Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare

How we manage medication-related osteonecrosis of the jaw

Bone-modifying agents (BMAs) are integral to managing patients with advanced cancer. They improve quality of survival by reducing skeletal-related events, treating hypercalcaemia and chemotherapy-induced bone loss (Coleman in Clin Cancer Res 12: 6243s-6249s, 2006), (Coleman in Ann Oncol 31: 1650-1663, 2020). Two decades ago, medication-related osteonecrosis of the jaw (MRONJ) was first reported following BMA therapy (Marx in J Oral Maxillofac Surg 61: 1115-1117, 2003). The risk of MRONJ extends over a decade following BMA treatment with bisphosphonates, complicating dental care such as extractions. In addition, MRONJ has been reported following additional therapies such as antiangiogenic agents, cytotoxic agents, immunotherapy, and targeted agents. The use of BMAs in the curative and adjuvant cancer setting is increasing, consequently the implication of MRONJ is growing. Over the past 20 years, the literature has consolidated major risk factors for MRONJ, the pathophysiology and management strategies for MRONJ. Our review aims to document the development of MRONJ preventative and management strategies in cancer patients receiving a BMA. The authors advocate the incorporation of dental oncology strategies into contemporary cancer care, to optimise long-term quality of survival after cancer treatment.

Identifying solutions to minimize meal tray waste: A mixed-method approach

BACKGROUND & AIMS

Over $150,000 are lost annually due to meal tray waste in a large hospital in the United States. This study aims to explore the root causes of meal tray waste within a decentralized foodservice model and strategies to mitigate waste.

METHODS

A mixed methods sequential explanatory design was used by first identifying hospital units high and low in meal tray waste using recorded food management data from January 2021 through September 2022, then conducting observations, mobile-interviews (n = 16), and in-depth interviews with hospital foodservice staff (n = 6) and nurses (n = 6) in each unit. Lastly, hospital and topic experts (n = 10) were engaged in strategizing solutions to reduce meal tray waste.

RESULTS

Findings indicate meal tray waste is increased when patients discharge and when standard trays (i.e., also known as house trays, which include items not requested by patients) are provided. Meal tray waste points to the unpredictability in a hospital that often arises due to patient circumstances, lack of coordination between nursing and foodservice staff, patients' food preferences, and the need for system and workflow improvements in a decentralized foodservice model.

CONCLUSIONS

Findings highlight considerations that may be applicable across diverse medical institutions seeking to reduce meal tray waste. Hospitals should choose the best foodservice model that suits their institution to manage operations efficiently, focusing on reducing waste, cost optimization, patient satisfaction, and sustainability.

Team member familiarity and team effectiveness in the operating room: The mediating effect of mutual trust and shared mental models

BACKGROUND

Teamwork in the operating room is of paramount importance to provide high-quality patient care. It has been shown that increased team member familiarity predicts improved teamwork. A complicating factor is the often-changing composition of the operating room teams. Team member familiarity is associated with shared mental models and mutual trust, which are in turn important factors for team effectiveness. However, it remains unclear how this interplay takes place and can be influenced (eg, through team training). Our aim was to investigate the relationship between team member familiarity and perceived team effectiveness in operating room teams. We hypothesized that shared mental models and mutual trust mediate this relationship.

METHODS

We performed a prospective, correlational study in 2 hospitals in the Netherlands. A questionnaire was used to assess team member familiarity, mutual trust, shared mental models (perceived and content-related), and perceived team effectiveness. Data were analyzed using a random intercept multilevel model.

RESULTS

Team member familiarity significantly predicted perceived team effectiveness, both through a direct effect, as well as mediated by perceived shared mental models. Mutual trust also significantly predicted team effectiveness. Variance is determined mostly at an individual level, but also partly (12%) at the operating room level.

CONCLUSION

Greater team member familiarity predicts greater team effectiveness, and this relationship is mediated by shared mental models. Training should be aimed at these aspects of team functioning to optimize team performance in the operating room.

Assessment of Anaesthesia Teams' Non-Technical Skills in Clinical Practice before and after Simulation-Based Team Training: A Quasiexperimental Study

Background

In situ simulation-based team training of non-technical skills is considered an important initiative for preventing adverse events caused by poor teamwork among healthcare personnel. This study aimed to assess the non-technical skills of anaesthesia personnel before and after in situ simulation-based team training in a clinical setting.

Methods

The study was conducted from October 2020 to June 2021 using a quasiexperimental before and after design based on video-recorded observations and ratings of anaesthesia teams' non-technical skills during anaesthesia induction in the operating room before and shortly after in situ simulation-based team training. Anaesthesia personnel were divided into 20 teams and video recorded during anaesthesia induction. The Anaesthetists' Non-technical Skills (ANTS) system was used to score the teams' non-technical skills. A paired-sample t-test was used to assess the impact of the intervention on the anaesthesia teams' scores on the various ANTS categories. Interrater agreement between the two ANTS raters was assessed using weighted kappa.

Results

At the category level, the overall scores had a statistically significant increase in performance after simulation-based team training (3.48 vs. 3.71; p < 0.001). Furthermore, scores of five of the 15 elements were significantly different. Interrater agreement revealed moderate agreement between the two raters (weighted kappa = 0.51, p value <0.001).

Conclusion

The anaesthesia teams' increased non-technical skills after simulation-based team training may indicate the transfer of knowledge from training to clinical practice. The moderate agreement between the raters could be attributed to the subjective nature of the evaluation procedure. The ANTS was originally used as an individual assessment tool; however, this study has demonstrated its potential as a team assessment tool.

Experiences of pursuing an intensivist career in regional and rural Australia: An interview study

The regional and rural intensivist workforce is vital to delivering high standards of healthcare to all Australians. Currently, there is an impending workforce disaster, with higher senior medical officer vacancy rates among regional and rural intensive care units, with these units being staffed by junior doctors who are in earlier stages of their training, which in turn increases supervisory burden. There is a lack of comprehensive literature on the barriers and enablers of training, recruiting and retaining regional and rural intensivists. To address this gap, a qualitative study was conducted, involving 13 in-depth, structured interviews with full-time and part-time intensivists from eight Australian regional and rural hospitals. Content analysis of the interview data resulted in the identification of four major categories: unique practice context, need for a broad generalist skill set, perks and challenges of working in a regional/rural area and workforce implications. The study findings revealed that regional and rural intensive care practice offers positive aspects, including work satisfaction, supportive local teams and an appealing lifestyle. However, these benefits are counterbalanced by challenges such as a heavier burden of on-call work, a higher proportion of junior staff which increase supervisory burden and limited access to subspecialist services. The implications of these findings are noteworthy and can be utilised to inform government policies, hospitals, the College of Intensive Care Medicine and the Australian and New Zealand College of Anaesthetists in developing strategies to enhance the provision of intensive care services and improve workforce planning in regional and rural areas.

