital components are as follows: annual patient safety (PS) assessment, annual PS culture survey, annual root cause analysis training, daily leadership walk-arounds, monthly PS forum, annual processes standardization review, Just Culture training, unit-based Clinical Team Training, unit-based continuous improvement projects, and annual Clinical Team Training simulation education. The impact of HRH was examined using a PS Culture Survey, PS event reporting, and quality outcomes of standardized mortality rate and complication rate. RESULTS Truman internally improved PS culture and PS event reporting rates resulting in outcomes better than all VHA facilities (All VHA; P < 0.001 and P < 0.001, respectively). Low-harm PS event reporting increased (P < 0.001); however, serious safety event rate remained unchanged versus All VHA. Significant improvement in Truman standardized mortality rate and complication rate versus All VHA occurred immediately and were sustained through intervention (slopes, P < 0.001 and P < 0.020; respectively). CONCLUSIONS High-reliability hospital is an effective framework for HRO implementation and will be applied to 18 additional VHA sites. Based on these results, the expected outcome will be improved PS culture and overall PS event reporting. The impact of HRH on serious safety event rate and quality measures requires further study.
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Affiliation(s)
- Gary L Sculli
- From the Veterans Health Administration National Center for Patient Safety, Ann Arbor, Michigan
| | - Robin Pendley-Louis
- From the Veterans Health Administration National Center for Patient Safety, Ann Arbor, Michigan
| | - Julia Neily
- From the Veterans Health Administration National Center for Patient Safety, Ann Arbor, Michigan
| | | | - David B Isaacks
- Veterans Health Administration, Kansas City VA Medical Center, Kansas City, Missouri
| | - Regina Knowles
- From the Veterans Health Administration National Center for Patient Safety, Ann Arbor, Michigan
| | - Yinong Young-Xu
- From the Veterans Health Administration National Center for Patient Safety, Ann Arbor, Michigan
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Which Factors Promote Shared Understanding Between Physicians and Nurses in Inpatient Oncology Care Settings?: A Qualitative Exploration. Cancer Nurs 2022; 45:E338-E344. [PMID: 34010215 PMCID: PMC8602402 DOI: 10.1097/ncc.0000000000000959] [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: 01/03/2023]
Abstract
BACKGROUND Effective communication between physicians and nurses is crucial to the safety of patients, especially for those with cancer, which is a complex disease requiring multidisciplinary treatment. However, little is known about the factors that contribute to effective communication, which is defined as the development of shared understanding between two or more people. OBJECTIVE This qualitative secondary analysis was conducted to identify factors that contribute to shared understanding between physicians and nurses from video-recorded conversations that occurred between them during inpatient rounds on oncology units. METHODS We used inductive grounded theory to identify videos depicting moments of shared understanding. We then searched for preceding events to develop a preliminary conceptual model that described the factors contributing to shared understanding. RESULTS Four factors emerged as contributors to shared understanding: engagement, clarification, confirmation, and resolution. These factors occurred in sequence with engagement occurring first and resolution occurring last, as the closure of a communication exchange. CONCLUSIONS Existing interventions to improve communication include some of the factors identified as contributing to shared understanding (eg, closed-loop communications require clarification and confirmation). However, nurses may need to pay attention to all four factors to develop shared understanding that will promote effective communication with physicians and thereby enhance cancer care. IMPLICATIONS FOR PRACTICE Nurses achieve effective communication when they are assertive and avoid indirect communication. A greater awareness of body language and positioning in relation to a physician at the start of a communication exchange may increase the effectiveness of nurse-physician communication.
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Alanazi S, Wiechula R, Foley D. Followership in health care clinicians: a scoping review protocol. JBI Evid Synth 2021; 19:3308-3314. [PMID: 34125505 DOI: 10.11124/jbies-20-00246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The main objective of this scoping review is to identify and map followership literature in order to understand the current state of followership research in relation to health care clinicians. INTRODUCTION Health care clinicians need to be flexible in switching between leader and follower roles as appropriate to advance patient care; however, much of the research effort in this regard has primarily concentrated on leadership. Effective followership in health care organizations may be necessary to enhance clinical team performance in order to improve patient safety and quality of care. There have been increasing calls in the literature recommending research of followership in the provision of health care. Thus, it is important to synthesize the available evidence on followership to identify what has been studied and highlight research gaps in this area. INCLUSION CRITERIA The review will focus on followership in health care clinicians. Only studies with participants who are health care clinicians will be included. The review will include studies of quantitative, qualitative, and mixed methods designs; systematic reviews; and meta-analyses. METHODS The search will include JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, CINAHL, MEDLINE, EPPI-Centre, Scopus, and Epistemonikos. In addition, unpublished or gray literature will be searched in ProQuest Dissertations and Theses Global and Google Scholar. No limits on date or language will be applied to the search. Data will then be extracted from included papers by three independent reviewers. Results from extracted data will be presented in tabular form accompanied by a narrative summary.
