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Austen K, Hutchinson M, Hurley J. Promoting speaking-up behaviours among nurses working in the care for older people: A scoping review. J Clin Nurs 2024; 33:3854-3868. [PMID: 38685802 DOI: 10.1111/jocn.17199] [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: 12/19/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
AIM To explore interventions employed to foster speaking-up behaviours of registered nurses (RNs) working in the care of older people. DESIGN Scoping review. METHODS The updated Joann Briggs Institute scoping review methodological guidelines were followed. DATA SOURCES CINAHL, PubMed, PsycINFO, and Scopus were searched. RESULTS A total of 1691 titles and abstracts were screened, resulting in 11 articles that met the inclusion criteria. Analysis focused upon intervention types, methodologies, speaking up strategies, barriers and effectiveness. Education was the most used intervention. CONCLUSION There is a lack of published research on successful interventions to promote speaking-up behaviours in the care of older people, particularly relating to poor care practices. Evidence of speaking-up interventions in the residential aged care setting is absent. This highlights the need to develop strategies to support the RN to lead and enable others to raise care concerns. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Developing strategies that enable staff, care recipients and their families to speak up about care concerns is a vital future area for nursing practice development. Nursing leadership of such strategies is central to improving the quality of care for older people, particularly those living in residential aged care. IMPACT Older people receiving care should feel respected and be treated humanely. Evidence suggests this is often not the case. This review found a paucity of interventions to promote speaking-up about poor care practices among RNs working in the care of older people. Future research needs to address this, to empower RNs and improve the care afforded to older people. REPORTING METHOD The PRISMA-ScR (Tricco et al., Annals of Internal Medicine, 169, 467-473, 2018) were adhered to throughout this scoping review. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in this review.
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Affiliation(s)
- Katrina Austen
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Marie Hutchinson
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
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Seo JK, Lee SE. Improving Patient Safety and Care Quality Through a "Speaking-Up" Climate: The Mediating Role of Situation Monitoring. Risk Manag Healthc Policy 2024; 17:2035-2043. [PMID: 39220176 PMCID: PMC11366246 DOI: 10.2147/rmhp.s471043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose In healthcare settings, a climate that encourages speaking up among staff is believed to enhance patient safety and quality of care. However, the specific mechanisms of this relationship remain underexplored. Particularly, there is a need to understand how components of teamwork, such as situation monitoring, can be linked to the impact of a speaking-up climate on relevant outcomes. This study aimed to investigate the direct and indirect effects of a speaking-up climate on patient safety and quality of care using situation monitoring as a potential mediator. Patients and Methods This cross-sectional study used survey data from 380 staff nurses who provided direct patient care at three Korean hospitals. Structural equation modeling was utilized to test a hypothesized mediation model using Mplus 7.0. Results Our data analysis confirmed the partial mediation model. As hypothesized, a speaking-up climate directly improved patient safety (β = 0.384, p < 0.001) and quality of care (β = 0.393, p < 0.001). Also, we found that indirect effects of a speaking-up climate on patient safety (β = 0.224, p < 0.001) and quality of care (β = 0.186, p = 0.005) through situation monitoring were significant. These results indicate that situation monitoring was found to significantly mediate the relationship between a speaking-up climate, patient safety, and quality of care. Conclusion Our study demonstrates that the positive impact of a speaking-up climate extends beyond improving nurses' speaking up. Further, fostering a speaking-up climate can significantly improve patient safety and quality of care, and situation monitoring has a critical role in this relationship. These findings contribute to understanding how encouraging a speaking-up climate could benefit patient safety and care quality in healthcare organizations.
