Antecedents of willingness to report medical treatment errors in health care organizations: A multilevel theoretical framework

How does subjective invulnerability impact young workers' safety voice?

INTRODUCTION

Young workers are at risk of workplace injuries for numerous reasons. One contentious yet untested theory is that subjective invulnerability to danger-a sense of indestructability in the face of physical hazards-can affect some young workers' reactions to workplace hazards. This study contends that subjective invulnerability can affect these reactions in two ways: (a) perceptions of physical hazards at work generate less fear of injury among those who perceive themselves as more invulnerable and/or; (b) fear of injury does not motivate speaking up about safety concerns (safety voice) among those who perceive themselves as more invulnerable.

METHOD

This paper tests a moderated mediation model in which higher perceptions of physical hazards at work are related to higher safety voice intentions via higher fear of injury, but that subjective invulnerability reduces the extent to which: (a) perceptions of physical hazards at work are associated with fear of injury and/or; (b) fear of injury is associated with safety voice. This model is tested in two studies of young workers (Study 1 on-line experiment: N = 114, M age = 20.67, SD = 1.79; range = 18-24 years; Study 2 field study using three waves of data collected at monthly intervals: N = 80, M age = 17.13, SD = 1.08, range = 15-20 years).

RESULTS

Contrary to expectations, the results showed that young workers who feel more invulnerable to danger are more likely to speak up about safety when experiencing higher fear of injury, and that perceptions of physical hazards-safety voice relationship is mediated by fear of injury for those who perceive themselves to be more invulnerable to danger. Conclusions/Practical Applications: Rather than subjective invulnerability silencing safety voice as predicted, the current data suggest that subjective invulnerability may serve to accelerate how fear of injury motivates safety voice.

Patient Safety and Legal Regulations: A Total-Scale Analysis of the Scientific Literature

OBJECTIVE

The aim of the study was to quantitatively analyze the scientific literature landscape covering legal regulations of patient safety.

METHODS

This retrospective bibliometric analysis queried Web of Science database to identify relevant publications. The identified scientific literature was quantitatively evaluated to reveal prevailing study themes, contributing journals, countries, institutions, and authors, as well as citation patterns.

RESULTS

The identified 1295 publications had a mean of 13.8 citations per publication and an h-index of 57. Approximately 78.8% of them were published since 2010, with the United States being the top contributor and having the greatest publication growth. A total of 79.2% (n = 1025) of the publications were original articles, and 12.5% (n = 162) were reviews. The top authors (by number of publications published on the topic) were based in the United States and Spain and formed 3 collaboration clusters. The top institutions by number of published articles were mainly based in the United States and United Kingdom, with Harvard University being on top. Internal medicine, surgery, and nursing were the most recurring clinical disciplines. Among 4 distinct approaches to improve patient safety, reforms of the liability system (n = 91) were most frequently covered, followed by new forms of regulation (n = 73), increasing transparency (n = 67), and financial incentives (n = 38).

CONCLUSIONS

Approximately 78.8% of the publications on patient safety and its legal implications were published since 2010, and the United States was the top contributor. Approximately 79.2% of the publications were original articles, whereas 12.5% were reviews. Healthcare sciences services was the most recurring journal category, with internal medicine, surgery, and nursing being the most recurring clinical disciplines. Key relevant laws around the globe were identified from the literature set, with some examples highlighted from the United States, Germany, Italy, France, Sweden, Poland, and Indonesia. Our findings highlight the evolving nature and the diversity of legislative regulations at international scale and underline the importance of healthcare workers to be aware of the development and latest advancement in this field and to understand that different requirements are established in different jurisdictions so as to safeguard the necessary standards of patient safety.

Examining Medical Office Owners and Clinicians Perceptions on Patient Safety Climate

OBJECTIVE

An essential element of effective medical practice management is having a shared set of beliefs among members regarding patient safety climate. Recognizing the need for improving patient safety, the Agency for Healthcare Research and Quality began a series of surveys to assess medical practice members' attitudes and beliefs on patient safety climate. The aim of the study was to examine owners and clinicians perceptions of their medical practice's patient safety climate.

METHODS

We used the 2010-2011 Medical Office Survey on Patient Safety Culture collected by the Agency for Healthcare Research and Quality. We used hierarchical linear modeling to examine owners' and clinicians' perceptions of practice's patient safety climate while controlling for the nested nature of individuals within practices.