Decoding healthcare teamwork: a typology of hospital teams

The effectiveness of healthcare depends on successful teamwork. Current understanding of teamwork in healthcare is limited due to the complexity of the context, variety of team structures, and unique demands of healthcare work. This qualitative study aimed to identify different types of healthcare teams based on their structure, membership, and function. The study used an ethnographic approach to observe five teams in an English hospital. Data were analyzed using a combined inductive-deductive approach based on the Temporal Observational Analysis of Teamwork framework. A typology was developed, consisting of five team types: structural, hybrid, satellite, responsive, and coordinating. Teams were challenged to varying degrees with staffing, membership instability, equipment shortages, and other elements of the healthcare environment. Teams varied in their ability to respond to these challenges depending on their characteristics, such as their teamworking style, location, and membership. The typology developed in this study can help healthcare organizations to better understand and design effective teams for different healthcare contexts. It can also guide future research on healthcare teams and provide a framework for comparing teams across settings. To improve teamwork, healthcare organizations should consider the unique needs of different team types and design effective training programs accordingly.

The impact of video consultation on interprofessional collaboration and professional roles: a simulation-based study in prehospital stroke chain of care

Healthcare is often conducted by interprofessional teams. Research has shown that diverse groups with their own terminology and culture greatly influence collaboration and patient safety. Previous studies have focused on interhospital teams, and very little attention has been paid to team collaboration between intrahospital and prehospital care. Addressing this gap, the current study simulated a common and time-critical event for ambulance nurses (AN) that also required contact with a stroke specialist in a hospital. Today such consultations are usually conducted over the phone, this simulation added a video stream from the ambulance to the neurologist on call. The aim of this study was to explore interprofessional collaboration between AN's and neurologists when introducing video-support in the prehospital stroke chain of care. The study took place in Western Sweden. The simulated sessions were video recorded, and the participants were interviewed after the simulation. The results indicate that video has a significant impact on collaboration and can help to facilitate better understanding among different professional groups. The participants found the video to be a valuable complement to verbal information. The result also showed challenges in the form of a loss of patient focused care. Both ANs and neurologists saw the video as benefiting patient safety.

Facilitating interprofessional learning: experiences of using a digital activity for training handover of critically ill patients between a primary health care centre and ambulance services - a qualitative study

OBJECTIVE

To explore students' and facilitators' experiences of using a developed digital activity for interprofessional learning (IPL) focusing on critically ill patient handovers from a primary healthcare (PHC) centre to the ambulance service.

DESIGN

A qualitative study design was employed, and the reporting of this study adheres to the Consolidated criteria for Reporting Qualitative research guidelines for qualitative studies.

SETTING

A PHC centre and the ambulance service in Stockholm, Sweden.

PARTICIPANTS

A total of 31 participants were included in the study: 22 students from five different healthcare professions, seven facilitators and two observers.

INTERVENTION

A digital IPL activity was developed to overcome geographical distances, and the scenario included the handover of a critically ill patient from personnel within the PHC centre to the ambulance service personnel for transport to an emergency department. Four digital IPL activities were conducted in 2021.

RESULTS

The digital IPL activity eliminated the issue of geographical distance for students and facilitators, and it enabled the students to find an interprofessional model for collaboration through reasoning, by communicating and sharing knowledge with the support of a common structure. Participants perceived the digital IPL activity and scenario as authentic, feasible and facilitated IPL. Using a case with an acute and life-threatening condition was a success factor for students to experience high realism in their IPL on patient safety, handover, care and treatment.

CONCLUSION

The developed digital IPL activity facilitated the students' IPL and demonstrated potential sustainability as the digital approach supported overcoming geographical distances for both students and facilitators. By using a scenario involving an authentic case focusing on handovers of a critically ill patient, IPL, feasibility and acceptability were supported. However, it is crucial to emphasise that a comprehensive evaluation, both quantitative and qualitative, over an extended period of clinical rotations and involving a larger group of students is still warranted to ensure continuous improvement and development.

Mapping Strategies for Strengthening Safety Culture: A Scoping Review

BACKGROUND

Twenty years after the "To Err Is Human" report, one in ten patients still suffer harm in hospitals in high-income countries, highlighting the need to strengthen the culture of safety in healthcare. This scoping review aims to map patient safety culture strengthening strategies described in the literature.

METHOD

This scoping review follows the JBI methodology. It adhered to all scoping review checklist items (PRISMA-ScR) with searches in the Lilacs, MedLine, IBECS, and PubMed databases and on the official websites of Brazilian and North American patient safety organizations. The research took place during the year 2023.

RESULTS

In total, 58 studies comprising 52 articles and 6 documents from health organizations were included. Various strategies were identified and grouped into seven categories based on similarity, highlighting the need for a comprehensive organizational approach to improve patient care. The most described strategies were communication (69%), followed by teamwork (58.6%) and active leadership (56.9%).

CONCLUSION

The identified strategies can promote the development of a culture in which an organization can achieve patient safety, involving practices and attitudes that reduce risks and errors in healthcare. However, the identification of strategies is limited because it is restricted to certain databases and websites of international organizations and does not cover a broader spectrum of sources. Furthermore, the effectiveness of these strategies in improving patient safety culture has not yet been evaluated.

'Our Voices Aren't Being Heard': A qualitative descriptive study of nurses' perceptions of interprofessional collaboration in care supporting older people's functioning during a hospital stay

INTRODUCTION

Older people admitted to hospital are highly susceptible to functional decline and related complications. Care supporting their functioning is complex and requires healthcare professionals working in concert, with nurses playing a central role. Yet, little is known about nurses' perceptions of interprofessional collaboration (IPC) in care supporting functioning in acutely admitted older people. To fill this knowledge gap, we elucidate the perspectives of nurses in Ontario, Canada, on IPC in care supporting older people's functioning during a hospital stay.

METHODS

We employed a qualitative methodology in conjunction with a qualitative descriptive design. Thirteen focus groups were held with a purposeful, criterion-based sample of 57 acute care nurses practising in a range of acute care settings (e.g. Emergency, General Medicine, General Surgery, Intensive Care, Coronary Care). Data were thematically analysed.

RESULTS

We identified two overarching themes: (1) IPC is improving, but nurses are excluded from decision-making and (2) nurse advocacy causes friction with other professionals. The first theme captures nurses' perception that IPC in older people's care is improving, but nurses are marginalised in interprofessional decision-making. As a result, nurses perceive that their knowledge is devalued, and their contributions to care supporting older people's functioning are undermined. The second theme underlines a tension between interprofessional team practices and patient- and family-centred care, while also demonstrating nurses' increasing willingness to act as patient and family advocates.

CONCLUSIONS

Findings can be used to enhance IPC in care supporting the functioning of acutely hospitalised older people. To improve IPC, clinical and administrative leaders should cultivate more egalitarian team relationships that encourage nurses to contribute to decision-making and advocate on behalf of older patients and their families.

Assessing intradisciplinary pharmacy communication related to transitions of care

Background

Pharmacists play an important role in transitions of care, where successful communication is vital. The primary objective of this study was to assess the extent of intradisciplinary communication between pharmacists during patient transitions of care. Secondary objectives were to evaluate pharmacist communication practices and to explore the potential barriers and facilitators to effective health communications.