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Affiliation(s)
- Ja Kyung Seo
- Psychological Science Innovation Institute, Department of Psychology, Yonsei University, Seoul, South Korea
| | - Seung Eun Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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Gray MM, Umoren R, Sayre C, Hagan A, Jackson K, Wong K, Kim S. Finding Your Voice: A Large-Scale Nursing Training in Speaking up and Listening Skills. J Contin Educ Nurs 2024; 55:309-316. [PMID: 38329397 DOI: 10.3928/00220124-20240201-05] [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: 02/09/2024]
Abstract
BACKGROUND Training in speaking up skills for nursing professionals provides the groundwork for promoting a culture of curiosity and inquiry. At the foundation of speaking up is psychological safety for team members to disagree, offer alternative ideas, and ask questions. METHOD A large-scale training session, Finding Your Voice: Speaking Up & Listening Skills, was designed and delivered to 1,306 nurses at an academic medical center. RESULTS Most participants reported that the session met the training goals (97%). There was an increase in participants' confidence in speaking up (pretraining 69% ± 19%; posttraining 73% ± 15%; p < .0001), and listening (pretraining 68% ± 19%; post-training 74% ± 15%; p < .0001). Leaders showed greater increases in confidence in listening and responding to nurses speaking up (leaders 5.6% vs. nonleaders 4.2%, p < .00001). CONCLUSION Nurses benefited from an interactive educational experience by practicing strategies for speaking up and listening. [J Contin Educ Nurs. 2024;55(6):309-316.].
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Kim ARJ, Nishino K, Bujang MA, Zulkifli Z, Inthaphatha S, Yamamoto E. What inhibits "speaking up" for patient safety among healthcare workers? A cross-sectional study in Malaysia. HUMAN RESOURCES FOR HEALTH 2024; 22:35. [PMID: 38807123 PMCID: PMC11134733 DOI: 10.1186/s12960-024-00916-x] [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: 12/17/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND In healthcare, "speaking up" refers to when healthcare workers raise concerns regarding patient safety through questions, sharing information, or expressing their opinion to prevent harmful incidents and ensure patient safety. Conversely, withholding voice is an act of not raising concerns, which could be beneficial in certain situations. Factors associated with speaking up and withholding voices are not fully understood, especially in strong authoritarian societies, such as Malaysia. This study aimed to examine the factors associated with speaking up and withholding the voices of healthcare workers in Malaysia, thus providing suggestions that can be used in other countries facing similar patient safety challenges. METHODS This cross-sectional study was conducted in a tertiary hospital in Sarawak State, Malaysia. Data were collected from 474 healthcare workers from 43 departments using a self-administered questionnaire for speaking up and withholding voices measures in 4 weeks prior to data analysis as well as socio-demographic factors of healthcare workers (sex, age group, profession, department, weekly work hours for patient care, years of employment in the hospital, and the hierarchical level) and speaking up related climate of the working environment were recorded. Data were analyzed using descriptive statistics. Logistic regression was performed to find out (adjusted) odds ratio of frequent speaking up and withholding voices. RESULTS Nurse compared to doctors and healthcare workers with short weekly working hours were more likely to speak up. Healthcare workers in emergency and intensive care department, those with short years of employment, and those who worked at low hierarchical levels were less likely to speak up. Healthcare workers in discouraging environment towards speaking up were more likely to withhold their voices. CONCLUSIONS This study demonstrates the characteristics of healthcare workers who speak up and those who withhold their voices in Malaysia. To ensure patient safety and prevent harm, it is essential to establish an encouraging environment that promotes speaking up and prevents withholding voices among healthcare worker, especially in circumstances where multiple types of healthcare workers with different socio-demographic backgrounds work together.
