1
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Angelilli S. Stop the Line: Interventions to Prevent Retained Surgical Items. AORN J 2024; 120:71-81. [PMID: 39073151 DOI: 10.1002/aorn.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/15/2023] [Accepted: 10/23/2023] [Indexed: 07/30/2024]
Abstract
The surgical team works collaboratively to prevent the occurrence of retained surgical items (RSIs). The purpose of this quality improvement project was to increase compliance with facility policies and improve teamwork skills to prevent the occurrence of RSIs. The project team implemented an evidence-based communication protocol, updated hospital network policies, introduced just-in-time job aids, and facilitated leader support through a daily huddle to address identified practice gaps. The TeamSTEPPS Teamwork Attitudes Questionnaire was used to measure the change in staff members' attitudes about teamwork before and after project implementation. Additional process and outcome measures included the number of near misses and actual RSIs, compliance with the daily huddle, and completion of the communication training. Results included improved perceived teamwork attitude scores and zero reports of actual RSI events over 7.5 weeks.
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2
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Makic MBF. Sustaining healthy work environments: Embracing best evidence to inform practice. Nurs Manag (Harrow) 2024; 55:51-54. [PMID: 38951729 DOI: 10.1097/nmg.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Affiliation(s)
- Mary Beth Flynn Makic
- Mary Beth Flynn Makic is a professor and the Clinical Nurse Specialist Program Director at the College of Nursing, University of Colorado, Anschutz Medical Campus in Aurora, Colo
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3
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Ghanmi N, Bondok M, Etherington C, Saddiki Y, Lefebvre I, Berthelot P, Dion PM, Raymond B, Seguin J, Sekhavati P, Islam S, Boet S. Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies. Cureus 2024; 16:e60522. [PMID: 38883070 PMCID: PMC11180536 DOI: 10.7759/cureus.60522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regarding the actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.
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Affiliation(s)
- Nibras Ghanmi
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Mostafa Bondok
- Department of Anesthesiology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, CAN
| | | | | | | | | | | | - Jeanne Seguin
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | | | - Sindeed Islam
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, CAN
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4
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Letvak S, Apple B, Jenkins M. Factors Affecting Perioperative Nurse Adherence to Ergonomic Safety Measures. AORN J 2024; 119:210-221. [PMID: 38407344 DOI: 10.1002/aorn.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 02/27/2024]
Abstract
AORN has identified safety risks unique to the perioperative setting and has developed ergonomic safety measures to help prevent musculoskeletal injuries and disorders. Little is known about adherence to these safety measures or the perceived barriers and facilitators to adherence. This study used a cross-sectional survey to determine the prevalence of pain and occurrence of musculoskeletal injuries and disorders. We asked perioperative staff members about their perceived barriers and facilitators to adherence with safety measures. A total of 155 perioperative nurses in one health system completed the online survey (55% response rate). Most (93%) had experienced at least one musculoskeletal injury or disorder or related pain. Years worked as a perioperative nurse and having neck pain were associated with safety measure adherence. The most reported barrier to safety measure adherence was inadequate staffing. Study findings highlight the need for increased attention to the physical workload demands in the perioperative setting.
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5
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Ostroff C. Social science and teams: a patient perspective. Colorectal Dis 2024; 26:386-391. [PMID: 38247217 DOI: 10.1111/codi.16871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/10/2023] [Indexed: 01/23/2024]
Abstract
Teamwork is fundamental for providing high quality care and providing positive experiences for patients. Concepts from organisational behaviour and social science are integrated with a patient perspective to elucidate how various aspects of teams impact on the patient experience. Particular attention is devoted to the team composition, the interaction and communication patterns among team members, how teams are structured, coordination among team members, facilitating a positive team climate, and considering patients as a member of the team.
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Affiliation(s)
- Cheri Ostroff
- Business, University of South Australia, Adelaide, South Australia, Australia
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6
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Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
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.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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7
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Turcotte M, Etherington C, Rowe J, Duong A, Kaur M, Talbot Z, Mansour F, Mohamed J, Zahrai A, Fournier K, Boet S. Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review. J Interprof Care 2023; 37:904-921. [PMID: 36373205 DOI: 10.1080/13561820.2022.2137116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/15/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.