Methods

A twenty item online survey was administered by email to all pharmacists practicing within a multisite regional healthcare system in central and northeastern Pennsylvania. Statistical analysis consisted of descriptive statistics for multiple choice, select all that apply, and Likert-type questions. Themes were summarized for open ended questions.

Results

A total of 132 (32%) pharmacists responded to the survey of which 90 responses were included in the analysis. The majority of pharmacists felt either extremely comfortable (53.3%) or somewhat comfortable (33.3%) reaching out to another pharmacist within the same health system. However, most contacted other pharmacy disciplines within the health system ≤25% of their work week. The ability to reach the pharmacist was the most important factor to pharmacist comfort (extremely important n = 56, somewhat important n = 27). Not knowing who to contact was the biggest barrier (44.8%). The electronic messaging systems Microsoft Teams (almost always n = 33, often n = 25) and TigerText (almost always n = 17, often n = 23) were the forms of communication utilized most often.

Conclusions

Pharmacists feel comfortable communicating with pharmacists across different entities within the health system, however, intradisciplinary communication related to transitions of care activities is limited. Improving awareness of system-wide pharmacist directories (34.2%) and distribution of pharmacist schedules (18.4%) were identified as tools that may improve communication.

The PREVSAM model, "prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders", is seen as beneficial for patients risking persistent musculoskeletal disorders but may be difficult to implement - a focus group study

PURPOSE

The rehabilitation model "Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders" (PREVSAM) was tested in a randomised controlled trial. This study aimed to explore participating healthcare professionals' experiences of working according to the PREVSAM model, and their perceptions of its clinical benefit and feasibility in primary care rehabilitation.

METHODS

A focus group study including 12 healthcare professionals from five primary care rehabilitation clinics was analysed according to the focus group methodology described by Krueger and Casey.

RESULTS

Four themes were identified. A clear framework describes how PREVSAM facilitates person-centred teamwork. The value of teamwork highlights benefits and challenges with teamwork. Through thick and thin discusses perceived patient benefits. In the ideal world focusses on feasibility of implementing the model.

CONCLUSIONS

The participants experienced that the PREVSAM model may be beneficial for the patients, for their own work situation and workplace, and for society. Identifying psychological risk factors was perceived as helpful, but not enough to capture patients in need of team-based rehabilitation. While considered feasible, barriers for implementing the model were identified. Managers and healthcare policy makers must prioritise and create appropriate conditions for team-based musculoskeletal rehabilitation in primary care.

Development and Testing of the Relational and Structural Components of Innovativeness Across Academia and Practice for Healthcare Progress Scale

OBJECTIVE

Using data from 5 academic-practice sites across the United States, researchers developed and validated a scale to measure conditions that enable healthcare innovations.

BACKGROUND

Academic-practice partnerships are a catalyst for innovation and healthcare development. However, limited theoretically grounded evidence exists to provide strategic direction for healthcare innovation across practice and academia.

METHODS

Phase 1 of the analytical strategy involved scale development using 16 subject matter experts. Phase 2 involved pilot testing the scale.

RESULTS

The final Innovativeness Across Academia and Practice for Healthcare Progress Scale (IA-APHPS) consisted of 7 domains: 3 relational domains, 2 structural domains, and 2 impact domains. The confirmatory factor analysis model fits well with a comparative fit index of 0.92 and a root-mean-square error of approximation of 0.06 (n = 477).

CONCLUSION

As the 1st validated scale of healthcare innovation, the IA-APHPS allows nurses to use a diagnostic tool to facilitate innovative processes and outputs across academic-practice partnerships.

Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration

BACKGROUND

An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams.

METHODS

This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups.

RESULTS

A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel.

CONCLUSION

Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.

Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach

BACKGROUND

Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients.

METHODS

This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study.

RESULTS

Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team.

CONCLUSIONS

The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.

Embracing ChatGPT for Medical Education: Exploring Its Impact on Doctors and Medical Students

ChatGPT (OpenAI), a cutting-edge natural language processing model, holds immense promise for revolutionizing medical education. With its remarkable performance in language-related tasks, ChatGPT offers personalized and efficient learning experiences for medical students and doctors. Through training, it enhances clinical reasoning and decision-making skills, leading to improved case analysis and diagnosis. The model facilitates simulated dialogues, intelligent tutoring, and automated question-answering, enabling the practical application of medical knowledge. However, integrating ChatGPT into medical education raises ethical and legal concerns. Safeguarding patient data and adhering to data protection regulations are critical. Transparent communication with students, physicians, and patients is essential to ensure their understanding of the technology's purpose and implications, as well as the potential risks and benefits. Maintaining a balance between personalized learning and face-to-face interactions is crucial to avoid hindering critical thinking and communication skills. Despite challenges, ChatGPT offers transformative opportunities. Integrating it with problem-based learning, team-based learning, and case-based learning methodologies can further enhance medical education. With proper regulation and supervision, ChatGPT can contribute to a well-rounded learning environment, nurturing skilled and knowledgeable medical professionals ready to tackle health care challenges. By emphasizing ethical considerations and human-centric approaches, ChatGPT's potential can be fully harnessed in medical education, benefiting both students and patients alike.

The Speaking Up Climate of Nurses for Patient Safety Concerns and Unprofessional Behaviors: The Effects of Teamwork and Safety Climate

PURPOSE

This study aims to investigate the influence of teamwork and safety climate on nurses' speaking up for patient safety concerns and unprofessional behaviors.

DESIGN

This study incorporates a cross-sectional research design.

METHODS

The study included 217 surgical nurses employed in a Turkish university hospital. The research data were collected between April and June 2023 using the Teamwork Climate, Safety Climate Survey, Speaking Up Climate for Patient Safety, and Speaking Up Climate for Professionalism instruments. The relationships between these scales were assessed using Pearson correlation analysis. The Turkish validity and reliability of the Speaking Up Climate for Patient Safety and Speaking Up Climate for Professionalism scales were verified. The research model was tested using path analysis.

FINDINGS

The mean age of the 217 surgical nurses was 25.88 ± 5.64 years. Teamwork climate showed a positive effect on safety climate and speaking up climate about patient safety concerns and unprofessional behaviors. Safety climate showed a positive association with nurses' speaking up climate about patient safety concerns and unprofessional behaviors.

CONCLUSIONS

Teamwork climate and safety climate both positively affect the speaking up climate about patient safety concerns and unprofessional behaviors. Nurse managers who wish to promote a culture of speaking up about patient safety and unprofessional behaviors should prioritize improvements in the teamwork climate and safety climate.

Organization of care of infants with congenital diaphragmatic hernia-Building a high-functioning CDH program

Infants born with congenital diaphragmatic hernia have high mortality and morbidity and require coordinated multidisciplinary care for optimal outcomes. Over the past several decades numerous articles have been published on the technical aspects of the care of these patients demonstrating both the variation in management across institutions as well as the desirability and need for standardization of care. Unfortunately, none have focused on the organization of care for CDH patients encompassing the range from early prenatal diagnosis to long-term postnatal care. However, to achieve optimal care and optimal outcomes, it is important to not only have excellent technical surgical and medical care but also to have an organized, systematic, and purposefully designed program for the delivery of healthcare to infants with this condition. In this article, based on our experience and drawing on general principles of building clinical programs, we describe the important elements of an ideal CDH program.