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Affiliation(s)
- Sulaiman Alanazi
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Nursing Department, Faculty of Applied Medical Sciences, Jouf University, Jouf, Saudi Arabia
| | - Richard Wiechula
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, SA, Australia
| | - David Foley
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Akamine Y, Imafuku R, Saiki T, Lee-Jayaram J, Berg BW, Suzuki Y. Physicians' perceptions of followership in resuscitation in Japan and the USA: a qualitative study. BMJ Open 2021; 11:e047860. [PMID: 34373302 PMCID: PMC8354256 DOI: 10.1136/bmjopen-2020-047860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While leadership is accepted as a crucial aspect of a successful resuscitation team, the role of followership has not been sufficiently explored. This study aims to explore physicians' perceptions of common favourable followership in resuscitation teams in two different countries. DESIGN A qualitative study with interviews and a reflexive thematic analysis. SETTING The authors individually interviewed critical care and emergency physicians whose clinical experience exceeded 6 years in Japan and the USA. PARTICIPANTS A total of 18 physicians participated in a face-to-face, semistructured and in-depth interviews. RESULTS Five themes and nine subthemes related to followership in resuscitation were identified. Under technical skills, two themes (being knowledgeable and skilled) and three subthemes (understanding guidelines/algorithms, clinical course and being competent with procedural skills), were generated. Under non-technical skills, three themes (assuming roles, team communication and flattening hierarchy) and six subthemes (taking roles spontaneously, calm tone of voice, sharing information, closed-loop communication, respectful attitude and speaking up), were generated. Each generated theme involved commonly perceived favourable attributes of followership in resuscitation teams by experienced critical care and emergency physicians in both countries. CONCLUSIONS This study clarified physicians' perception of common favourable followership attributes in resuscitation teams, both in Japan and in the USA. The results of this study shed light on followership-focused resuscitation education, where followership skills are generally underestimated.
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Affiliation(s)
- Yoko Akamine
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Rintaro Imafuku
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Takuya Saiki
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Jannet Lee-Jayaram
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Benjamin W Berg
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Yasuyuki Suzuki
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
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Manojlovich M, Harrod M, Hofer T, Lafferty M, McBratnie M, Krein SL. Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual Saf 2020; 30:747-754. [PMID: 33168635 PMCID: PMC8140397 DOI: 10.1136/bmjqs-2020-011441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units. METHODS Using a qualitative design, we collected data through observation, shadowing, interviews and focus groups of bedside registered nurses and physicians who worked in four hospitals in the Midwest USA. We analysed the data using inductive content analysis. RESULTS A total of 155 physicians and nurses participated. Eighty-six nurses and 32 physicians participated in focus groups or individual interviews; we shadowed 37 physicians and nurses across all sites. Two major inter-related themes emerged, message and non-message related factors. Message-related factors included the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response. Non-message related factors included trust and interpersonal relationships, and different perspectives between nurses and physicians on the same clinical issue that affected perceptions of urgency, and contributed to delays in responsiveness. CONCLUSIONS Physician responsiveness to communications from bedside nurses depends on a complex combination of factors related to the message itself and non-message related factors. How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups.
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Affiliation(s)
| | - Molly Harrod
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Megan Lafferty
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sarah L Krein
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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Psychological safety and infection prevention practices: Results from a national survey. Am J Infect Control 2020; 48:2-6. [PMID: 31706546 DOI: 10.1016/j.ajic.2019.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psychological safety is a critical factor in team learning that positively impacts patient safety. We sought to examine the influence of psychological safety on using recommended health care-associated infection (HAI) prevention practices within US hospitals. METHODS We mailed surveys to infection preventionists in a random sample of nearly 900 US acute care hospitals in 2017. Our survey asked about hospital and infection control program characteristics, organizational factors, and the use of practices to prevent common HAIs. Hospitals that scored 4 or 5 (5-point Likert scale) on 7 psychological safety questions were classified as high psychological safety. Using sample weights, we conducted multivariable regression to determine associations between psychological safety and the use of select HAI prevention practices. RESULTS Survey response rate was 59%. High psychological safety was reported in approximately 38% of responding hospitals, and was associated with increased odds of regularly using urinary catheter reminders or stop-orders and/or nurse-initiated urinary catheter discontinuation (odds ratio, 2.37; P = .002) for catheter-associated urinary tract infection prevention, and regularly using sedation vacation (odds ratio, 1.93; P = .04) for ventilator-associated pneumonia prevention. CONCLUSIONS We provide a snapshot of psychological safety in US hospitals and how this characteristic influences the use of select HAI prevention practices. A culture of psychological safety should be considered an integral part of HAI prevention efforts.