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Affiliation(s)
- Alex Ren Jye Kim
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
- Quality and Training Unit, Sarawak General Hospital, Ministry of Health Malaysia, 93586, Kuching, Sarawak, Malaysia
| | - Kimihiro Nishino
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
| | - Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, 93586, Kuching, Sarawak, Malaysia
| | - Zubalqiah Zulkifli
- Quality and Training Unit, Sarawak General Hospital, Ministry of Health Malaysia, 93586, Kuching, Sarawak, Malaysia
| | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
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Gusoff G, Ringel JB, Bensson-Ravunniarath M, Wiggins F, Lee A, Espinosa CG, Avgar AC, Sarkisian C, Sterling MR. Having a Say in Patient Care: Factors Associated with High and Low Voice among Home Care Workers. J Am Med Dir Assoc 2024; 25:737-743.e2. [PMID: 38432645 PMCID: PMC11262414 DOI: 10.1016/j.jamda.2024.01.021] [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: 08/28/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To identify factors associated with high and low "voice"-or level of input in patient care decisions-among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions. DESIGN We conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs' voice using a validated, 5-item instrument. SETTING AND PARTICIPANTS The survey was conducted virtually from June 2020 to July 2021 in partnership with the 1199 Service Employees International Union (1199SEIU) Training and Employment Funds, a union labor management fund. English- or Spanish-speaking HCWs employed by a certified or licensed home care agency in New York, NY, were eligible. METHODS HCW voice was the main outcome of interest, which we assessed by tertiles (low, medium, and high, with medium as the referent group). Using multinominal logistic regression, we calculated odds ratios (ORs) and 95% CIs for the relationship between participant characteristics and low and high levels of voice. RESULTS The 261 HCWs had a mean age of 48.4 years (SD 11.9), 96.6% were female, and 44.2% identified as Hispanic. A total of 38.7% had low voice, 37.9% had medium voice, and 23.4% had high voice. In the adjusted model, factors associated with low voice included Spanish as a primary language (OR 3.71, P = .001), depersonalization-related burnout (OR 1.14, P = .04), and knowing which doctor to call (OR 0.19, P < .001). Factors associated with high voice included Spanish as a primary language (OR 2.61, P = .04) and job satisfaction (OR 1.22, P = .001). CONCLUSIONS AND IMPLICATIONS Organizational factors such as team communication practices-including among non-English speakers-may play an important role in HCW voice. Improving HCW voice may help retain HCWs in the workforce, but future research is needed to evaluate this.
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Affiliation(s)
- Geoffrey Gusoff
- National Clinician Scholars Program, University of California, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | | | | | - Faith Wiggins
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Ann Lee
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Cisco G Espinosa
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Catherine Sarkisian
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA, USA
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Pavithra A, Mannion R, Sunderland N, Westbrook J. Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals. J Health Organ Manag 2022; ahead-of-print:245-271. [PMID: 36380424 PMCID: PMC10424643 DOI: 10.1108/jhom-04-2022-0129] [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: 04/29/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The study aimed to understand the significance of how employee personhood and the act of speaking up is shaped by factors such as employees' professional status, length of employment within their hospital sites, age, gender and their ongoing exposure to unprofessional behaviours. DESIGN/METHODOLOGY/APPROACH Responses to a survey by 4,851 staff across seven sites within a hospital network in Australia were analysed to interrogate whether speaking up by hospital employees is influenced by employees' symbolic capital and situated subjecthood (SS). The authors utilised a Bourdieusian lens to interrogate the relationship between the symbolic capital afforded to employees as a function of their professional, personal and psycho-social resources and their self-reported capacity to speak up. FINDINGS The findings indicate that employee speaking up behaviours appear to be influenced profoundly by whether they feel empowered or disempowered by ongoing and pre-existing personal and interpersonal factors such as their functional roles, work-based peer and supervisory support and ongoing exposure to discriminatory behaviours. ORIGINALITY/VALUE The findings from this interdisciplinary study provide empirical insights around why culture change interventions within healthcare organisations may be successful in certain contexts for certain staff groups and fail within others.