RESULTS

Managers with ownership responsibility, clinicians with ownership responsibility, and staff clinicians have different perceptions of the practice's patient safety climate. In particular, managers with ownership responsibility have more positive perceptions of the patient safety climate, as compared with non-owners. Clinicians with ownership responsibility had less favorable views than managers in a similar role. Finally, staff clinicians have the most negative perceptions of patient safety climate as compared with individuals in the ownership positions.

CONCLUSIONS

There is a statistically significant lack of agreement among medical office team members depending on their backgrounds and roles. Increasing the communication among organizational members about their practice's patient safety climate is a principal aim whether improvements in care quality are to be achieved.

Workplace verbal abuse, nurse-reported quality of care and patient safety outcomes among early-career hospital nurses

AIMS

To examine the differences in early-career nurses' verbal abuse experiences based on their sociodemographic characteristics, and to investigate the associations of verbal abuse experiences with nurse-reported care quality and patient safety outcomes.

BACKGROUND

Few studies have examined the relationships between early-career nurses' verbal abuse experiences and nurse-reported patient care quality and safety outcomes.

METHODS

Cross-sectional survey data from 799 early-career hospital nurses in the United States were analysed. Items assessed verbal abuse experiences from patients or their families, physicians and other employees. Associations between verbal abuse experiences and nurse-reported care quality and patient safety outcomes were examined using multiple logistic regression analyses.

RESULTS

There were significant differences in verbal abuse experiences by age, gender and work unit. Nurses who experienced verbal abuse, regardless of the perpetrator, were less likely to report high-quality care and a favourable safety grade. Nurses who experienced verbal abuse specifically from physicians or other employees were also less likely to feel comfortable reporting safety problems.

CONCLUSION

Managing verbal abuse may be important for improving patient care quality and safety. Future intervention study is needed to reduce verbal abuse.

IMPLICATIONS FOR NURSING MANAGEMENT

To optimize patient safety, managers should thoroughly monitor verbal abuse and organisations' need to establish clear expectations and ramifications for when verbal abuse occurs.

Let's be civil: Elaborating the link between civility climate and hospital performance

BACKGROUND

The importance of interpersonal behavior at the workplace is increasingly recognized in the health care industry and related literature. An unresolved issue in the existing health care research is how a climate of courteous interpersonal behavior may form the foundation for strong hospital care performance.

PURPOSE

The aim of this study was to test the link between a climate of courteous interpersonal behavior, termed "civility climate," and hospital care performance. We conceptualize a multidimensional model of care performance by contrasting two dimensions: performance as perceived by employees and performance as perceived by patients. Furthermore, for both performance perspectives, we test an intermediate variable (error orientation climate) that may explain the relationship between civility climate and hospital care performance.

METHODOLOGY

The 2011 study sample comprised responses from 6,094 nurses and 38,627 patients at 123 Veterans Health Administration acute care inpatient hospitals in the United States. We developed and empirically tested a theoretical model using regression modeling, and we used a bootstrap method to test for mediation.

RESULTS

The results indicate a direct effect of civility climate on employee perceptions of care performance and an indirect effect mediated by error orientation climate. With regard to patient perceptions of care performance, the analyses reveal a direct effect of civility climate. The indirect effect mediated by error orientation climate was not supported.

PRACTICE IMPLICATIONS

Our findings point to the importance of strengthening interpersonal interactions for ensuring and improving both employees' and patients' perceptions of care, which constitute key success factors in the increasingly competitive hospital market. The insights may further stimulate discussion regarding interventions to foster a strong civility climate in hospitals.

Waiting too long: bottlenecks and improvements – a case study of a surgery department

Purpose

The purpose of this paper is to promote a business process approach for developing and improving the efficiency of hospital service quality in order to reduce clinical risks and increase patients satisfaction. The problems healthcare facilities face are how to reduce waste and risk and improve quality. The adoption of a process-focused organization could reduce organizational errors which have a negative influence on performance.

Design/methodology/approach

The research is based on a case study methodology, analyzing a specific real-life case. It is shown a practical example in the surgery department of an Italian hospital, identifying, analyzing and managing critical situations, in terms of improvement. To this end, national and international contributions, public documents, institutional websites, conference papers, books, workshops and hospital websites have been analyzed. Moreover, other data were collected through questionnaires.

Findings

Results show how a comprehensive view of the processes may lead to improvement in operations by identifying different risks and bottlenecks, suggesting the rapid implementation of corrective policies and improvements, in terms of overall efficiency.

Practical implications

By implementing innovative organizational processes to identify and reduce bottleneck a healthcare system could achieve a competitive advantage.

