Open organisational culture: what does it entail? Healthcare stakeholders reaching consensus by means of a Delphi technique

Key tips to shift student perspectives through transformative learning in medical education

Healthcare systems are increasingly complex, facing challenges such as rising costs, aging populations, and persistent health inequities. These challenges demand that medical education adapts, to equip health professionals with the competencies required to navigate and transform complex systems. This is where transformative learning theory can play a crucial role. This article offers twelve practical tips to integrate transformative learning in medical education, emphasizing the need for a shift from traditional educational approaches to more transformative methods. These tips focus on educating learners on the principles of transformative learning, encouraging critical reflection, fostering interdisciplinary collaboration, addressing the hidden curriculum, and creating a supportive learning environment. By implementing these tips, medical education can better prepare healthcare professionals to act as change agents, contributing to the long-term sustainability and effectiveness of healthcare systems. The potential impact of these tips on medical education is substantial, as they provide a pathway toward a more responsive, ethical, and sustainable future of healthcare. Clinical trial number: Not applicable.

Constructing a measure for self-perceived open organizational culture in a university hospital pharmacy

Background

An open organizational culture in the workplace represents an environment where information, ideas, and feedback are freely exchanged among all members, regardless of position or rank. Currently, there are no valid survey instruments to measure this culture within a healthcare context. To address this gap, we developed a survey instrument to measure self-perceived open organizational culture at a university pharmacy using a test re-test study design.

Methods

Data were collected during classroom training on basic mediation skills study. Participants completed the same questionnaire before (test phase) and after the training (validation phase). The questionnaire included statements assessing open organizational culture. The data were analyzed using standardized psychometric methods, including correlations, Exploratory Factor Analysis (structural validity), and construct validity by correlating the open organizational culture scores with the Interpersonal Communication Inventory.

Results

In the test phase, 191 participants (161 females, 84%; response rate = 39.7%) contributed to the initial construction of the self-perceived open organizational culture survey instrument. In the validation phase, 81 of the original respondents completed the questionnaire again. Three latent factors were identified, retaining 22 of the 37 items: "enabling systems" (7 items), "open behavior" (8 items), and "trusting and supporting coworkers" (7 items). High correlations were found among the three factors (r > 0.6), and between these factors and the Interpersonal Communication Inventory (r > 0.35). Cronbach's alphas were all above 0.85, indicating good internal consistency. During the validation phase, the factors demonstrated high internal consistency, test/re-test correlations, and agreement.

Conclusion

This study presents a 22-item survey instrument for measuring individual differences in self-perceived open organizational culture within a university hospital pharmacy. The instrument demonstrates internal consistency and construct validity. Further validation of its psychometric properties and testing in other healthcare departments are recommended.

How do cultural elements shape speak-up behavior beyond the patient safety context? An interprofessional perspective in an obstetrics and gynecology department

Introduction

Interprofessional working and learning thrives with speak-up behavior. Efforts to improve speak-up have mainly focused on isolated techniques and training programs within the patient safety scope, yet sustained improvement requires a cultural shift beyond this scope. This research investigates the influence of culture elements on speak-up behavior in interprofessional teams beyond the patient safety context.

Methods

An exploratory qualitative study design was used in a Dutch hospital's Obstetrics and Gynecology department. A representative sample of stakeholders was purposefully selected, resulting in semi-structured interviews with 13 professionals from different professional backgrounds (nurses, midwifes, managers, medical specialists, and residents). A speak-up pledge was developed by the research team and used to prime participants for discussion. Data analysis involved three-step coding, which led to the development of themes.

Results

This study has identified six primary cultural themes that enhance speak-up behavior. These themes encompass the importance of managing a shared vision, the role of functional hierarchy, the significance of robust interpersonal relationships, the formulation of a strategy delineating when to speak up and when to exercise restraint, the promotion of an open-minded professional mindset, and the integration of cultural practices in the context of interprofessional working and learning.

Conclusion

Six crucial cultural elements have been pinpointed to boost the practice of speaking up behavior in interprofessional working and learning. Remarkably, hierarchy should not be held responsible as the wrongdoer; instead, can be a great facilitator through respect and appreciation. We propose that employing transformational and humble leadership styles can provide guidance on effectively integrating the identified cultural elements into the workplace and provide an IMOI framework for effective interprofessional speak-up beyond patient safety.

Design and Validation of a Questionnaire to Measure Interprofessional Collaborative Practice for Auditing Integrated Hospital Care: Empirical Research

INTRODUCTION

Interprofessional teamwork is the key issue of delivering integrated hospital care; however, measuring interprofessional collaboration for auditing is fragmented. In this study, a questionnaire to measure InterProfessional collaborative Practice for Integrated Hospital care (IPPIH) has been developed and validated.

