24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations

Perceptions of interprofessional team collaboration among professionals working in the occupational health service in Sweden

OBJECTIVES

Interprofessional collaboration (IPC) among professionals in occupational health (OH) services is crucial when rendering a service to clients and customers. The aim of this study was to describe and compare perceptions relating to IPC among professionals working as OH providers in Sweden.

METHODS

This cross-sectional study with a descriptive and comparative design included 456 respondents representing different OH professions in Sweden. Data were collected using the Swedish short version of the Assessment of Interprofessional Team Collaboration Scale adapted for OH ([AITCS]-SII[OH]), with its 3 subscales Partnership, Cooperation, and Coordination, and were analyzed and presented descriptively. Items and sum scores were dichotomized into inadequate and adequate and compared between sexes, workplaces, types of employment, and professions.

RESULTS

According to the responses, items related to openness, honesty, and trust were perceived as adequate among the respondents. The findings show that perceptions about IPC differed among the professions. The perception of IPC also differed between different types of organizations.

CONCLUSIONS

The results show diverse perceptions between professionals and organizations. The perception of IPC may be influenced by the professional's education in occupational safety and health. Study findings may be used to support further development of IPC in the OH service for the benefit of the clients. To develop IPC in the best interests of both professionals and customers/clients, further studies need to be performed to gain a deeper understanding of IPC in the OH context.

Interprofessional teamwork before and after organizational change in a tertiary emergency department: An observational study

In healthcare settings, suboptimal interprofessional teamwork and communication contribute to unsafe care and avoidable harm. Interprofessional teamwork is essential in high-risk clinical areas such as the emergency department (ED). The aims of this study were to describe interprofessional teamwork in a hospital ED and to evaluate factors influencing interprofessional communication before and after implementation of a department-wide multifaceted intervention. Structured observations were undertaken during 2015/16 and 2019. Differences in interprofessional communication practices, teamwork, and sources of interruptions were compared before and after the intervention. The following domains were surveilled: (a) healthcare professionals (HCPs) communication initiatives, (b) HCPs' contribution to patient assessment, (c) interprofessional communication processes, and (d) team interruptions. The intervention included strategies to enable use of communication tools, changes to team structures, changes in work environment, ethical principles, and establishment of a code of professional conduct during interprofessional communication. Team interruptions significantly decreased post-intervention, and our findings suggest that organizational changes affect domains of teamwork. Statistically significant differences were observed in the initiated communication pre-intervention and contribution to patient assessment significantly increased post-intervention. Multifaceted organizational interventions can positively affect interprofessional team communication and work-flow in the ED, thus patient safety and quality of care can be improved.

Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach

The implementation of competency-based medical education (CBME) focuses on learners' competency outcomes and performance during their training. Competencies should meet the local demands of the healthcare system and achieve the desired patient-centered outcomes. Continuous professional education for all physicians also emphasizes competency-based training to provide high-quality patient care. In the CBME assessment, trainees are evaluated on applying their knowledge and skills to unpredictable clinical situations. A priority of the training program is essential in building competency development. However, no research has focused on exploring strategies for physician competency development. In this study, we investigate the professional competency state, determine the driving force, and provide emergency physicians' competency development strategies. We use the Decision Making Trial and Evaluation Laboratory (DEMATEL) method to identify the professional competency state and investigate the relationship among the aspects and criteria. Furthermore, the study uses the PCA (principal component analysis) method to reduce the number of components and then identify the weights of the aspects and components using the ANP (analytic network process) approach. Therefore, we can establish the prioritization of competency development of emergency physicians (EPs) with the VIKOR (Vlse kriterijumska Optimizacija I Kompromisno Resenje) approach. Our research demonstrates the priority of competency development of EPs is PL (professional literacy), CS (care services), PK (personal knowledge), and PS (professional skills). The dominant aspect is PL, and the aspect being dominated is PS. The PL affects CS, PK, and PS. Then, the CS affects PK and PS. Ultimately, the PK affects the PS. In conclusion, the strategies to improve the professional competency development of EPs should begin with the improvement from the aspect of PL. After PL, the following aspects that should be improved are CS, PK, and PS. Therefore, this study can help establish competency development strategies for different stakeholders and redefine emergency physicians' competency to reach the desired CBME outcomes by improving advantages and disadvantages.

Patients' perspectives on care, communication, and teamwork in the emergency department

BACKGROUND

The work of healthcare professionals (HCPs) in the emergency department (ED) involves effective communication and efficient teamwork, which may be perceived differently by patients and HCPs. Therefore, it is important to explore patient perspectives of information exchange and clinical assessment.

AIM

To evaluate experiences of care, communication, and teamwork from ED patients' perspectives.

