1
|
Incze T, Pinkney SJ, Li C, Hameed U, Hallbeck MS, Grantcharov TP, Trbovich PL. Using the Operating Room Black Box to Assess Surgical Team Member Adaptation Under Uncertainty: An Observational Study. Ann Surg 2024; 280:75-81. [PMID: 38193296 PMCID: PMC11161221 DOI: 10.1097/sla.0000000000006191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty. BACKGROUND The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, and medical trainee) uniquely contribute to teamwork during instances of uncertainty, particularly when adapting to and rectifying an intraoperative adverse event (IAE). METHODS Audiovisual data of 23 laparoscopic cases from a large community teaching hospital were prospectively captured using OR Black Box. Human factors researchers retrospectively coded videos for teamwork skills (backup behavior, coordination, psychological safety, situation assessment, team decision-making, and leadership) by team role under 2 conditions of uncertainty: associated with an IAE versus no IAE. Surgeons identified IAEs. RESULTS In all, 1015 instances of teamwork skills were observed. Nurses adapted to IAEs by expressing more backup behavior skills (5.3× increase; 13.9 instances/hour during an IAE vs 2.2 instances/hour when no IAE) while surgeons and medical trainees expressed more psychological safety skills (surgeons: 3.6× increase; 30.0 instances/hour vs 6.6 instances/hour and trainees: 6.6× increase; 31.2 instances/hour vs 4.1 instances/hour). All roles expressed fewer situation assessment skills during an IAE versus no IAE. CONCLUSIONS OR Black Box enabled the assessment of critically important details about how team members uniquely contribute during instances of uncertainty. Some teamwork skills were amplified, while others dampened when dealing with IAEs. The knowledge of how each role contributes to teamwork and adapts to IAEs should be used to inform the design of tailored interventions to strengthen interprofessional teamwork.
Collapse
Affiliation(s)
- Taylor Incze
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sonia J. Pinkney
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cherryl Li
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Usmaan Hameed
- Department of Surgery, North York General Hospital, Toronto, ON, Canada
| | - M. Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Teodor P. Grantcharov
- Department of Surgery, Clinical Excellence Research Centre, Stanford University, Stanford, CA
| | - Patricia L. Trbovich
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- HumanEra, Office of Research and Innovation, North York General Hospital, Toronto, ON, Canada
| |
Collapse
|
2
|
Lee SE, Choi J, Dahinten VS, Lee H, Ji H, Kim E. Registered nurses’ perceptions and experiences with speaking up for patient safety in hospitals. Collegian 2023. [DOI: 10.1016/j.colegn.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
3
|
Barlow M, Watson B, Jones E, Maccallum F, Morse KJ. The influence of professional identity on how the receiver receives and responds to a speaking up message: a cross-sectional study. BMC Nurs 2023; 22:26. [PMID: 36710343 PMCID: PMC9884599 DOI: 10.1186/s12912-023-01178-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Research focused on understanding what enables or hinders health professionals to speak up about a safety concern has been to date predominately atheoretical and speaker focused. However, the role the receiver of the message plays in these often-difficult encounters is highly influential. To date, speaking up programs have created conversational mnemonics that technically should respectfully engage the receiver, yet speaking up remains challenging. This paper utilises Communication Accommodation Theory to explore the impact the communication behaviour and speaker characteristics has on the receiver of a speaking up message, and if these impacts differ between receiver groups (clinical disciplines). METHOD Clinicians (N = 208) from varying disciplines responded to two hypothetical speaking up vignettes, where participants were the receivers of speaking up messages. Analysis of variance was used to explore any potential differences between receiver groups. RESULTS Findings indicated that the level of perceived accommodation and group membership, whether defined by speaker discipline or seniority, collectively influenced how the receiver of a speaking up message evaluated the interaction, which influenced their anticipated response to the speaker. CONCLUSIONS The receiver's perceptions and evaluations of the message, their own professional identity and the presence of others, influenced receivers' anticipated responses. This has direct implications on healthcare speaking up training and provision of care, as the varying clinical disciplines received and responded to the same messages differently.