METHODS

A four-step iterative process was conducted: (1) literature search to find suitable questionnaires; (2) semistructured stakeholder interviews (individual and in focus groups) to discuss the topics and questions (face validity), (3) pretesting the prototype of the questionnaire in two different integrated care pathways for feasibility, usability, and internal consistency, and (4) testing (content and construct validity and responsiveness) of the revised questionnaire in eight integrated care pathways; the validation and responsiveness was tested by means of exploratory factor analysis, calculation of Cronbach alpha, item analysis, and linear mixed model analysis.

RESULTS

Based on six questionnaires and the opinion of direct stakeholders, the questionnaire IPPIH comprised 27 items. Five different domains could be distinguished: own skills, culture, coordination and collaboration, practical support, and appreciation with the Cronbach alpha varied from 0.91 to 0.48. The self-reported intensity of the collaboration within a specific care pathway significantly influenced the outcome ( P = .000).

DISCUSSION

The product is a questionnaire, IPPIH, which can measure the degree of interprofessional collaborative practice in integrated hospital care pathways. The IPPIH was initially developed for quality assurance. However, the IPPIH also seems to be suitable as a self-assessment tool for directors to monitor and improve the interprofessional collaboration and the quality of their integrated care pathway.

Unravelling clinicians' shared decision-making adoption: a qualitative exploration through the lens of diffusion of innovations theory

OBJECTIVES

This study uses the diffusion of innovations (DOI) theory to comprehensively understand the adoption of shared decision-making (SDM) in clinical practice, specifically focusing on the 'knowledge' and 'persuasion' stages within DOI. We aim to understand the challenges and dynamics associated with SDM adoption, offering insights for more patient-centred decision-making in healthcare.

DESIGN

This qualitative study employs a modified framework analysis approach, integrating ethnographic and interview data from prior research, along with additional interviews. The framework used is based on the DOI theory.

STUDY SETTING AND PARTICIPANTS

This study was conducted in the obstetrics and gynaecology department of a tertiary teaching hospital in the Eastern region of the Netherlands. It included interviews with 20 participants, including gynaecologists, obstetrics registrars and junior doctors currently practising in the department. Additionally, data from prior research conducted within the same department were incorporated, ensuring the maintenance of contextual consistency.

RESULTS

Findings reveal a complex interplay between SDM's benefits and challenges. Clinicians value SDM for upholding patient autonomy and enhancing medical practice, viewing it as valuable for medical decision-making. Decision aids are seen as advantageous in supporting treatment decisions. Challenges include compatibility issues between patient and clinician preferences, perceptions of SDM as time-consuming and difficult and limitations imposed by the rapid pace of healthcare and its swift decisions. Additionally, perceived complexity varies by situation, influenced by colleagues' attitudes, with limited trialability and sparsely observed instances of SDM.

CONCLUSIONS

Clinicians' decision to adopt or reject SDM is multifaceted, shaped by beliefs, cognitive processes and contextual challenges. Cognitive dissonance is critical as clinicians reconcile their existing practices with the adoption of SDM. Practical strategies such as practice assessments, open discussions about SDM's utility and reflective practice through professional development initiatives empower clinicians to make the best informed decision to adopt or reject SDM.

Lessons learned spanning 17 years of experience with three consecutive nationwide competency based medical education training plans

Introduction

Curricula for postgraduate medical education have transformed since the introduction of competency based medical education (CBME). Postgraduate training plans offer broader training with different competencies and an outcome-based approach, in addition to the medical technical aspects of training. However, CBME also has its challenges. Over the past years, critical views have been shared on the potential drawbacks of CBME, such as assessment burden and conflicts with practicality in the workplace. Recent studies identified a need for a better understanding of how the evolving concept of CBME has been translated to curriculum design and implemented in the practice of postgraduate training. The aim of this study was to describe the development of CBME translations to curriculum design, based on three consecutive postgraduate training programs spanning 17 years.

Method

We performed a document analysis of three consecutive Dutch gynecology and obstetrics training plans that were implemented in 2005, 2013, and 2021. We used template analysis to identify changes over time.

Results

Over time, CBME-based curriculum design changed in several domains. Assessment changed from a model with a focus on summative decision to one with an emphasis on formative, low-stakes assessments aimed at supporting learning. The training plans evolved in parallel to evolving educational insights, e.g., by placing increasing emphasis on personal development. The curricula focused on a competency-based concept by introducing training modules and personalized authorization based on feedback rather than on a set duration of internships. There was increasing freedom in personalized training trajectories in the training plans, together with increasing trust towards the resident.

Conclusion

The way CBME was translated into training plans has evolved in the course of 17 years of experience with CMBE-based education. The main areas of change were the structure of the training plans, which became increasingly open, the degree to which learning outcomes were mandatory or not, and the way these outcomes were assessed.