METHODS

Semi-structured interviews were conducted with 17 patients who were assessed in a Swedish ED during Spring 2021. Thematic analysis was used.

RESULTS

Participants' experiences reflected the complex environment of the ED. Findings emphasize the importance of information exchange in relation to a caring approach. Three themes emerged: the need for a caring approach by HCPs towards patients'; the need for dialogue between patient and HCPs; and the need for information on ED environment constraints.

CONCLUSIONS

Patients felt comforted when they experienced a caring empathic approach from the HCPs. For example, patients valued an individual holistic approach rather than feeling that they were being objectified by their medical conditions. This was important in coping with the anxiety caused by a stressful ED environment. There is a critical need for effective exchange of information between patients and HCPs.

Flying high: pilot peer coaching to champion well-being and mitigate hazardous attitudes

Purpose

The “Germanwings” air crash in 2015 in which 150 people were killed highlighted the challenges pilots working in the aviation industry face. Pilots regularly work for extensive periods in inhospitable and high-pressure operational conditions, exposing them to considerable work-related stress. This has raised calls for a more systemic cultural change across the aviation industry, championing a more holistic perspective of pilot health and well-being. The study aims to explore how peer coaching (PC) can promote an inclusive psychosocial safety climate enhancing pilot well-being and can mitigate hazardous attitudes and dysfunctional behaviours.

Design/methodology/approach

Adopting an interpretative phenomenological analysis (IPA), semi-structured interviews and questionnaires were conducted with military and civilian peer coach/coachee pilots and key industry stakeholders, totalling 39 participants. The research provided significant insights into the perceived value of PC in promoting both pilot health and mental well-being (MW) and flight safety across the aviation industry.

Findings

The study highlights four key PC superordinate themes, namely, coaching skills, significance of well-being, building of peer relationships and importance of confidentiality and autonomy. Such combined themes build reciprocal trust within peer conversations that can inspire engagement and effectively promote personal well-being. The contagious effect of such local interventions can help stimulate systemic cultural change and promote a positive psychosocial safety climate throughout an organisation and, in this case, across the aviation industry. This study provides a PC conceptual framework “Mutuality Equality Goals Autonomy Non-evaluative feedback, Skill Confidentiality Voluntary Supervisory (MEGANS CVS),” highlighting the salient features of PC in promoting MW.

Research limitations/implications

The study highlights the salient features of PC and its role in promoting peer conversations that enable personal transition, openness and acceptance. This study also highlights how PC and well-being can be used to encourage inclusivity and engagement, thereby strengthening institutional resilience.

Practical implications

This study highlights how PC that can assist HRM/HRD professionals to embed a more inclusive and salutogenic approach to MW that can reshape organisational cultures. This study highlights the significance and link of workplace stress to hazardous attitudes and dysfunctional behaviours. It further notes that whilst the MEGANS CVS peer coaching framework has been applied to pilots, it can also be applied across all sectors and levels.

Social implications

This study highlights the value of PC as an inexpensive means to engage at the grassroots level, which not only improves personal performance, safety and well-being but by building peer relationships can also act as a catalyst for positive and deep organisational cultural change.

Originality/value

This study offers the MEGANS CVS framework that exposes insights into PC practice that can assist HRM/HRD professionals embed a more inclusive and salutogenic approach to health and well-being that can reshape organisational cultures. This study highlights the significance and link of workplace stress to hazardous attitudes and dysfunctional behaviours, and whilst this framework has been applied to pilots, it can also have relevance across all sectors and levels. This study calls for a “salutogenic turn,” employing MW and PC to transform organisational capabilities to be more forward-thinking and solution-focused, promoting an inclusive “just culture” where leaders positively lead their people.

Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis

INTRODUCTION

Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America.

PURPOSE

Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC).

METHODS

This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated.

RESULTS

In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66).

CONCLUSIONS

Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.

Teamwork in home care nursing: A scoping literature review

Due to an increased number of complex multi- and long-term ill patients, healthcare and nursing provided in patients' homes are expected to grow. Teamwork is important in order to provide effective and safe care. As care becomes more complex, the need for teamwork in home care nursing increases. However, the literature on teamwork in the patients' home environment is limited. The aim of this study is to describe the scope of the current literature on teamwork in home care nursing and outline needs for future research. Seven electronic databases were systematically searched and 798 articles were identified and screened. Seventy articles remained and were assessed for eligibility by two of the authors. Eight themes were identified among the 32 articles that met the inclusion criteria. Studies concerned with teamwork regarding isolated tasks/problems and specific teamwork characteristics were most common. Methods were predominantly qualitative. Multiple method approaches and ethnographic field studies were rare. Descriptions of the context were often lacking. The terms 'team' and 'teamwork' were inconsistently used and not always defined. However, it is apparent that teamwork is important and home care nurses play a crucial role in the team, acting as the link between professionals, the patient and their families. Future studies need to pay more attention to the context and be more explicit about how the terms team and teamwork are defined and used. More research is also needed regarding necessary team skills, effects of teamwork on the work environment and technology-mediated teamwork.