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Affiliation(s)
- Michelle Turcotte
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer Rowe
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Ann Duong
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Manvinder Kaur
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Zoé Talbot
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Fadi Mansour
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Janna Mohamed
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - Amin Zahrai
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Canada
- Translational and Molecular Medicine Program, University of Ottawa, Ottawa, Canada
- Department of Innovation in Medical Education, University of Ottawa Ottawa Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa Ottawa Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Education, University of Ottawa, Ottawa, Canada
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8
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Lim PJH, Chen L, Siow S, Lim SH. Facilitators and barriers to the implementation of surgical safety checklist: an integrative review. Int J Qual Health Care 2023; 35:mzad086. [PMID: 37847116 DOI: 10.1093/intqhc/mzad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
Surgical procedures pose an immense risk to patients, which can lead to various complications and adverse events. In order to safeguard patients' safety, the World Health Organization initiated the implementation of the Surgical Safety Checklist (SSC) in operating theatres worldwide. The aim of this integrative review was to summarize and evaluate the use and implementation of SSC, focusing on facilitators and barriers at the individual, professional, and organizational levels. This review followed closely the integrative review method by Whittemore and Knafl. An English literature search was conducted across three electronic databases (PubMed, CINAHL, and EMBASE) and other hand search references. Keywords search included: 'acute care', 'surgical', 'adult patients', 'pre-operative', 'intra-operative', and 'post-operative'. A total of 816 articles were screened by two reviewers independently and all articles that met the pre-specified inclusion criteria were retained. Data extracted from the articles were categorized, compared, and further analysed. A total of 34 articles were included with the majority being observational studies in developed and European countries. Checklists had been adopted in various surgical specialities. Findings indicated that safety checklists improved team cohesion and communication, resulting in enhanced patient safety. This resulted in high compliance rates as healthcare workers expressed the benefits of SSC to facilitate safety within operating theatres. Barriers included manpower limitations, hierarchical culture, lack of staff involvement and training, staff resistance, and appropriateness of checklist. Common facilitators and barriers at individual, professional, and organizational levels have been identified. Staff training and education, conducive workplace culture, timely audits, and appropriate checklist adaptations are crucial components for a successful implementation of the SSC. Methods have also been introduced to counter barriers of SSC.
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Affiliation(s)
- Petrina Jia Hui Lim
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Lin Chen
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Serene Siow
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Siew Hoon Lim
- Nurse Clinician, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
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9
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Huang Y, Eden J, Ivanova E, Burdet E. Can Training Make Three Arms Better Than Two Heads for Trimanual Coordination? IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:148-155. [PMID: 38274776 PMCID: PMC10810309 DOI: 10.1109/ojemb.2023.3305808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/05/2023] [Accepted: 08/08/2023] [Indexed: 01/27/2024] Open
Abstract
Supernumerary effectors have been proposed to enable users to perform tasks alone that normally require assistance from a partner. While various supernumerary robotic limbs have been developed in the last decade, the capability of users to operate them effectively has not yet been proven. Here we tested whether users (i) can complete a task that requires simultaneous and fine control of three effectors, and (ii) can be trained to do so with similar or superior performance as through collaboration with a human partner. As in previous studies, initial augmented capability was less than that of working with a partner. However, one hour of dedicated solo trimanual training across three days significantly increased task performance, so that participants became able to perform trimanual control alone as well as or better than they could with a new partner. This shows the viability of augmentation systems for applications such as in robotic surgery or industrial assembly, which can be further validated on real tasks with physical systems.
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Affiliation(s)
- Yanpei Huang
- Department of BioengineeringImperial College of Science Technology, MedicineSW7 2BXLondonU.K.
| | - Jonathan Eden
- Department of BioengineeringImperial College of Science Technology, MedicineSW7 2BXLondonU.K.