Innovation in education: the military medical ethics 'playing cards' and smartphone application

Military medical personnel need to understand military medical ethics to comply with international humanitarian law, national health practice and professional norms. Teaching this subject is constrained by a lack of educational resources, being further exacerbated by the limits imposed by the COVID-19 pandemic. This paper describes an innovative approach to deliver military medical ethics education using 52 scenarios published as a set of playing cards and a smartphone app. The rationale for the methodology and the development of these scenarios is summarised. This package forms a part of a 'd(igital)-learning' educational suite that includes physical cards, the app and a website for teaching both military and military medical ethics. The paper describes the experience of delivering this d-learning package in military medical ethics to UK and international audiences. The final sections offer a look ahead to the next stages for refinement to the current suite and the wider d-learning resources.

A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings

By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.

Factors of Missed Nursing Care in Intensive Care Units: Palestinian Perspective

Maintaining a high standard of nursing care is imperative for ensuring patient safety. Several factors significantly impact the provision of nursing care, including work environment resources, personnel coordination, work systems, and head nurse leadership. In addition, each nurse's clinical and academic career also plays a role in shaping the quality of care provided to patients. This article reports results of a cross-sectional study aimed to identify the different types of missed nursing care and the factors that contribute to them, as perceived by nurses, and second, to investigate how nurses' characteristics may relate to the occurrence of missed nursing care. Data for this study were obtained through a self-administered questionnaire that was distributed to participants working in an intensive care unit. The study included a final sample size of 176 participants, all of whom worked in intensive care unit hospitals located in the north region of Palestine. The study found that handwashing, setting up meals for patients who feed themselves, discharge planning, and response to a call light were the most frequently missed nursing care activities. The primary factors identified as reasons for missed nursing care were inadequate availability of labor and material resources, along with communication issues. Efforts to address these identified issues can potentially lead to improved quality of nursing care in intensive care units.

Teaming in Graduate Medical Education: Ward Rounds and Beyond

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.

Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes

OBJECTIVE

This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related.

BACKGROUND

Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition.

METHOD

We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes.

RESULTS

Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task.

CONCLUSION

Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.

A qualitative study to explore student learning and development of interprofessional collaboration during an online interprofessional education intervention

Interprofessional education (IPE) during undergraduate education and training has been found to improve collaboration between health care students. This supports interprofessional working in clinical practice to enhance patient safety and care delivery.Undergraduate students from pharmacy and medical programmes worked online in pairs to review notes of hospital patients due to be discharged. Students were tasked to complete a discharge letter and undertake an online consultation with a simulated patient prior to discharge. Online interactions were recorded and assessed using a validated tool to measure interprofessional professionalism. Students undertook this intervention in different pairings with different patient cases for three iterations after receiving feedback and undertaking a reflective exercise.The aim was to investigate the student learning and development that could be used to inform intervention optimisation and scale-up.Qualitative data were collected from different sources. Method triangulation was employed to develop a comprehensive understanding of the student learning and development. Data was collected from written feedback provided by the assessment team, student reflections on their performance, and from semi-structured interviews conducted with the student pairs and one to one with the assessment team. Content and thematic analysis was used to analyse these data and the Kirkpatrick/Barr evaluation model provided a framework to organise the themes.Eighteen students (nine from each professional programme) completed the study and a total of 27 IPE sessions were conducted. The assessment team completed 54 assessment tools and 31 student reflections were received (from a maximum of 36). Students were interviewed in their interprofessional pairs to yield nine interview transcripts and one interview was conducted with the assessment team.Students reported and were observed to improve in interprofessional collaboration over the three iterations following feedback and rehearsal opportunities. Longitudinal observation and assessment of student interprofessional working in changing teams provided the opportunity to capture the influence of interdependence on student performance and assessment of competence.

Distributed team processes in healthcare services: a scoping review

Objective

High-quality healthcare services is delivered by teams rather than individuals and depends heavily on multidisciplinary cooperation between dispersed healthcare professionals. The aim of this scoping review is to identify common barriers and innovative applications of technology supporting team processes and patient safety, in geographically dispersed healthcare services.

Methods

Studies were identified from searches in APA PsychINFO, Epistemonikos and Medline databases, from 2010 to 2023. A detailed search strategy was performed, and studies were included, based on prior established criteria.

Results

Among the 19 studies that fulfilled our inclusion criteria, the majority (85%) were from Europe or North America, and most studies (53%) were quantitative, with a cross-sectional study design. Several reported observed distributed team processes in training and education. Most studies described barriers and detailed how innovative approaches and technological solutions were introduced to improve communication, coordination, and shared mental models in distributed healthcare settings. A small proportion of studies (16%) used health services data to examine interpersonal exchange and team processes.

Conclusion

The scoping review offer recommendations to enhance future research on distributed team processes in healthcare services.

Symbols and rituals are alive and well in clinical practice in Australia: Perspectives from a longitudinal qualitative professional identity study

PURPOSE

Many factors impact an individual's professional identity on their journey to becoming a doctor, including their experiences, the learning environment, role models, and symbols and rituals. Rituals and symbols associated with the medical profession have historically included wearing a white coat (now rare) and the stethoscope. This study explored two medical students' perspectives of symbolic identifiers in a six-year longitudinal study in Australia (2012-2017).

METHODOLOGY

A 2012 qualitative cross-sectional qualitative professional identity study in an Australian five-year undergraduate medical programme was extended to a longitudinal study with annual interviews. A conversation about the symbolism of the stethoscope and other identifiers began in Year 1 and concluded when the students were junior doctors.

FINDINGS

Symbols and rituals remain part of the 'becoming' and 'being' a doctor. In the context of Australian hospitals, the stethoscope appears to no longer be exclusively associated with the medical profession, with 'professional attire' distinguishing medical students and doctors from other team members (uniform). The study identified lanyard colour and design as a symbol and language as a ritual.

CONCLUSIONS

Although symbols and rituals may change over time and across cultural contexts, some forms of treasured material possessions and rituals will persist in medical practice.[Box: see text].

Recommendations for creating a collaborative NICU environment to support teamwork and trainee education

In a 2022 survey, a majority of neonatology program directors reported regular conflict between neonatal-perinatal fellows and frontline providers (FLPs) (i.e., neonatal nurse practitioners (NNPs), neonatal physician assistants (PAs), and neonatal hospitalists). This paper reviews recommendations of a multidisciplinary workgroup for creating a more collaborative unit environment that supports teamwork and education. The self-study framework is a helpful tool to identify specific pressure points at individual institutions. Implementing clear guidelines for procedural distribution and role clarification are often critical interventions. FLPs and Pediatric Physician Trainees may benefit from conflict management coaching and communication training. At the same time, we recommend that respective leaders support a psychologically safe environment for team members to feel safe to solve problems on their own. Going forward, more work is important to optimize teamwork in the setting of anticipated staffing shortages, limitations to resident neonatology exposure, changes in training requirements, and ongoing development of the FLP role.