Patient safety culture in Austria and recommendations of evidence-based instruments for improving patient safety

This study aimed to investigate the patient safety culture in Austria. We identified factors that contributed to a higher degree of patient safety and subsequently developed evidence-based suggestions on how to improve patient safety culture in hospitals. Moreover, we examined differences in the perception of patient safety culture among different professional groups. This study used a cross-sectional design in ten Austrian hospitals (N = 1,525). We analyzed the correlation between ten patient safety culture factors, three background characteristics (descriptive variables), and three outcome variables (patient safety grade, number of adverse events reported, and influence on patient safety). We also conducted an analysis of variance to determine the differences in patient safety culture factors among the various professional groups in hospitals. The findings revealed that all ten factors have considerable potential for improvement. The most highly rated patient safety culture factors were communication openness and supervisor/manager’s expectations and actions promoting safety; whereas, the lowest rated factor was non-punitive response to error. A comparison of the various professional groups showed significant differences in the perception of patient safety culture between nurses, doctors, and other groups. Patient safety culture in Austria seems to have considerable potential for improvement, and patient safety culture factors significantly contribute to patient safety. We determined evidence-based practices as recommendations for improving each of the patient safety factors.

Protocol for establishing and evaluating a public and patient panel for organisation science and management principles in healthcare

INTRODUCTION

Patient and public involvement (PPI) has not been used to its full potential when examining the organisational science and management principles side of healthcare. With more and more acknowledgement of the relationship between management tools and patient outcomes, having meaningful engagement with the patient and the public in conducting research with the potential to enhance the patient experience, has never been more important. This study aims to outline the process in identifying members for a PPI for the organisational science and management principles side of healthcare, as well as providing guidelines for the establishment of PPIs in this nascent field. In addition, it aims to produce a charter for the panel, by and with the panel members, ensuring they are involved at every stage of research.

METHODS AND ANALYSIS

A hybrid of both a priority-setting and partnership approach to PPI will provide guidance on identifying, recruiting and establishing a PPI for research on the organisational science and management principles in healthcare. The panel will consist of approximately 20 members including patients, members of the public and researchers. A World Café approach to panel workshops will be adopted to produce a charter for the group. An assessment of panel engagement will be conducted through analysis of records of the meetings/workshops, as well as one-to-one interviews with all panel members at key points in time. Assessment criteria will be agreed with all members of the PPI panel. Data will be transcribed and managed using NVivo through a thematic analysis.

ETHICS AND DISSEMINATION

Ethical approval for the evaluation of the PPI has been received from the Kemmy Business School's Ethics Committee. Papers outlining the process in establishing a PPI in the area of organisational science and management principles of healthcare, and the results of the assessment of the panel's engagement will be published in journals.

Application of the Team Emergency Assessment Measure for Prehospital Cardiopulmonary Resuscitation

Introduction: Communication and teamwork are critical for ensuring patient safety, particularly during prehospital cardiopulmonary resuscitation (CPR). The Team Emergency Assessment Measure (TEAM) is a tool applicable to such situations. This study aimed to validate the TEAM efficiency as a suitable tool even in prehospital CPR. Methods: A multi-centric observational study was conducted using the data of all non-traumatic out-of-hospital cardiac arrest patients aged over 18 years who were treated using video communication-based medical direction in 2018. From the extracted data of 1494 eligible patients, 67 sample cases were randomly selected. Two experienced raters were assigned to each case. Each rater reviewed 13 or 14 videos and scored the TEAM items for each field cardiopulmonary resuscitation performance. The internal consistency, concurrent validity, and inter-rater reliability were measured. Results: The TEAM showed high reliability with a Cronbach’s alpha value of 0.939, with a mean interitem correlation of 0.584. The mean item–total correlation was 0.789, indicating significant associations. The mean correlation coefficient between each item and the global score range was 0.682, indicating good concurrent validity. The mean intra-class correlation coefficient was 0.804, indicating excellent agreement. Discussion: The TEAM can be a valid and reliable tool to evaluate the non-technical skills of a team of paramedics performing CPR.