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Watters DA, Smith K, Tobin S, Beasley SW. Follow the leader: followership and its relevance for surgeons. ANZ J Surg 2018; 89:589-593. [DOI: 10.1111/ans.14912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- David A. Watters
- Department of SurgeryDeakin University and Barwon Health, University Hospital Geelong Melbourne Victoria Australia
| | - Kyleigh Smith
- Education DevelopmentVictorian Comprehensive Cancer Centre Melbourne Victoria Australia
| | - Stephen Tobin
- Department of EducationRoyal Australasian College of Surgeons Melbourne Victoria Australia
| | - Spencer W. Beasley
- Department of Paediatric SurgeryCanterbury District Health Board Christchurch New Zealand
- Department of PaediatricsUniversity of Otago Christchurch New Zealand
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Abstract
To improve patient satisfaction ratings and decrease readmissions, many organizations utilize internal staff to complete postdischarge calls to recently released patients. Developing, implementing, monitoring, and sustaining an effective call program can be challenging and have eluded some of the renowned medical centers in the country. Using collaboration with an outsourced vendor to bring state-of-the-art call technology and staffed with specially trained callers, health systems can achieve elevated levels of engagement and satisfaction for their patients postdischarge.
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Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G. Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06100] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundInterventions to improve the antimicrobial prescribing practices of doctors have been implemented widely to curtail the emergence and spread of antimicrobial resistance, but have been met with varying levels of success.ObjectivesThis study aimed to generate an in-depth understanding of how antimicrobial prescribing interventions ‘work’ (or do not work) for doctors in training by taking into account the wider context in which prescribing decisions are enacted.DesignThe review followed a realist approach to evidence synthesis, which uses an interpretive, theory-driven analysis of qualitative, quantitative and mixed-methods data from relevant studies.SettingPrimary and secondary care.ParticipantsNot applicable.InterventionsStudies related to antimicrobial prescribing for doctors in training.Main outcome measuresNot applicable.Data sourcesEMBASE (via Ovid), MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Web of Science core collection limited to Science Citation Index Expanded (SCIE) and Conference Proceedings Citation Index – Science (CPCI-S) (via Thomson Reuters), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, the Health Technology Assessment (HTA) database (all via The Cochrane Library), Applied Social Sciences Index and Abstracts (ASSIA) (via ProQuest), Google Scholar (Google Inc., Mountain View, CA, USA) and expert recommendations.Review methodsClearly bounded searches of electronic databases were supplemented by citation tracking and grey literature. Following quality standards for realist reviews, the retrieved articles were systematically screened and iteratively analysed to develop theoretically driven explanations. A programme theory was produced with input from a stakeholder group consisting of practitioners and patient representatives.ResultsA total of 131 articles were included. The overarching programme theory developed from the analysis of these articles explains how and why doctors in training decide to passively comply with or actively follow (1) seniors’ prescribing habits, (2) the way seniors take into account prescribing aids and seek the views of other health professionals and (3) the way seniors negotiate patient expectations. The programme theory also explains what drives willingness or reluctance to ask questions about antimicrobial prescribing or to challenge the decisions made by seniors. The review outlines how these outcomes result from complex inter-relationships between the contexts of practice doctors in training are embedded in (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels and application in practice) and the mechanisms triggered in these contexts (fear of criticism and individual responsibility, reputation management, position in the clinical team and appearing competent). Drawing on these findings, we set out explicit recommendations for optimal tailoring, design and implementation of antimicrobial prescribing interventions targeted at doctors in training.LimitationsMost articles included in the review discussed hospital-based, rather than primary, care. In cases when few data were available to fully capture all the nuances between context, mechanisms and outcomes, we have been explicit about the strength of our arguments.ConclusionsThis review contributes to our understanding of how antimicrobial prescribing interventions for doctors in training can be better embedded in the hierarchical and interprofessional dynamics of different health-care settings.Future workMore work is required to understand how interprofessional support for doctors in training can contribute to appropriate prescribing in the context of hierarchical dynamics.Study registrationThis study is registered as PROSPERO CRD42015017802.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, Exeter, UK
| | - Mark Pearson
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Simon Briscoe
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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15
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Schwartz ME, Welsh DE, Paull DE, Knowles RS, DeLeeuw LD, Hemphill RR, Essen KE, Sculli GL. The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities. J Healthc Risk Manag 2017; 38:17-37. [PMID: 29120515 DOI: 10.1002/jhrm.21292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Communication failure is a significant source of adverse events in health care and a leading root cause of sentinel events reported to the Joint Commission. The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT) as a comprehensive program to enhance patient safety and to improve communication and teamwork among health care professionals. CTT is based on techniques used in aviation's Crew Resource Management (CRM) training. The aviation industry has reached a significant safety record in large part related to the culture change generated by CRM and sustained by its recurrent implementation. This article focuses on the improvement of communication, teamwork, and patient safety by utilizing a standardized, CRM-based, interprofessional, immersive training in diverse clinical areas. The Teamwork and Safety Climate Questionnaire was used to evaluate safety climate before and after CTT. The scores for all of the 27 questions on the questionnaire showed an increase from baseline to 12 months, and 11 of those increases were statistically significant. A recurrent training is recommended to maintain the positive outcomes. CTT enhances patient safety and reduces risk of patient harm by improving teamwork and facilitating clear, concise, specific and timely communication among health care professionals.