Originality/value

Within the Italian healthcare system, limited attention has been paid to the design of healthcare facilities. Flexible solutions are necessary for lean management. The originality of this work lies in the analysis applied to a complex organization, through which hidden critical situations have been identified, and solutions to improve and provide better healthcare management have been suggested.

Does Psychological Safety Impact the Clinical Learning Environment for Resident Physicians? Results From the VA's Learners' Perceptions Survey

BACKGROUND

Psychological safety (PS) is the perception that it is safe to take interpersonal risks in the work environment. In teaching hospitals, PS may influence the clinical learning environment for trainees.

OBJECTIVE

We assessed whether resident physicians believe they are psychologically safe, and if PS is associated with how they rate satisfaction with their clinical learning experience.

METHODS

Data were extracted from the Learners' Perceptions Survey (LPS) of residents who rotated through a Department of Veterans Affairs health care facility for academic years 2011-2014. Predictors of PS and its association with resident satisfaction were adjusted to account for confounding and response rate biases using generalized linear models.

RESULTS

The 13 044 respondents who completed the LPS (30% response rate) were comparable to nonpediatric, non-obstetrics-gynecology residents enrolled in US residency programs. Among respondents, 11 599 (89%) agreed that ". . . members of the clinical team of which I was part are able to bring up problems and tough issues." Residents were more likely to report PS if they were male, were in a less complex clinical facility, in an other medicine or psychiatry specialty, or cared for patients who were aged, had multiple illnesses, or had social supports. Nonpsychiatric residents felt safer when treating patients with no concurrent mental health diagnoses. PS was strongly associated with how residents rated their satisfaction across 4 domains of their clinical learning experience (P < .001).

CONCLUSIONS

PS appears to be an important factor in resident satisfaction across 4 domains that evaluators of graduate medical education programs should consider when assessing clinical learning experiences.

Nursing governance and clinical error control

Purpose

– This study aims to fathom the role of nursing governance as a mechanism to activate the chain effect from corporate social responsibility (CSR) through psychological contract to knowledge sharing, which in turn reduces clinical errors in hospitals in the Vietnam context. Clinical errors not merely result from human factors but also from mechanisms which influence human factors.

Design/methodology/approach

– The clues for the research model were established through structural equation modeling-based analysis of cross-sectional data from 233 nurses of Vietnam-based hospitals.

Findings

– Research findings unveiled the positive correlation between nursing governance and ethical CSR as well as the negative correlations between nursing governance and legal CSR or economic CSR. Ethical CSR was found to have positive effect on psychological contract, whereas legal or economic CSR was found to have negative effect on psychological contract. The chain effects from psychological contract through knowledge sharing to clinical error control were also attested in this inquiry.

Originality/value

– Research results have contributed to literature in some ways, for example, expanding health-care quality and patient safety literature through the chain of antecedents (nursing governance, CSR, psychological contract and knowledge sharing) to clinical error control, underscoring the role of psychological contract in cultivating knowledge sharing and adding organizational outcomes such as knowledge sharing and clinical error control to the nursing governance literature.

Junior doctors' views on reporting concerns about patient safety: a qualitative study

BACKGROUND

Enabling healthcare staff to report concerns is critical for improving patient safety. Junior doctors are one of the groups least likely to engage in incident reporting. This matters both for the present and for the future, as many will eventually be in leadership positions. Little is known about junior doctors' attitudes towards formally reporting concerns.

AIMS

To explore the attitudes and barriers to junior doctors formally reporting concerns about patient safety to the organisations in which they are training.

METHODS

A qualitative study comprising three focus groups with 10 junior doctors at an Acute Teaching Hospital Trust in the Midlands, UK, conducted in 2013. Focus group discussions were transcribed verbatim and analysed using a thematic approach, facilitated by NVivo 10.

RESULTS

Participants were supportive of the idea of playing a role in helping healthcare organisations become more aware of risks to patient safety, but identified that existing incident reporting systems could frustrate efforts to report concerns. They described barriers to reporting, including a lack of role modelling and senior leadership, a culture within medicine that was not conducive to reporting concerns, and a lack of feedback providing evidence that formal reporting was worthwhile. They reported a tendency to rely on informal ways of dealing with concerns as an alternative to engaging with formal reporting systems.

CONCLUSIONS

If healthcare organisations are to be able to gather and learn from intelligence about risks to patient safety from junior doctors, this will require attention to the features of reporting systems, as well as the implications of hierarchies and the wider cultural context in which junior doctors work.