Buffering the Effects of Burnout on Healthcare Professionals' Health-The Mediating Role of Compassionate Relationships at Work in the COVID Era

Managing the COVID-19 pandemic posed several challenges for healthcare professionals, which likely heightened their risk of burnout (Amanullah and Ramesh Shankar, 2020) and, consequently, their general physical and mental health. Although it may not be possible to address and eliminate the causes of burnout, current research informs healthcare organizations about protective strategies to reduce its detrimental consequences. The promotion of compassionate interactions among healthcare professionals may play such a role. Compassion within healthcare organizations positively affects individual performance and well-being. Building on these considerations and within the framework of the Conservation of Resources theory, this study explores the relationships among burnout dimensions, received compassion at work, and general health in 711 Italian healthcare professionals (68.5% female), aged between 21 and 73 years (Mage = 36.4, SD = 11.2). Analyses were conducted to investigate the association between burnout and general well-being (H1) and between burnout symptoms and perceived compassion at work (H2); and the mediational role of compassion in the relationship between burnout symptoms and general well-being. H1 and H2 were confirmed (r < 0.01 for both), and a SEM model showed the mediating role of compassion at work in the association between burnout symptoms and general well-being (RMSEA < 0.08, SRMR < 0.08, CFI and TLI > 0.90). Theoretical and practical implications of the findings are discussed in the paper.

Healthcare professionals' perceptions of interprofessional teamwork in the emergency department: a critical incident study

BACKGROUND

Interprofessional teams contribute to patient safety during clinical care. However, little is known about how interprofessional teams manage and cope with critical incidents in the emergency department (ED). Therefore, the study aimed to describe healthcare professionals (HCPs) perceptions of critical incidents linked to the enablers of and barriers to interprofessional teamwork in a high-risk setting, the ED.

METHODS

Individual interviews with HCPs regarding events at the ED were held during the period of May 2019-January 2020. The Critical Incident Technique approach was used to guide the interviews and the qualitative analysis. Data were analyzed inductively using qualitative content analysis.

RESULTS

Interview participants (n = 28) included 7 physicians (25%), 12 registered nurses (43%), 7 nurse assistants (25%) and 2 administrators (7%). Overall, 108 critical incidents were described. Eight categories that described functional and dysfunctional experiences within interprofessional teamwork were identified: salience of reflection; professional experience makes a difference; demanding physical and psychosocial work environment; balancing communication demands; lacking management support, structure, and planning; tensions between professional role and responsibility; different views on interprofessional teamwork; and confidence in interprofessional team members.

CONCLUSION

Findings of this study indicate that poor ED-specific communication and limited professional experience are essential factors in handling critical incidents related to interprofessional teamwork. An important aspect of critical incident management is the ergonomics of the physical work environment and how it enables interprofessional teamwork. This study emphasizes the factors enabling interprofessional teamwork to manage critical incidents in the complex working environment of the ED.

Healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care: a cross-sectional study

Background

In complex healthcare organizations, such as intrapartum care, both patient safety culture and teamwork are important aspects of patient safety. Patient safety culture is important for the values and norms shared by interprofessional teams in an organization, and such values are principles that guide team members’ behavior. The aim of this study was 1) to investigate differences in perceptions of patient safety culture and teamwork between professions (midwives, physicians, nursing assistants) and between labor wards in intrapartum care and 2) to explore the potential associations between teamwork and overall perceptions of patient safety and frequency of events reported. 

Methods

The design was cross-sectional, using the Swedish version of the Hospital Survey on Patient Safety Culture (14 dimensions) and the TeamSTEPPS® Teamwork Perceptions Questionnaire (5 dimensions). Midwives, physicians, and nursing assistants in three labor wards in Sweden in 2018 were included. Descriptive statistics, the Kruskal–Wallis H test, two-way ANOVA, and standard multiple regression analysis were used.

Results

The questionnaires were completed by 184 of the 365 healthcare professionals, giving a response rate of 50.4%. Two-way ANOVA showed a significant main effect of profession on two patient safety culture dimensions and one teamwork dimension and a significant main effect of labor ward on four patient safety culture dimensions and four teamwork dimensions. A significant interaction effect of profession and labor ward was found on four patient safety culture dimensions and four teamwork dimensions. The regression analysis revealed that four out of the five teamwork dimensions explained 40% of the variance in the outcome dimension ´Overall perceptions of patient safety´.

Conclusions

The results of the study indicate that profession and labor ward are important for healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care. Teamwork perceptions are significant for overall patient safety.

The Effect of the Electronic Health Record on Interprofessional Practice: A Systematic Review

BACKGROUND

 Interprofessional practice and teamwork are critical components to patient care in a complex hospital environment. The implementation of electronic health records (EHRs) in the hospital environment has brought major change to clinical practice for clinicians which could impact interprofessional practice.

