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Kuske S, Vondeberg C, Minartz P, Vöcking M, Obert L, Hemming B, Bleck C, Znotka M, Ose C, Heistermann P, Schmitz-Kießler J, Karrenbrock A, Cürlis D. Emotional and psychological safety in the context of digital transformation in healthcare: a mixed-method strategic foresight study. BMJ Health Care Inform 2024; 31:e101048. [PMID: 39306332 PMCID: PMC11418536 DOI: 10.1136/bmjhci-2024-101048] [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: 02/11/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Perceived safety has received attention in the digital transformation of healthcare. However, the impact of perceived safety on the future of digital transformation has not been fully elucidated. AIM To investigate perceived safety in the context of the digital transformation of healthcare while considering relevant needs, influencing factors and impacts, including crisis events, to provide recommendations for action based on a participatory, multiperspective, strategic 5-year foresight viewpoint. METHODS A strategic foresight study is conducted via a participatory mixed-methods design to understand the present related factors that are likely to be relevant to future developments in the digital transformation of healthcare. RESULTS We observed that feeling safe plays a complex role in the digital transformation of healthcare. How perceived safety is considered has and will continue to impact the individual, organisational and system levels. Regarding a potential crisis event, controversial consequences have been observed. At its core, digital (health) literacy related to equity of access and human support is one of the crucial aspects in the context of perceived safety related to the successful implementation of digital technologies in healthcare. CONCLUSIONS The scenarios showed that a continuation of the current situation over the next 5 years may result in partly desirable and partly undesirable outcomes. Concrete key factors should be used in practice to support both education and healthcare quality development and research. The essence of the scenarios should serve as a starting point for research agenda setting and political decision-making in the future. However, additional research is needed to quantify the correlations among the relevant factors.
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Affiliation(s)
- Silke Kuske
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
| | | | - Peter Minartz
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
| | - Mara Vöcking
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
| | - Laura Obert
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
| | | | | | - Matti Znotka
- Katholisches Klinikum Koblenz Montabaur gGmbH, Koblenz, Germany
| | - Claudia Ose
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
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Gilbert P. Threat, safety, safeness and social safeness 30 years on: Fundamental dimensions and distinctions for mental health and well-being. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:453-471. [PMID: 38698734 DOI: 10.1111/bjc.12466] [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: 10/30/2023] [Accepted: 03/18/2024] [Indexed: 05/05/2024]
Abstract
In 1993, the British Journal of Clinical Psychology published my paper titled 'Defence and safety: Their function in social behaviour and psychopathology'. The paper highlights that to understand people's sensitivity to threat, we also need to understand their ability to identify what is safe. This paper offers an update on these concepts, highlighting distinctions that were implicit but not clearly defined at the time. Hence, the paper seeks to clarify distinctions between: (i) threat detection and response, (ii) safety and safety seeking, (iii) safeness and (iv) their social and non-social functions and forms. Threat detection and response are to prevent or minimize harm (e.g., run from a predator or fire). Safety checking relates to monitoring for the absence and avoidance of threat, while safety seeking links to the destination of the defensive behaviour (e.g., running home). Safety seeking also relates to maintaining vigilance to the appearance of potential harms and doing things believed to avoid harm. Threat-defending and safety checking and seeking are regulated primarily through evolved threat processing systems that monitor the nature, presence, controllability and/or absence of threat (e.g., amygdala and sympathetic nervous system). Safeness uses different monitoring systems via different psychophysiological systems (e.g., prefrontal cortex, parasympathetic system) for the presence of internal and external resources that support threat-coping, risk-taking, resource exploration. Creating brain states that recruit safeness processing can impact how standard evidence-based therapies (e.g., exposure, distress tolerance and reappraisal) are experienced and produce long-term change.
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Affiliation(s)
- Paul Gilbert
- Centre of Compassion Research and Training, College of Health and Social Care Research Centre, University of Derby, Derby, UK
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Flyvholm AM, Johansen BS. Hate, crime and epistemic vulnerability: on sense-making and feelings of (un)safety among Danish Muslims. FRONTIERS IN SOCIOLOGY 2024; 9:1347803. [PMID: 38957647 PMCID: PMC11218732 DOI: 10.3389/fsoc.2024.1347803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/23/2024] [Indexed: 07/04/2024]
Abstract
This article investigates feelings of (un)safety emerging from knowing and sharing knowledge about hate crime and hate incidents. Drawing on fieldwork and interviews with young Muslims living in the greater Copenhagen area, the article explores the way the interlocutors seek to make sense of their experiences through available epistemic categories, and how this sense-making is shaped by reactions from the surrounding society, e.g., whether it is questioned, supported, ignored etc. Combining criminological and psychological research on direct and indirect harms of hate crime with insights from philosophy on epistemic encounters and their ethical implications the article provides a framework for investigating safety in epistemic interactions. Based on this framework, the article show the often hard work that people perform in order to balance epistemic needs (e.g. the need for knowledge and for recognition) with epistemic risks (e.g. the risk of testimonial rejection, of damaged epistemic confidence, or loss of credibility).
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Liu SK, Bourgeois F, Dong J, Harcourt K, Lowe E, Salmi L, Thomas EJ, Riblet N, Bell SK. What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process. Diagnosis (Berl) 2024; 11:63-72. [PMID: 38114888 PMCID: PMC10875277 DOI: 10.1515/dx-2023-0075] [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: 06/21/2023] [Accepted: 10/18/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Accurate and timely diagnosis relies on close collaboration between patients/families and clinicians. Just as patients have unique insights into diagnostic breakdowns, positive patient feedback may also generate broader perspectives on what constitutes a "good" diagnostic process (DxP). METHODS We evaluated patient/family feedback on "what's going well" as part of an online pre-visit survey designed to engage patients/families in the DxP. Patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) were invited to complete the survey between December 2020 and March 2022. We adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words. RESULTS In total, 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Of all participants, 1,578 volunteered positive feedback, ranging from 1-79 words. Qualitative analysis of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). Compared to primary care, subspecialty comments showed the same overall rankings. Within Relationships, patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). Within Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %). CONCLUSIONS Patients/families valued relationships with clinicians above all else in the DxP, emphasizing the importance of supporting clinicians to nurture effective relationships and relationship-centered care in the DxP.
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Affiliation(s)
- Stephen K. Liu
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Fabienne Bourgeois
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Joe Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kendall Harcourt
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth Lowe
- Patient and Family Advisory Council, Department of Social Work, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric J. Thomas
- Department of Medicine, University of Texas McGovern Medical School, Houston, TX, USA
- Center for Healthcare Quality and Safety, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Natalie Riblet
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sigall K. Bell
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Liberati E, Richards N, Ratnayake S, Gibson J, Martin G. Tackling the erosion of compassion in acute mental health services. BMJ 2023; 382:e073055. [PMID: 37402535 PMCID: PMC10316385 DOI: 10.1136/bmj-2022-073055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Elisa Liberati
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Natalie Richards
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | | | | | - Graham Martin
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
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