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Affiliation(s)
- Miriam E Schwartz
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI.,Greater Los Angeles Veterans Affairs (VA) Healthcare System, Los Angeles, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Deborah E Welsh
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Douglas E Paull
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI.,University of Michigan, Ann Arbor, MI.,Georgetown University School of Medicine, Washington, D.C
| | - Regina S Knowles
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Lori D DeLeeuw
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Robin R Hemphill
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Keith E Essen
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Gary L Sculli
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
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16
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Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G. Social and professional influences on antimicrobial prescribing for doctors-in-training: a realist review. J Antimicrob Chemother 2017; 72:2418-2430. [PMID: 28859445 PMCID: PMC5890780 DOI: 10.1093/jac/dkx194] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
Background Antimicrobial resistance has led to widespread implementation of interventions for appropriate prescribing. However, such interventions are often adopted without an adequate understanding of the challenges facing doctors-in-training as key prescribers. Methods The review followed a realist, theory-driven approach to synthesizing qualitative, quantitative and mixed-methods literature. Consistent with realist review quality standards, articles retrieved from electronic databases were systematically screened and analysed to elicit explanations of antimicrobial prescribing behaviours. These explanations were consolidated into a programme theory drawing on social science and learning theory, and shaped though input from patients and practitioners. Results By synthesizing data from 131 articles, the review highlights the complex social and professional dynamics underlying antimicrobial prescribing decisions of doctors-in-training. The analysis shows how doctors-in-training often operate within challenging contexts (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels, uncertainty about application of knowledge in practice) where they prioritize particular responses (fear of criticism and individual responsibility, managing one's reputation and position in the team, appearing competent). These complex dynamics explain how and why doctors-in-training decide to: (i) follow senior clinicians' prescribing habits; (ii) take (or not) into account prescribing aids, advice from other health professionals or patient expectations; and (iii) ask questions or challenge decisions. This increased understanding allows for targeted tailoring, design and implementation of antimicrobial prescribing interventions. Conclusions This review contributes to a better understanding of how antimicrobial prescribing interventions for doctors-in-training can be embedded more successfully in the hierarchical and inter-professional dynamics of different healthcare settings.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Mark Pearson
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Peninsula Schools of Medicine & Dentistry, Plymouth University, Drake Circus Plymouth, Devon PL4 8AA, UK
| | - Simon Briscoe
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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Abstract
The allegation of delay in performing an emergency cesarean delivery is common in litigation involving neurological injury to newborns. Analyzing the actual performance of an emergency cesarean involves multiple steps, individuals, and systemic processes that need coordination for appropriate action when necessary. This article gives risk managers a systematic way to evaluate a given perinatal unit's approach to the ability to perform an emergency cesarean through evaluating the 6 "A"s: Assess, Alert, Align, Assemble, Act, and Analyze. Each of these elements is discussed based on current evidence. A checklist that may be useful in the evaluation of the elements of performance of emergency cesarean delivery is provided.
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18
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Greene MT, Saint S. Followership characteristics among infection preventionists in U.S. hospitals: Results of a national survey. Am J Infect Control 2016; 44:343-5. [PMID: 26698669 DOI: 10.1016/j.ajic.2015.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 12/30/2022]
Abstract
Infection prevention practices vary across U.S. hospitals. Although the importance of leadership in infection prevention has been described, little is known about how followership influences such efforts. Our national survey found that hospitals with truly exemplary followers in infection control roles may be more likely to use recommended prevention practices.
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Affiliation(s)
- M Todd Greene
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Ann Arbor Veterans' Affairs Medical Center/University of Michigan Patient Safety Enhancement Program (PSEP), Ann Arbor, MI.
| | - Sanjay Saint
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Ann Arbor Veterans' Affairs Medical Center/University of Michigan Patient Safety Enhancement Program (PSEP), Ann Arbor, MI; Veterans' Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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