OBJECTIVES

 The aim of the study is to identify, describe, and evaluate studies on the effect of an EHR or modification/enhancement to an EHR on interprofessional practice in a hospital setting.

METHODS

 Seven databases were searched including PubMed, Scopus, Web of Science, CINAHL, Cochrane, EMBASE, and ACM Digital Library until November 2021. Subject heading and title/abstract searches were undertaken for three search concepts: "interprofessional" and "electronic health records" and "hospital, personnel." No date limits were applied. The search generated 5,400 publications and after duplicates were removed, 3,255 remained for title/abstract screening. Seventeen studies met the inclusion criteria and were included in this review. Risk of bias was quantified using the Quality Assessment Tool for Studies with Diverse Designs. A narrative synthesis of the findings was completed based on type of intervention and outcome measures which included: communication, coordination, collaboration, and teamwork.

RESULTS

 The majority of publications were observational studies and of low research quality. Most studies reported on outcomes of communication and coordination, with few studies investigating collaboration or teamwork. Studies investigating the EHR demonstrated mostly negative or no effects on interprofessional practice (23/31 outcomes; 74%) in comparison to studies investigating EHR enhancements which showed more positive results (20/28 outcomes; 71%). Common concepts identified throughout the studies demonstrated mixed results: sharing of information, visibility of information, closed-loop feedback, decision support, and workflow disruption.

CONCLUSION

 There were mixed effects of the EHR and EHR enhancements on all outcomes of interprofessional practice, however, EHR enhancements demonstrated more positive effects than the EHR alone. Few EHR studies investigated the effect on teamwork and collaboration.

It's not about the errors, it's about the learning: How the Royal College of Radiologists has developed a Radiology Events and Learning process in the United Kingdom

The Royal College of Radiologists (RCR) is based in the United Kingdom but is a global organisation with members and fellows worldwide. In this invited article, the chair of the RCR Radiology Events and Learning (REAL) panel recounts his experience in looking at radiological errors. He starts with his personal work auditing his own mistakes as a junior consultant, describes what he learned in his departmental role in a large teaching hospital running a Radiology Events and Learning Meeting (REALM) and gives an overview of some of the work done over the last two decades by the RCR. This includes publishing national guidelines which set standards for running a REALM, setting up the REAL panel which produces a quarterly newsletter of cases from RCR members, and running an annual conference to share information with local radiology departments around the country. A review of the literature describing the drivers for this work and looking at the parallels with industry lies alongside the practical tips he found useful which he hopes would be helpful to anyone setting up their own departmental errors or discrepancy meeting.

A mental models approach for defining explainable artificial intelligence

BACKGROUND

Wide-ranging concerns exist regarding the use of black-box modelling methods in sensitive contexts such as healthcare. Despite performance gains and hype, uptake of artificial intelligence (AI) is hindered by these concerns. Explainable AI is thought to help alleviate these concerns. However, existing definitions for explainable are not forming a solid foundation for this work.

METHODS

We critique recent reviews on the literature regarding: the agency of an AI within a team; mental models, especially as they apply to healthcare, and the practical aspects of their elicitation; and existing and current definitions of explainability, especially from the perspective of AI researchers. On the basis of this literature, we create a new definition of explainable, and supporting terms, providing definitions that can be objectively evaluated. Finally, we apply the new definition of explainable to three existing models, demonstrating how it can apply to previous research, and providing guidance for future research on the basis of this definition.

RESULTS

Existing definitions of explanation are premised on global applicability and don't address the question 'understandable by whom?'. Eliciting mental models can be likened to creating explainable AI if one considers the AI as a member of a team. On this basis, we define explainability in terms of the context of the model, comprising the purpose, audience, and language of the model and explanation. As examples, this definition is applied to regression models, neural nets, and human mental models in operating-room teams.

CONCLUSIONS

Existing definitions of explanation have limitations for ensuring that the concerns for practical applications are resolved. Defining explainability in terms of the context of their application forces evaluations to be aligned with the practical goals of the model. Further, it will allow researchers to explicitly distinguish between explanations for technical and lay audiences, allowing different evaluations to be applied to each.

On the Relationship Between Authentic Leadership, Flourishing, and Performance in Healthcare Teams: A Job Demands-Resources Perspective

This study integrates the job demands-resources model and authentic leadership theory to test the general hypothesis that authentic leadership is a job resource that enables flourishing and performance in healthcare teams. Furthermore, this article tests the hypothesis that the daily bed occupancy is a job demand that weakens this relationship. Participants were 106 nurses that were distributed across 33 teams from two hospitals. The results suggest that the authentic leadership of team leaders is positively related with subjective and objective team performance, but only when daily bed occupancy is low. Authentic leadership had no relationship with team flourishing, regardless of the daily bed occupancy. Our findings suggest that the extent to which authentic leadership is adequate to promote the performance of teams working in a hospital setting is sensitive to contextual boundary conditions. Leading authentically might only be effective under specific circumstances.