Collapse
Affiliation(s)
- Melanie Barlow
- grid.411958.00000 0001 2194 1270 Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, QLD Australia ,grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, St Lucia, QLD Australia
| | - Bernadette Watson
- grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, St Lucia, QLD Australia ,grid.16890.360000 0004 1764 6123 Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Elizabeth Jones
- grid.440425.30000 0004 1798 0746 School of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan Malaysia
| | - Fiona Maccallum
- grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, St Lucia, QLD Australia
| | - Kate J. Morse
- grid.166341.70000 0001 2181 3113 College of Nursing & Health Professions, Drexel University, 245 N 15th Street, Mail Stop 501, 4th Floor, Room 4606, Philadelphia, PA 19102 USA
| |
Collapse
|
4
|
Abebe E, Bao A, Kokkinias P, Russ-Jara AL, Degnan D. Maximizing student potential: Lessons for pharmacy programs from the patient safety movement. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100216. [PMID: 36632371 PMCID: PMC9827372 DOI: 10.1016/j.rcsop.2022.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/06/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
Higher education institutions (HEIs), including pharmacy programs, are experiencing growing pressure from the public and policy makers to develop student-centered learning experiences that meet societal needs. While HEIs may have in-house initiatives to meet such challenges, there are also opportunities for cross-domain learning and application of useful concepts from other sectors. One such sector that lends itself to cross-domain learning is the healthcare industry. Like HEIs, the healthcare industry has been experiencing pressure from its stakeholders, in this case, to address patient safety gaps. These forces intensified at the turn of the century leading to the emergence of what is now known as the patient safety movement, which enabled increased advocacy, education, and research to reduce healthcare-related harm. Despite persistent challenges, a key achievement of the patient safety movement has been application of a systems framework to understand and solve patient safety gaps. That is, patient safety gaps are often a result of system defects rather than isolated acts of individual workers operating in a complex social and technical work setting (often referred to as sociotechnical system). Commonly used systems frameworks describe a sociotechnical system through its components: 1) structure (e.g., people, tools/technology, physical workspaces); 2) processes (e.g., medication administration); and 3) outcomes (e.g., medication safety, patient satisfaction). At their core, both HEIs and healthcare organizations are complex sociotechnical systems that organize their structures to support specific processes - learning in HEIs and patient safety in healthcare - to ultimately improve outcomes for students and patients, respectively. This paper describes parallels between HEIs and the healthcare domain to illustrate how patient safety concepts and practices from healthcare can be adapted to HEIs in order to enhance educational structures, processes, and learning outcomes.
Collapse
Affiliation(s)
- Ephrem Abebe
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
- School of Medicine, Indiana University, Indianapolis, IN, USA
- Corresponding author at: Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA.
| | - Amy Bao
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Peter Kokkinias
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Alissa L. Russ-Jara
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
| | - Dan Degnan
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
5
|
Meier S, Kasting ML, Liu SS, DeMaria AL. Shared decision-making among non-physician healthcare professionals: Enhancing patient involvement in women's reproductive health in community healthcare settings. PATIENT EDUCATION AND COUNSELING 2021; 104:2304-2316. [PMID: 33685762 DOI: 10.1016/j.pec.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is an important approach to patient-centered care in women's reproductive healthcare. This study explored SDM experiences and perceptions among non-physician healthcare professionals. METHODS We completed 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes. RESULTS Professionals noted community-based healthcare required contextualized decision-making approaches. Results identified listening, decisional ownership, and engagement strategies that enhanced SDM involvement. Findings suggested outcome-oriented SDM concepts, including decisional ownership and investigative listening to enhance SDM. Providers redefined 'challenging' patients as engaged in their healthcare and discussed ways SDM improved healthcare experience beyond one visit. CONCLUSION Findings offered insight into actionable and practical strategies for enhancing SDM in community-based women's reproductive healthcare. The findings offer strategies to improve SDM by addressing barriers and facilitators among professionals. This extends SDM beyond the patient-physician dyad and supports broader application of SDM. PRACTICE IMPLICATIONS Incorporating professionals' experiences into SDM concepts can enhance SDM in community-based women's healthcare practice, offering opportunities to support a culture of SDM across settings.
Collapse
Affiliation(s)
- Stephanie Meier
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA.
| | - Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Sandra S Liu
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| |
Collapse
|
6
|
Violato E, King S, Bulut O. A multi-method exploratory study of health professional students' experiences with compliance behaviours. BMC MEDICAL EDUCATION 2020; 20:359. [PMID: 33046072 PMCID: PMC7552343 DOI: 10.1186/s12909-020-02265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/28/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Research in healthcare, including students as participants, has begun to document experiences with negative compliance, specifically conformity and obedience. There is a growing body of experimental and survey literature, however, currently lacking is a direct measure of the frequency at which health professional students have negative experiences with conformity and obedience integrated with psychological factors, the outcomes of negative compliance, and students' perceptions. METHODS To develop empirical knowledge about the frequency of negative compliance and student perceptions during health professional education a multi-methods survey approach was used. The survey was administered to health professional students across ten disciplines at four institutions. RESULTS The results indicated students regularly experience obedience and conformity and are influenced by impression management and displacement of responsibility. Moral distress was identified as a consistent negative outcome. Student self-reported experiences aligned with the empirical findings. CONCLUSIONS The findings of the present study demonstrate the pervasiveness of experiences with negative compliance during health professional's education along with some attendant psychological factors. The findings have educational and practical implications, as well as pointing to the need for further integration of social and cognitive psychology in explaining compliance in healthcare. The results are likely generalizable to a population level however replication is encouraged to better understand the true frequency of negative compliance at a health professional population level.
Collapse
Affiliation(s)
- Efrem Violato
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada.
| | - Sharla King
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada
| | - Okan Bulut
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada
| |
Collapse
|