Key factors for effective implementation of healthcare workers support interventions after patient safety incidents in health organisations: a scoping review

OBJECTIVES

This study aims to map and frame the main factors present in support interventions successfully implemented in health organisations in order to provide timely and adequate response to healthcare workers (HCWs) after patient safety incidents (PSIs).

DESIGN

Scoping review guided by the six-stage approach proposed by Arksey and O'Malley and by PRISMA-ScR.

DATA SOURCES

CINAHL, Cochrane Library, Embase, Epistemonikos, PsycINFO, PubMed, SciELO Citation Index, Scopus, Web of Science Core Collection, reference lists of the eligible articles, websites and a consultation group.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Empirical studies (original articles) were prioritised. We used the Mixed Methods Appraisal Tool Version 2018 to conduct a quality assessment of the eligible studies.

DATA EXTRACTION AND SYNTHESIS

A total of 9766 records were retrieved (last update in November 2022). We assessed 156 articles for eligibility in the full-text screening. Of these, 29 earticles met the eligibility criteria. The articles were independently screened by two authors. In the case of disagreement, a third author was involved. The collected data were organised according to the Organisational factors, People, Environment, Recommendations from other Audies, Attributes of the support interventions. We used EndNote to import articles from the databases and Rayyan to support the screening of titles and abstracts.

RESULTS

The existence of an organisational culture based on principles of trust and non-judgement, multidisciplinary action, leadership engagement and strong dissemination of the support programmes' were crucial factors for their effective implementation. Training should be provided for peer supporters and leaders to facilitate the response to HCWs' needs. Regular communication among the implementation team, allocation of protected time, funding and continuous monitoring are useful elements to the sustainability of the programmes.

CONCLUSION

HCWs' well-being depends on an adequate implementation of a complex group of interrelated factors to support them after PSIs.

Spiritual care competence, moral distress and job satisfaction among Iranian oncology nurses

BACKGROUND

Nurses have a crucial role in identifying spiritual needs and providing spiritual care to patients living with cancer.

AIM

This study evaluated Iranian oncology nurses' spiritual care competence and its relationship with job satisfaction and moral distress.

METHOD

This cross-sectional study was conducted on 280 Iranian oncology nurses in 2020 using four questionnaires: demographic questionnaires, the Spiritual Care Competence Questionnaire (SCCQ), the Minnesota Job Satisfaction Questionnaire (MSQ) and the nurses' Moral Distress Questionnaire (MDS-R).

FINDINGS

The mean scores indicated a medium to high Spiritual Care Competence (SCC), mild to moderate moral distress and high job satisfaction. There was a positive correlation between SCC and external job satisfaction (r=184, p<0.05) and a negative correlation between SCC and moral distress (r=-0.356, p<0.05).

CONCLUSIONS

SCC diminishes with decreasing external job satisfaction and increasing moral distress. To improve the SCC of nurses working with patients living with cancer, it is recommended that nursing managers and policymakers revise the organisational policies to tackle the obstacles and consider the related factors to provide an ethical climate, implement quality spiritual care and increase job satisfaction.

Learning from the implementation of clinical empathy training: an explorative qualitative study in search of the barriers and facilitators

BACKGROUND

Amid concerns about the decline of empathy during the clinical training of medical clerks, evidence that empathy improves patient outcomes suggests some potential for teaching empathy in ways that will affect the knowledge, attitude and behaviour of medical clerks. This potential alone cannot, however, guarantee the success of educational innovations to introduce empathy to the medical curriculum. This research aims to identify the barriers and facilitators of the implementation of a specific clinical initiative to enhance the empathy skills of clerks, namely the training of clerks to act as a 'MedGezel' or 'medical coach'.

METHOD

We conducted an explorative qualitative study based on interview data collected and analyzed using reflexive thematic analysis and the readiness for change theory. We conducted semi-structured interviews with relevant stakeholders in this particular qualitative study. Thematic analysis was based on open and axial coding using ATLAS.ti 9, which facilitated the emergence of common themes of interest and meaning for the study.

RESULTS

A total of 13 relevant stakeholders participated as interviewees in our study. The data was collected from April to June 2021. Our analysis generated 6 main themes which can provide insights into why the implementation of the MedGezel educational innovation failed so far. The following themes emerged: the case for change: why change?; practical necessity; leadership; management and resources; staff culture; and alignment with the corporate strategy.

DISCUSSION

The implementation failure can be partially explained as resulting from the personal attitudes and choices of participants, who struggled to reconcile a vision that they liked with side effects that they feared. While participants repeatedly mentioned management and leadership issues, these organizational issues seemed less important as they could be easily resolved in practice. What was more important and fatal for the initiative was its lack of alignment with staff culture, despite its alignment with corporate strategy.

CONCLUSION

This investigation into the barriers and facilitators influencing the implementation of the MedGezel program identified 6 explanatory themes, the most impactful one being staff culture.