The effects of COVID-19 on training within urology: Lessons learned in virtual learning, human factors, non-technical skills and reflective practice

The COVID-19 pandemic has changed training and recruitment in urology in unprecedented ways. As efforts are made to ensure trainees can continue to progress, lessons can be learned to improve training and urological practice even after the acute phase of the pandemic is over. Novel methods of education through virtual learning have burgeoned amidst the social distancing the pandemic has brought. The importance of training in human factors and non-technical skills has also been brought to the fore while operating under the constraints of personal protective equipment and working in new teams and unfamiliar environments. This paper critically appraises the available evidence of how urological training has been affected by COVID-19 and the lessons we have learned and continue to learn going forward.

Level of Evidence

Not Applicable.

Healthcare professionals at the Gazan public hospitals: are they collaborative?

Purpose

This study aimed to assess interprofessional collaboration among healthcare professionals at governmental hospitals in the Gaza Strip.

Design/methodology/approach

This is qualitative study at six governmental hospitals, four general and two specialized. Thirty healthcare professionals were purposefully recruited to seven semi-structured interviews and three focus group discussions. Analysis was carried out using the open-coded thematic analysis.

Findings

Eight themes had been identified: (1) unity of goals among health professionals, (2) physicians as team leaders, (3) patient involvement, (4) decision-making and conflict management (5) relationships among professionals, (6) general responsibilities and autonomy, (7) mutual trust and information exchange and (8) collaboration with the community to coordinate care. The first three themes were impediments, whilst “decision-making and conflict resolution” was a significant enabler of interprofessional collaboration. The last four themes were the lowest in their level and varied from one hospital to another as well.

Research limitations/implications

The main limitation in this study was the number of participants; a relatively large sample might be needed for more data saturation. Therefore, health professionals from diverse backgrounds and different managerial levels have been recruited.

Practical implications

Policymakers could rely upon the recommendations in strengthening the enablers of interprofessional collaboration and overcoming barriers, both on system, organizational and individual levels.

Originality/value

This study was conducted at six hospitals of different specialties and sizes, and health professionals from different six professions have been recruited. In addition, two qualitative tools were used, interviews and focus group discussions.

Professional faultlines and interprofessional differentiation in multidisciplinary team innovation: The moderating role of inclusive leadership

BACKGROUND

Interprofessional health care teams are increasingly employed to solve complex problems through innovative solutions. However, there is evidence that such teams are not always successful. The impact of profession and professional divides is likely to be particularly important in health care teams as team membership and contribution typically derive from member's unique professional expertise. Yet, there remains a dearth of research exploring the role of professional faultlines in multidisciplinary teams. In an effort to address this research gap, we explore the role of professional faultlines in interprofessional team innovation.

PURPOSE

Drawing on faultline theory and learning from the sociology of the professions, this study develops and investigates a model of team innovation predicted by professional faultlines. More specifically, we propose that professional faultlines increase interprofessional differentiation within teams and, through this mediator, increase innovation, contingent on interprofessional inclusive leadership.

METHODOLOGY

We investigate our model and hypothesis using a cross-sectional correlational design. Survey data of 70 interprofessional health care teams is used to investigate our model.

RESULTS

Support is found for our moderated mediation model. We find evidence that professional faultlines increase interprofessional differentiation, which, in turn, increases team innovation contingent on inclusive leadership.

CONCLUSION

Our study finding allows us to contribute to the evolving discussion on health care teams and team faultlines, particularly professional faultlines, and their role in team innovation.

PRACTICE IMPLICATIONS

A number of strategies to increase innovation in interprofessional teams are indicated by our findings. In particular, the role of inclusive leadership is highlighted as a useful approach, particularly when profession aligns with biodemographic attributes, such as gender.

Patient experience of communication consistency amongst staff is related to nurse-physician teamwork in hospitals

Aim

To investigate whether nurse reported teamwork with physicians was associated with patient perceived consistency in staff-to-patient communication.

Design

A cross-sectional survey design was used, drawing on data collected from two surveys in England.

Methods

Teamwork was assessed using data from the RN4CAST survey of 2,990 nurses in 31 Trusts in England. Data on patient experience derived from the National Health Services Adult Inpatient Questionnaire, including 12,506 patients in the same Trusts. A cross-sectional design with multivariate logistic regression was used.