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Affiliation(s)
- Antoinette Pavithra
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
| | - Russell Mannion
- Australian Institute of Health Innovation
, Sydney,
Australia
- Health Services Management Centre
,
University of Birmingham
, Birmingham,
UK
| | - Neroli Sunderland
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research
,
Australian Institute of Health Innovation
, Sydney,
Australia
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Lee SE, Dahinten VS, Ji H, Kim E, Lee H. Motivators and inhibitors of nurses' speaking up behaviours: A descriptive qualitative study. J Adv Nurs 2022; 78:3398-3408. [PMID: 35765723 DOI: 10.1111/jan.15343] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
AIMS To identify factors that motivate or inhibit nurses' speaking up for patient safety. DESIGN A descriptive qualitative study. METHODS We conducted semi-structured interviews with 15 nurses from four Korean hospitals between December 2020 and January 2021. Data were analysed using inductive content analysis. RESULTS We identified safety culture, supportive unit managers and role models, positive reactions from or familiarity with others, high-risk situations and personal characteristics and beliefs as motivators of nurses' speaking up. Hierarchies and power differentials, seniority and unit tenure, concerns about relationships, and heavy workloads inhibited nurses' speaking up. CONCLUSION Individual, organizational and cultural characteristics influence nurses' decisions on whether or not to voice their concerns, suggestions or ideas. Certain characteristics of Korean culture, such as strong hierarchies and the valuing of good relationships, play an important role in nurses' speaking up behaviours. Our findings can be used to inform educational interventions and management expectations about interpersonal behaviours, especially in a culture where age- and seniority-based hierarchies and collectivism are prevalent. IMPACT Nurses perceived speaking up as a challenging behaviour, and they sometimes withhold their voices even when speaking up is needed for patient safety. We found that individual, organizational, and contextual factors affect the speaking up behaviours of nurses. Nurse managers can create environments that are more supportive of nurses' speaking up behaviours by using inclusive leadership to create psychological safety, by inviting and showing appreciation for staff input, and by helping physicians and senior nurses understand the importance of all nurses' voices. NO PATIENT OR PUBLIC CONTRIBUTION Patient or public contribution does not apply to this study as its purpose was to explore the speaking up experiences of nurses themselves.
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Affiliation(s)
- Seung Eun Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyunju Ji
- Severance Hospital, Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Eunkyung Kim
- Brain Korea 21 FOUR Project, Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Hyunjie Lee
- Severance Hospital, Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
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Preckel B, Staender S, Arnal D, Brattebø G, Feldman JM, Ffrench-O'Carroll R, Fuchs-Buder T, Goldhaber-Fiebert SN, Haller G, Haugen AS, Hendrickx JFA, Kalkman CJ, Meybohm P, Neuhaus C, Østergaard D, Plunkett A, Schüler HU, Smith AF, Struys MMRF, Subbe CP, Wacker J, Welch J, Whitaker DK, Zacharowski K, Mellin-Olsen J. Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects. Eur J Anaesthesiol 2020; 37:521-610. [PMID: 32487963 DOI: 10.1097/eja.0000000000001244] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.
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Affiliation(s)
- Benedikt Preckel
- From the Department of Anaesthesiology, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands (BP), Institute for Anaesthesia and Intensive Care Medicine, Spital Männedorf AG, Männedorf, Switzerland (SS), Department of Anaesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University Salzburg, Salzburg, Austria (SS), Department of Anaesthesiology and Critical Care, University Hospital Fundación Alcorcón Madrid, Spain (DA), Department of Anaesthesia and Intensive Care, Haukeland University Hospital (GB, ASH), Department of Clinical Medicine, University of Bergen, Bergen, Norway (GB), Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA (JMF), Anaesthetic Department, St James's Hospital, Dublin, Ireland (RF-OC), Department of Anesthesiology & Critical Care, University de Lorraine, CHRU Nancy, Brabois University Hospital, Nancy, France (TF-B), Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA (SNG-F), Department of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland (GH), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (GH), Department of Anesthesiology, Onze-Lieve-Vrouwziekenhuis Hospital Aalst, Aalst, Belgium (JFAH), Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands (CJK), Department of Anesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Frankfurt (PM, KZ), Department of Anaesthesiology, University Hospital Würzburg, Würzburg (PM), Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany (CN), Copenhagen Academy for Medical Education and Simulation (DØ), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (DØ), Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK (AP), Product Management Anesthesiology, Drägerwerk AG & Co. KGaA, Lübeck, Germany (HUS), Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK (AFS), Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (MMRFS), Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium (MMRFS), Department of Acute Medicine, Ysbyty Gwynedd Hospital, Bangor, UK (CPS), School of Medical Science, Bangor University, Bangor, UK (CPS), Institute of Anaesthesia and Intensive Care IFAI, Hirslanden Clinic, Zurich, Switzerland (JWa), Department of Critical Care, University College Hospital, London (JWe), Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK (DKW) and Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway (JM-O)
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Dennis JL. Cybersecurity starts at home. J Healthc Risk Manag 2019; 39:7. [PMID: 31297917 DOI: 10.1002/jhrm.21383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 06/10/2023]
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