"That's probably how you would want care to be" - experiences of sick leave teams at a health center, a mixed method study

BACKGROUND

The health center where this study was performed the management wanted to test whether a sick leave team provided the physicians with better conditions for the task of assessing sick leave. The goals were to ensure the quality of the assessment of patients with sick leave needs and to improve the work environment. The aim of this study was to take part in the staff's experiences of having access to and working in sick leave teams and how the working method affected the number of sick leave patients and sick leave pattern.

METHODS

A mixture of qualitative and quantitative methods. Two focus groups were conducted with a total of 11 participants. The head of the health center formed the focus groups, which consisted of 6 doctors, 3 district nurses, 1 rehab coordinator and 1 psychologist. Aggregated sick leave data for full-time and part-time sick leave of more than 90, 180 and 360 days, respectively, were obtained and compiled at project start and end, and from the corresponding period 18 months before project start.

RESULTS

The introduction of sick leave teams with physicians and rehabilitation coordinator for patients who turn to the health center for mental illness and / or musculoskeletal problems emerged three main categories from the analysis of the focus group discussions: working environment, clear roles and in-depth competence. The total number of people who were on sick leave more than 365 days decreased by 27% between start and the end of the project, and the proportion of women increased by 11%.

CONCLUSIONS

The study shows that the complex task of sick leave can be perceived as positive by physicians with the support of teamwork. The working method is similar to that applied in occupational health care, where the physician is not alone with this task. This can also be a way to make primary care a more attractive workplace.

Using interprofessional education to build dynamic teams to help drive collaborative, coordinated and effective newborn care

BACKGROUND

As countries strive to achieve sustainable development goal 3.2, high-quality medical education is crucial for high-quality neonatal care. Women are encouraged to deliver in health units attended by a skilled team. Traditionally, the team is doctors and nurses, but they are members of a large group of interdependent experts from other disciplines. Each discipline trains separately, yet the goal of good neonatal care is common to all. The use of interprofessional education breaks down these professional silos improving collaborative practice and promoting excellent clinical care. Introduction of new educational materials and training requires a rigorous approach to ensure sustainability.

METHODS

An extensive needs assessment identified gaps in neonatal training. Specifically, there was a lack of inclusion of medical devices used in clinical care. In each country, national key stakeholders came together to develop and revise their own neonatal curricula, trainings or guidelines. A core writing education team were tasked to develop evidence-based materials on pertinent medical devices to include in these national materials. These then underwent internal and external review. A provider course for biomedical engineers and technicians was introduced. Skills labs were established to improve practical skills teaching. To improve the quality of teaching, a NEST360 generic instructors course (GIC) was developed.

RESULTS

Twenty modules, 14 scenarios, 17 job aids and 34 videos have been published to date. Materials have been embedded into neonatal curricula and national trainings. Forty-one skills labs were installed in pre-service learning institutions and, up to June 2022, have been used by 7281 students. Pre- and in-service interprofessional training was implemented at all NEST360 institutions (clinical and biomedical). GIC courses were conducted at least twice a year in all countries. Three hundred seventeen nurses, biomedical and clinical staff have undertaken the GIC in all four countries. GIC participants report that the course has very positively influenced their teaching practice.

CONCLUSIONS

Inclusion of key stakeholders throughout has ensured training is embedded within the four countries. Use of interprofessional education and inclusion of biomedical engineers and technicians has been very successful. Introduction of the GIC has developed a pool of high-quality educators for neonatal care. This approach has ensured that high-quality interprofessional neonatal training is included within national agendas for neonatal care and beyond.

Supervision, scheduling, satisfaction and shared working: how experiences of junior doctors relate to excess mortality within the NHS

BACKGROUND

We sought to explore associations between trainee doctor perception and excess patient mortality.

METHODS

Data from two publicly available databases reflecting mortality and components of trainee satisfaction within 81 NHS healthcare institutions between the years 2012 and 2019 were analysed. Pearson's correlation coefficients were calculated.

RESULTS

All domains of trainee perception were correlated with excess mortality. Clinical supervision out of hours (R=-0.44; p<0.0001), teamwork (R=-0.36; p<0.0001) and clinical supervision at any time (R=-0.35; p<0.0001) were most strongly correlated. Most associations remained consistent year on year.

CONCLUSION

Trainee doctor perceptions of clinical supervision, rota design and teamwork within the NHS are consistently correlated with excess patient mortality. Further exploration of these associations could identify opportunities for interventions to reduce excess patient mortality. Given the clinical significance of our findings, organisations should consider rapid implementation of evidence-based interventions where they exist.

Comfort and Coordination among Interprofessional Care Providers Involved in Intubations in the Pediatric Intensive Care Unit

Background

Successful execution of invasive procedures in acute care settings, including tracheal intubation, requires careful coordination of an interprofessional team. The stress inherent to the intensive care unit (ICU) environment may threaten the optimal communication and planning necessary for the safe execution of this complex procedure. The objective of this study is to characterize the perceptions of interprofessional team members surrounding tracheal intubations in the pediatric ICU (PICU).

Methods

This is a single-center survey-based study of staff involved in the intubation of pediatric patients admitted to a tertiary level academic PICU. Physicians, nurses, and respiratory therapists (RT) involved in tracheal intubations were queried via standardized, discipline-specific electronic surveys regarding their involvement in procedural planning and overall awareness of and comfort with the intubation plan. Qualitative variables were assessed by both Likert scales and free-text comments that were grouped and analyzed thematically.

Results

One hundred and eleven intubation encounters were included during the study time period, of which 93 (84%) had survey responses from at least 2 professional teams. Among those included in the analysis, the survey was completed 244 times by members of the PICU teams including 86 responses from physicians, 76 from nurses, and 82 from RTs. Survey response rates were >80% from each provider team. There were significant differences in interprofessional team comfort with nurses feeling less well informed and comfortable with the intubation plan and process compared to physicians and RTs (p < 0.001 for both). Qualitative themes including clear communication, adequate planning and preparation prior to procedure initiation, and clear definition of roles emerged among both affirmative and constructive comments.

Conclusions

Exploration of provider perceptions and emergence of constructive themes expose opportunities for teamwork improvement strategies involving intubations in the PICU. The use of a preintubation checklist may improve organization and communication amongst team members, increase provider morale, decrease team stress levels, and, ultimately, may improve patient outcomes during this high stakes, coordinated event.

How to enrich team research in healthcare by considering five theoretical perspectives

The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.

No size fits all - a qualitative study of factors that enable adaptive capacity in diverse hospital teams

Introduction

Resilient healthcare research studies how healthcare systems and stakeholders adapt and cope with challenges and changes to enable high quality care. By examining how performance emerges in everyday work in different healthcare settings, the research seeks to receive knowledge of the enablers for adaptive capacity. Hospitals are defined as complex organizations with a large number of actors collaborating on increasingly complexity tasks. Consequently, most of today's work in hospitals is team based. The study aims to explore and describe what kind of team factors enable adaptive capacity in hospital teams.

Methods

The article reports from a multiple embedded case study in two Norwegian hospitals. A case was defined as one hospital containing four different types of teams in a hospital setting. Data collection used triangulation of observation (115 h) and interviews (30), followed by a combined deductive and inductive analysis of the material.