Results

Each 5% increase in the proportion of nurses who agree that there "is a lot of teamwork between nurses and physicians" was associated with 7% lower odds that patients reported inconsistency in communication amongst staff. The results suggest that patients seem to experience the consequences of less teamwork between nurses and physicians through their own perceptions of inconsistency in communication between staff. The findings emphasize good teamwork between doctors and nurses are not only important for the team, but also can have consequences for patients. It provides additional incentive to find mechanisms to breakdown disciplinary barriers and improve the cohesion of clinical teams for the benefit of their patients.

From super-hero to super-connector, changing the -leadership culture in the NHS

The NHS Long Term Plan recently published recognises the critical role of leadership to the delivery of high-quality, sustainable healthcare and sets out an ambition for compassionate and inclusive leadership behaviours. There is good evidence that the biggest influence on organisational culture is the quality of leadership, affecting patient outcomes and staff experience. However, the current NHS staff survey paints a sobering picture of the current experience of the 1.2 million staff who work in the NHS in England. Changing culture requires leadership effort and behavioural change at every level of the system, from the clinical microsystem to the national arms-length bodies. Leaders can take positive action by regularly seeking feedback, paying attention to the leadership behaviours within their team and finding ways to ensure the team can reflect and improve their team working. This opinion article offers an introduction to compassionate and inclusive leadership in healthcare. Our intention is to provide the reader with a sense of agency to act and improve local culture for the benefits of patients and staff.

Survey of family doctors' attitudes towards statin treatment in patients with type 2 diabetes

AIMS

Clinical guidelines advocate that cardiovascular benefits of statin treatment overweigh the risk of impairment of glucose metabolism. The aim of the study was to examine the attitudes of family doctors towards statin treatment in patients with type 2 diabetes.

METHODS

We disseminated a questionnaire examining doctors' attitudes to existing clinical guidelines and the factors leading to a doctor's decision to prescribe statins to diabetic patients.

RESULTS

Clinical policy and guidelines were defined by doctors as having the greatest influence on the decision to prescribe statins for diabetic patients particularly by salaried doctors in comparison to self-employed doctors (χ² = 9.138, df = 3, p ≤ 0.01). When considering the ways healthcare services can assist cholesterol control, monetary compensation yielded higher importance by young doctors compared to mature doctors (χ² = 8.15, df = 2, p ≤ 0.01), while nursing services in the clinic yielded higher importance by mature doctors in comparison to younger doctors(χ² = 13.7, df = 2, p ≤ 0.01).

CONCLUSIONS

Doctors defined a list of priorities for organizational support mechanisms that are likely to lead to the formation of an intervention plan for increasing the percentage of balanced cholesterol levels in patients with diabetes.

What do doctors mean when they talk about teamwork? Possible implications for interprofessional care

The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.

Running too far ahead? Towards a broader understanding of mindfulness in organisations

Current workplace mindfulness research and interventions assume that teaching mindfulness will have beneficial effects for people and organizations. While research shows that mindfulness trainings may increase resilience of working adults, assuming that mindfulness will have independent effects on outcomes at different levels of an organization is not well grounded. We assert that mindfulness training would, however, be beneficial for organizations when tailored to that context and shaped by an understanding of organizational theory and practice. We also envisage mindfulness as a beneficial property of teams, organizations and the individuals who constitute them. To close the evidence gap we propose building multi-level models of mindfulness in organizations, broadening training programs, and developing a novel competency framework for teachers in this context.

Examining the Indirect Effects of Perceived Organizational Support for Teamwork Training on Acute Health Care Team Productivity and Innovation: The Role of Shared Objectives

This study examines the relationship between a specific type of team climate for perceived organizational support, team perceived organizational support for teamwork training (team POS-TT), and its effects on the productivity and innovation of acute health care teams. Drawing on organizational support theory, we examine how this relationship emerges via the mediating mechanism of shared objectives. Using survey data from 88 teams based in 13 health care organizations across the United Kingdom, we found support for the indirect effects of team POS-TT via shared objectives, but not for the direct effect of team POS-TT, thus indicating a mediated relationship with team productivity and innovation. As predicted, through the satisfaction of important esteem and affiliation needs of team members, team POS-TT compelled teams to engage in the process of generating shared objectives, which, in turn, positively predicted team productivity and innovation. These findings contribute to the scant literature on perceived organizational support (POS) as a form of team climate, and respond to recent calls to consider different types of POS by focusing on perceived support for teamwork training, an area which has particular relevance in the context of health care. Furthermore, the study serves to extend understanding regarding exactly how team POS-TT affects team outcomes via the specific process of shared objectives. We conclude with a discussion of these contributions to the literature and delineate several practical implications for leaders and managers in health care organizations.