Results

The study identified four main themes of team related factors for enabling adaptive capacity; (1) technology and tools, (2) roles, procedures, and organization of work, (3) competence, experience, knowledge, and learning, (4) team culture and relations.

Discussion

Investigating adaptive capacity in four different types of teams allowed for consideration of a range of team types within healthcare and how the team factors vary within and across these teams. All of the four identified team factors are of importance in enabling adaptive capacity, the various attributes of the respective team types prompt differences in the significance of the different factors and indicates that different types of teams could need diverse types of training, structural and relational emphasis in team composition, leadership, and non-technical skills in order to optimize everyday functionality and adaptive capacity.

Professional Fulfillment, Burnout, and Turnover Intention Among US Dialysis Patient Care Technicians: A National Survey

RATIONALE & OBJECTIVE

High professional fulfillment and low burnout and staff turnover are necessary for a stable dialysis workforce. We explored professional fulfillment, burnout, and turnover intention among US dialysis patient care technicians (PCTs).

STUDY DESIGN

Cross-sectional national survey.

SETTING & PARTICIPANTS

National Association of Nephrology Technicians/Technologists (NANT) members in March-May 2022 (N=228; 42.6% aged 35-49 years, 83.9% female, 64.6% White, 85.3% non-Hispanic).

EXPOSURE

Likert-scale items (range, 0-4) related to professional fulfillment and 2 domains of burnout (work exhaustion and interpersonal disengagement) and dichotomous items related to turnover intention.

ANALYTICAL APPROACH

Summary statistics (percentages, means, medians) were calculated for individual items and average domain scores. Burnout was defined by combined work exhaustion and interpersonal disengagement scores of≥1.3 and professional fulfillment by a score≥3.0.

RESULTS

Most respondents (72.8%) worked ≥40 hours per week. Overall scores for work exhaustion, interpersonal disengagement, and professional fulfillment (median [IQR]) were 2.3 (1.3-3.0), 1.0 (0.3-1.8), and 2.6 (2.0-3.2), respectively; 57.5% reported burnout, and 37.3% reported professional fulfillment. Important contributors to burnout and professional fulfillment included salary (66.5%), supervisor support (64.0%), respect from other dialysis staff (57.8%), sense of purpose about work (54.5%), and hours worked per week (52.9%). Only 52.6% reported that they plan to be working as a dialysis PCT in 3 years. Free text responses reinforced perceived excessive work burden and lack of respect.

LIMITATIONS

Limited generalizability to all US dialysis PCTs.

CONCLUSIONS

More than half of dialysis PCTs reported burnout, driven by work exhaustion; only about one-third reported professional fulfillment. Even among this relatively engaged group of dialysis PCTs, only half intended to continue working as PCTs. Because of the critical, frontline role of dialysis PCTs in the care of patient receiving in-center hemodialysis, strategies to improve morale and reduce turnover are imperative.

Interdisciplinary and interprofessional communication intervention: How psychological safety fosters communication and increases patient safety

Background

Effective teamwork and communication are imperative for patient safety and quality care. Communication errors and human failures are considered the main source of patient harm. Thus, team trainings focusing on communication and creating psychologically safe environments are required. This can facilitate challenging communication and teamwork scenarios, prevent patient safety risks, and increase team performance perception. The sparse research concerning communication interventions calls for an understanding of psychological mechanisms. Therefore, this study investigated mechanisms of an interpersonal team intervention targeting communication and the relation of psychological safety to patient safety and team performance perception based on the applied input-process-output model of team effectiveness.

Methods

Before and after a 4-h communication intervention for multidisciplinary teams, a paper-pencil survey with N = 137 healthcare workers from obstetric units of two university hospitals was conducted. Changes after the intervention in perceived communication, patient safety risks, and team performance perception were analyzed via t-tests. To examine psychological mechanisms regarding psychological safety and communication behavior, mediation analyses were conducted.

Results

On average, perceived patient safety risks were lower after the intervention than before the intervention (M_T1 = 3.220, SD_T1 = 0.735; M_T2 = 2.887, SD_T2 = 0.902). This change was statistically significant (t (67) = 2.760, p =.007). However, no such effect was found for interpersonal communication and team performance perception. The results illustrate the mediating role of interpersonal communication between psychological safety and safety performances operationalized as perceived patient safety risks (α1∗β1 = -0.163, 95% CI [-0.310, -0.046]) and team performance perception (α1∗β1 = 0.189, 95% CI [0.044, 0.370]).

Discussion

This study demonstrates the psychological mechanisms of communication team training to foster safety performances and psychological safety as an important predecessor for interpersonal communication. Our results highlight the importance of teamwork for patient safety. Interpersonal and interprofessional team training represents a novel approach as it empirically brings together interpersonal communication and collaboration in the context of patient safety. Future research should work on follow-up measures in randomized-controlled trials to broaden an understanding of changes over time.

Improved neonatal outcomes by multidisciplinary simulation-a contemporary practice in the demonstration area of China

Background

Simulation-based training improves neonatal resuscitation and decreases perinatal mortality in low- and middle-income countries. Interdisciplinary in-situ simulation may promote quality care in neonatal resuscitation. However, there is limited information regarding the effect of multidisciplinary in-situ simulation training (MIST) on neonatal outcomes. We aimed to investigate the impact of MIST on neonatal resuscitation in reducing the incidence of neonatal asphyxia and related morbidities.

Methods

Weekly MIST on neonatal resuscitation has been conducted through neonatal and obstetrical collaboration at the University of Hong Kong-Shenzhen Hospital, China, since 2019. Each simulation was facilitated by two instructors and performed by three health care providers from obstetric and neonatal intensive care units, followed by a debriefing of the participants and several designated observers. The incidence of neonatal asphyxia, severe asphyxia, hypoxic-ischemic encephalopathy (HIE), and meconium aspiration syndrome (MAS) before (2017-2018) and after (2019-2020) the commencement of weekly MIST were analyzed.

Results

There were 81 simulation cases including the resuscitation of preterm neonates of different gestational ages, perinatal distress, meconium-stained amniotic fluid, and congenital heart disease with 1,503 participant counts (225 active participants). The respective incidence of neonatal asphyxia, severe asphyxia, HIE, and MAS decreased significantly after MIST (0.64%, 0.06%, 0.01%, and 0.09% vs. 0.84%, 0.14%, 0.10%, and 0.19%, respectively, all P < 0.05).

Conclusions

Weekly MIST on neonatal resuscitation decreased the incidence of neonatal asphyxia, severe asphyxia, HIE, and MAS. Implementation of regular resuscitation simulation training is feasible and may improve the quality of neonatal resuscitation with better neonatal outcomes in low- and middle-income countries.

Transforming Team Culture: A Case Study From Critical Care

Interprofessional team conflict amplifies division and impedes patient care. Normal differences of opinion escalate to frank conflicts when members respond with indignation or resentment. These behaviors engender a workplace culture that degrades collaborative clinical management and patient safety. We describe the impacts of dysfunctional team culture along with interventions that can lead to more productive teams. In our case study, an interprofessional group of critical care clinicians recognized that their interactions impaired collaborative care and requested support. Two experts, a nurse and a physician, facilitated two 2-h workshops with 18 critical care physicians, nurses, and fellows to begin transforming their dysfunctional unit culture. After establishing psychological safety, facilitators introduced the learning pathways grid to explore (1) how faulty assumptions lead to dysfunctional interactions and suboptimal results and (2) how new assumptions informed by new insights enable teams to redesign their interactions. Through reflection and analysis, clinicians concluded that understanding other clinicians' goals and perspectives benefits patients and families, helps clinicians feel valued, and fosters mutual trust. This exercise supports interprofessional teams to transform dysfunctional interactions by helping team members to develop a mindset of humility and inquiry and to remind themselves about the good intentions in others. To address conflict, we offer a conversational approach grounded in curiosity, respect, and transparency. Ultimately, the most important communication strategy for effective critical care is caring about the perspectives and experiences of other members of the interprofessional team.

Assessment of interprofessional obstetric and midwifery care from the midwives' perspective using the Interprofessional Collaboration Scale (ICS)

Introduction

Interprofessional collaboration of physicians and midwives is essential for appropriate and safe care of pregnant and parturient women as well as their newborns. The complexity of woman-centered care settings requires the continuous exchange of information and the coordinated implementation of multi-and interprofessional care concepts. To analyze the midwives' perspective on the multi-and interprofessional care process during pregnancy, birth and postpartum period, we aimed to adapt and psychometrically evaluate the Interprofessional Collaboration Scale (ICS).

Methods

The ICS (13 items) was answered by 299 midwives for (i) prenatal and postpartum care as well as (ii) perinatal care. Three items on equitable communication (EC) identified in qualitative interviews with N = 6 midwives were added as further aspects of quality in collaborative midwifery care. Confirmatory factor analysis was used to test competing theoretically hypothesized factorial model structures, including both care settings simultaneously, i.e., birth and prenatal/postpartum.

Results

A two-dimensional structure assuming the 13 original ICS items and the 3 items on EC as psychometric distinct item groups accounts for the data best. After deleting 5 ICS items with insufficient indicator reliability, a very good-fitting model structure was obtained for both prenatal/postpartum as well as perinatal care: χ²_df = 192 = 226.35, p = 0.045, CFI = 0.991, RMSEA = 0.025 (90%CI: [0.004; 0.037]). Both the reduced ICS-R and the EC scale (standardized response mean = 0.579/1.401) indicate significantly higher interprofessional collaboration in the birth setting. Responsibility in consulting, attitudes toward obstetric care and frequency of collaboration with other professional groups proved to be associated with the ICS-R and EC scale as expected.

Discussion

For the adapted ICS-R and the EC scale a good construct validity could be confirmed. Thus, the scales can be recommended as a promising assessment for recording the collaboration of midwives with physicians working in obstetric care from the perspective of midwives. The instrument provides a validated assessment basis in midwifery and obstetric care to identify potentially divergent perspectives within interprofessional care teams in woman's centered care.

Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes

BACKGROUND

Standard precautions may prevent patient health care associated infections and provider occupational exposures but are not often used by health care workers. A positive patient safety climate might contribute to improved adherence. The aim of this study was to determine the relationships among patient safety climate, standard precaution adherence, and health care worker exposures and HAIs.

METHODS

This multi-site, cross-sectional study included survey data from nurses on patient safety climate, observational data on adherence, and existing health care worker exposure and health care associated infections data. Data were aggregated to hospital unit level for correlational and multivariable regression analyses.

RESULTS

A total of 5,285 standard precaution observations and 452 surveys were collected across 43 hospital units. Observed adherence to all categories of standard precautions was 64.4%; there were significant differences by provider role. Multivariable models identified key predictors explaining sizeable variance in methicillin-resistant Staphylococcus aureus (41%), catheter associated urinary tract infections (23%), mucotaneous exposures (43%) and needlestick and sharps injuries (38%).

DISCUSSION

This study produced findings not previously published thus advancing the state of the science in patient and occupational health safety. These include identifying modifiable features of the safety climate and key organizational characteristics associated better outcomes.

CONCLUSIONS

In this novel study we identified that a positive patient safety climate and adherence to standard precautions predict key HAI and occupational health outcomes.

Psychosocial Processes in Healthcare Workers: How Individuals' Perceptions of Interpersonal Communication Is Related to Patient Safety Threats and Higher-Quality Care

Interpersonal communication, as a central form of social resource derived from social relations, is crucial for individuals coping with threats in the workplace, especially for hospitals that provide high-quality care and patient safety. Using social system mentalization as a theoretical background, we applied psychosocial processes and a psychodynamic system approach to get insights on how healthcare workers interact with team members and patients. The goal was to test the following hypotheses: H1: Better communication is associated with fewer patient safety threats (H1a) and higher-quality care (H1b). H2: The associations between communication and patient safety threats (H2a) and higher-quality care (H2b) are mediated by psychological safety. In this two-studies design, we conducted a cross-sectional hospital survey (N = 129) and a survey of obstetric team members (N = 138) in Germany. Simple mediation analyses were run. Results revealed that communication is associated with safety performance. Further, the mediating effect of psychological safety between communication and safety performance was demonstrated. These findings contribute to an understanding of social relation representations, as individuals' communication interrelates with safety performance mediated by psychological safety to complement healthcare and public health strategies. With a better understanding of communication and psychological safety, tools, routines, and concrete trainings can be designed.

Exploring healthcare staff narratives to gain an in-depth understanding of changing multidisciplinary team power dynamics during the COVID-19 pandemic

BACKGROUND

Multidisciplinary teams (MDTs) are integral to healthcare provision. However, healthcare has historically adopted a hierarchical power structure meaning some voices within the MDT have more influence than others. While power dynamics can influence interprofessional communication and care coordination, the field's understanding of these power structures during the COVID-19 pandemic is limited.

METHODS

Adopting a narrative inquiry methodology, this research addresses this knowledge gap and provides an in-depth understanding of MDT power dynamics during COVID-19. Using semi-structured interviews (n = 35) and inductive thematic analysis, this research explores staff perspectives of changing power dynamics in MDTs during the pandemic response.

RESULTS

An in-depth analysis generated three overarching themes: (1) Healthcare: a deeply embedded hierarchy reveals that while a hierarchical culture prevails within the Irish health system, staff perceptions of influence in MDTs and 'real' experiences of autonomy differ significantly. (2) Team characteristics: the influence of team structure on MDT power dynamics highlights the impact of organisational structures (e.g., staff rotations) and local processes (e.g., MDT meeting structure) on collaborative practice. (3) Ongoing effort to stimulate true collaboration underscores the importance of ongoing interprofessional education to support collaborative care.

CONCLUSION

By offering a greater understanding of MDT power dynamics throughout the COVID-19 pandemic, this research supports the development of more appropriate strategies to promote the provision of interprofessional care in practice.

COVID-19 pandemic: a qualitative study with an opportunity-centric approach from an ICU perspective in a teaching hospital. Upsides worth to secure?