Leadership in interprofessional health and social care teams: a literature review

Purpose The purpose of this study is to review evidence on the nature of effective leadership in interprofessional health and social care teams. Design/methodology/approach A critical review and thematic synthesis of research literature conducted using systematic methods to identify and construct a framework to explain the available evidence about leadership in interprofessional health and social care teams. Findings Twenty-eight papers were reviewed and contributed to the framework for interprofessional leadership. Twelve themes emerged from the literature, the themes were: facilitate shared leadership; transformation and change; personal qualities; goal alignment; creativity and innovation; communication; team-building; leadership clarity; direction setting; external liaison; skill mix and diversity; clinical and contextual expertise. The discussion includes some comparative analysis with theories and themes in team management and team leadership. Originality/value This research identifies some of the characteristics of effective leadership of interprofessional health and social care teams. By capturing and synthesising the literature, it is clear that effective interprofessional health and social care team leadership requires a unique blend of knowledge and skills that support innovation and improvement. Further research is required to deepen the understanding of the degree to which team leadership results in better outcomes for both patients and teams.

Team Leadership and Cancer End-of-Life Decision Making

End-of-life decision making in cancer can be a complicated process. Patients and families encounter multiple providers throughout their cancer care. When the efforts of these providers are not well coordinated in teams, opportunities for high-quality, longitudinal goals of care discussions can be missed. This article reviews the case of a 55-year-old man with lung cancer, illustrating the barriers and missed opportunities for end-of-life decision making in his care through the lens of team leadership, a key principle in the science of teams. The challenges demonstrated in this case reflect the importance of the four functions of team leadership: information search and structuring, information use in problem solving, managing personnel resources, and managing material resources. Engaging in shared leadership of these four functions can help care providers improve their interactions with patients and families concerning end-of-life care decision making. This shared leadership can also produce a cohesive care plan that benefits from the expertise of the range of available providers while reflecting patient needs and preferences. Clinicians and researchers should consider the roles of team leadership functions and shared leadership in improving patient care when developing and studying models of cancer care delivery.

Doctors’ functional leadership in psychiatric healthcare teams – a reversible leadership logic

Purpose

– The purpose of this paper was to study how psychiatric doctors practise leadership in multidisciplinary healthcare teams. The paper seeks to answer the question: How do psychiatric doctors lead multidisciplinary teams during treatment conferences?

Design/methodology/approach

– Six psychiatric teams were studied at a university hospital. Each team was observed over a period of 18 months, and data were collected during four years (2008-2011). Data were collected through interviews with doctors (n = 19) and observations (n = 30) of doctors’ work in multidisciplinary psychiatric teams.

Findings

– Doctors in a multidisciplinary team use either self-imposed or involuntary leadership style. Oscillating between these two extremes was a strategy for handling the internal tensions of the team.

Research limitations/implications

– The study was a case study, performed during treatment conferences at psychiatric wards in a university hospital. This limitation means that there is cause for some caution in generalising the results.

Practical implications

– The results are useful for understanding leadership in multidisciplinary medical teams. By understanding the reversible logic of leadership, cooperation and knowledge sharing can be gained, which means that a situation of mere peaceful coexistence can be avoided. Understanding the importance of the informal contract makes it possible to switch leadership among team members. A reversible leadership with an informal contract makes the team less vulnerable. The team’s professionals can thus easily handle difficult situations and internal tensions, facilitating leadership and management of multidisciplinary teams.

Originality/value

– Doctors in multidisciplinary psychiatric teams use reversible leadership logic.

Collective leadership for cultures of high quality health care

Purpose

– The purpose of this paper is to examine the challenges that health care organizations face in nurturing and sustaining cultures that ensure the delivery of continually improving, high quality and compassionate care for patients and other service users.

Design/methodology/approach

– Based on an extensive review of the literature, the authors examine the current and very challenging context of health care and highlight the core cultural elements needed to enable health care organizations to respond effectively to the challenges identified.

Findings

– The role of leadership is found to be critical for nurturing high-quality care cultures. In particular, the authors focus on the construct of collective leadership and examine how this type of leadership style ensures that all staff take responsibility for ensuring high-quality care for patients.

Practical implications

– Climates for quality and safety can be accomplished by the development of strategies that ensure leaders, leadership skills and leadership cultures are appropriate to meet the challenges health care organizations face in delivering continually improving, high quality, safe and compassionate patient care.

Originality/value

– This paper provides a comprehensive integration of research findings on how to foster quality and safety climates in healthcare organizations, synthesizing insights from academic literature, practitioner reports and policy documents to propose clear, timely and much needed practical guidelines for healthcare organizations both nationally and internationally.