OBJECTIVES

During the COVID-19 pandemic, the staff in the intensive care unit (ICU) was materially, physically and emotionally challenged. This qualitative study investigated the effects that ICU staff experienced and were considered of value to be permanently implemented.

SETTING

ICU in an university medical centre during the first wave of the COVID-19 pandemic.

DESIGN

An opportunity-centric approach was applied in individual semi-structured interviews to optimise the achieved results and was guided by the theoretical model of appreciative inquiry (AI).

PARTICIPANTS

Fifteen ICU staff members (8 nurses and 7 intensivists) participated.

RESULTS

Working during the COVID-19 pandemic catalysed interprofessional collaboration and team learning in the ICU on an individual and team level, centred around a common goal: taking care of critically ill patients with COVID-19. The effect of interprofessional collaboration was that provisions were taken care of quicker than usual, without bureaucratic delays. However, this effect was experienced to be transient. Also, ICU staff perceived limited possibilities to help patients and families around the palliative phase, and they perceived a lack of appreciation from higher management. This is a point of future attention: how to make this perceived lack of appreciation more visible to all (ICU) staff.

CONCLUSION

Regarding our primary question, the ICU staff voiced that the direct communication and collaboration are the most important elements of the COVID-19 peak they would like to preserve. Furthermore, it was learnt that consolation and support for family members should not be forgotten. Considering the results, we believe that further research concerning team reflexivity might contribute to (or enhance) our knowledge about working together during and after a crisis.

In situ simulation-based team training and its significance for transfer of learning to clinical practice-A qualitative focus group interview study of anaesthesia personnel

BACKGROUND

Anaesthesia personnel are an integral part of an interprofessional operating room-team; hence, team-based training in non-technical skills (NTS) are important in preventing adverse events. Quite a few studies have been done on interprofessional in situ simulation-based team training (SBTT). However, research on anaesthesia personnel's experiences and the significance for transfer of learning to clinical practice is limited. The aim of this study is to explore anaesthesia personnel's experience from interprofessional in situ SBTT in NTS and its significance for transfer of learning to clinical practice.

METHODS

Follow-up focus group interviews with anaesthesia personnel, who had taken part in interprofessional in situ SBTT were conducted. A qualitative inductive content analysis was performed.

RESULTS

Anaesthesia personnel experienced that interprofessional in situ SBTT motivated transfer of learning and provided the opportunity to be aware of own practice regarding NTS and teamwork. One main category, 'interprofessional in situ SBTT as a contributor to enhance anaesthesia practice' and three generic categories, 'interprofessional in situ SBTT motivates learning and improves NTS', 'realism in SBTT is important for learning outcome', and 'SBTT increases the awareness of teamwork' illustrated their experiences.

CONCLUSIONS

Participants in the interprofessional in situ SBTT gained experiences in coping with emotions and demanding situations, which could be significant for transfer of learning essential for clinical practice. Herein communication and decision-making were highlighted as important learning objectives. Furthermore, participants emphasized the importance of realism and fidelity and debriefing in the learning design.

Interprofessional communication in the hospital setting : a systematic review of the qualitative literature

Communication plays a key role in the provision of safe patient care, and miscommunication in healthcare can lead to avoidable patient harm or mortality. Interprofessional communication (IPCom) can be challenging due to differences in training, education and roles between healthcare professions. The aim of this systematic review was to synthesize the qualitative evidence regarding healthcare providers' perceptions of interprofessional communication in the hospital setting. Four databases (PubMed, CINAHL, Web of Science, and Embase) were searched for studies that met the inclusion criteria. Eighteen studies were identified as suitable for inclusion in the review and were examined using thematic synthesis. Thematic synthesis led to the development of five descriptive themes: 1) 'Hierarchy", 2) "Interprofessional Ethos," 3) "Healthcare Environment," 4) "Personal Factors" and 5) "Methods of Communication," and two overarching analytical themes: "Barriers to Communication" and "Facilitators to Communication." Personal factors, such as strong interprofessional relationships, were found to be important facilitators to IPCom, while organizational factors, such as challenging and hierarchical working environments, were found to pose barriers to IPCom.

Hospital Mortality and Trainee Experiences: How General Medical Council Survey Findings Correlate With Summary Hospital-Level Mortality Indicator

OBJECTIVES

This study aimed to investigate whether components of junior doctor satisfaction are associated with patient mortality within the United Kingdom.

METHODS

We conducted a cross-sectional study of publicly available data (the General Medical Council [GMC] National Survey and the Summary Hospital-level Mortality Indicator [SHMI]) pertaining to subjective physician trainee satisfaction and patient mortality within 80 United Kingdom-based healthcare institutions. The direction and strength of correlation between components of the GMC National Survey and relative patient mortality as described by the SHMI were calculated. Additional outcomes included mean GMC survey scores for reported domains and mean SHMI by healthcare institution.

RESULTS

SHMI for included healthcare institutions ranged from 0.69 to 1.21 (mean [SD], 1.01 [0.1]). Mean GMC domain scores ranged between 44.61 and 88.62 (mean [SD], 71.16 [10.84]). Statistically significant correlations were observed for clinical supervision, clinical supervision out of hours, rota design, overall satisfaction, and teamwork. After application of Bonferroni correction, statistically significant correlations remained for both clinical supervision and clinical supervision out of hours.

CONCLUSIONS

There is a significant association between components of subjective trainee satisfaction and patient mortality within the United Kingdom. Further investigation to examine these relationships, perhaps to target intervention, may prevent avoidable patient harm.

Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review

The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams.

Factors influencing pharmacist interest and preparedness to work as on-site aged care pharmacists: Insights from qualitative analysis of free-text survey responses

BACKGROUND

High rates of suboptimal medication use exist in residential aged care facilities (RACFs). Pharmacist interventions can improve medication appropriateness. In 2023 there will be a phased implementation of pharmacists working on-site in Australian RACFs.

OBJECTIVE

To explore factors influencing Australian pharmacists' interest and perceived preparedness to work as on-site pharmacists in RACFs.

METHODS

A national cross-sectional anonymous online survey of Australian pharmacists was conducted. Pharmacists were recruited using a broad advertising strategy. The 36-question survey included three free-text questions that are the focus of this study. The questions asked participants (1) what influenced their interest in the role, (2) what influenced how prepared they felt for the role, and (3) if they had any other comments about the role. Responses were thematically analysed by two investigators using an inductive approach.

RESULTS

Most survey respondents (n=546, 84.9%) answered at least one free-text questions. Four factors influenced interest: on-site pharmacist role, aged care setting, individual pharmacist circumstances and employment model. Four factors influenced preparedness: familiarity with aged care setting, resident-level clinical skills; ability to communicate and work with a multidisciplinary team, and experience with system-level quality use of medicines activities. Four factors important for successful roll-out emerged from the 'other comments': pharmacist attributes, pharmacist workforce planning, resources and support, and RACF stakeholder engagement.

CONCLUSION

Key factors influencing pharmacist interest and preparedness to work on-site in RACFs and factors important for success were identified. These findings will support the national roll-out of the role, particularly as most identified factors are currently modifiable.