- Department of Mechanical EngineeringUniversity of MelbourneParkvilleVIC3052Australia
| | - Ekaterina Ivanova
- Department of BioengineeringImperial College of Science Technology, MedicineSW7 2BXLondonU.K.
- School of Electronic Engineering, Computer ScienceQueen Mary University of LondonE1 4NSLondonU.K.
| | - Etienne Burdet
- Department of BioengineeringImperial College of Science Technology, MedicineSW7 2BXLondonU.K.
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10
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Thomas T, Hampton D, Butler K, Hudson JL. Assessing the Value of Huddle Implementation in the Perioperative Setting. AORN J 2023; 118:14-23. [PMID: 37368531 DOI: 10.1002/aorn.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 06/29/2023]
Abstract
Communication is essential for safe, effective patient care. In perioperative services, where interdisciplinary teamwork is crucial, communication breakdowns may lead to increased errors, decreased staff member satisfaction, and poor team performance. This process improvement project focused on instituting perioperative huddles for two months and measuring the effect that they had on staff members' satisfaction, engagement, and communication effectiveness. We used validated, Likert-style survey tools to gauge participants' satisfaction, level of engagement, communication practices, and opinions about the value of huddles before and after implementation, in addition to an open-ended descriptive question in the postsurvey. Sixty-one participants completed the presurvey and 24 participants completed the postsurvey. Scores across all categories increased post huddle implementation. Benefits of the huddles noted by participants included timely and consistent messaging, sharing essential information, and increased feelings of connection between perioperative leaders and staff members.
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11
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Paquette S, Kilcullen M, Hoffman O, Hernandez J, Mehta A, Salas E, Greilich PE. Handoffs and the challenges to implementing teamwork training in the perioperative environment. Front Psychol 2023; 14:1187262. [PMID: 37397334 PMCID: PMC10310998 DOI: 10.3389/fpsyg.2023.1187262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.
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Affiliation(s)
- Shannon Paquette
- Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
| | - Molly Kilcullen
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Olivia Hoffman
- Division of Critical Care Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jessica Hernandez
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ankeeta Mehta
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Philip E. Greilich
- Department of Anesthesiology and Pain Management, Health System Chief Quality Office, Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
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12
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Acquadro Maran D, Minniti D, Presutti M, Alesina M, Brizio A, Gatti P. Workplace Bullying among Healthcare Professionals: A Quanti-Qualitative Survey in a Sample of Women Working in an Italian Healthcare Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105859. [PMID: 37239585 DOI: 10.3390/ijerph20105859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
The main objective of this study was to analyze, in a sample of female healthcare workers in Italy, the training needs to improve positive relationships in the healthcare organization. To better understand these needs, perceived workplace bullying and its consequences in terms of professional commitment and well-being were analyzed from a descriptive and quantitative perspective (or mixed-methods analysis). A questionnaire was completed online in a healthcare facility in northwestern Italy. The participants were 231 female employees. The quantitative data showed that, on average, the sampled population perceived a low burden of WPB. The majority of the sample expressed moderate engagement at work and moderate perception of psychological well-being. It is interesting to note that one element seemed to be overarching in the responses to the open-ended questions: communication, which emerged as a problematic element that affects the entire organization. The research data provide useful evidence for intervention in favor of an environment that helps to recognize the phenomenon and intervene in time, offering the possibility of accepting the discomfort and fatigue of healthcare workers and offering useful interventions to the individual and the team.
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Affiliation(s)
| | - Davide Minniti
- Azienda Sanitaria Locale Torino3, Collegno, 10093 Torino, Italy
| | | | - Marta Alesina
- Azienda Sanitaria Locale Torino3, Collegno, 10093 Torino, Italy
| | - Adelina Brizio
- Department of Psychology, Università di Torino, Via Verdi 10, 10124 Torino, Italy
- Department of Chemistry, Università di Torino, Via Pietro Giuria 7, 10125 Torino, Italy
| | - Paola Gatti
- Department of Psychology, Università degli Studi di Milano-Bicocca, 20126 Milano, Italy
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Rogers L, De Brún A, McAuliffe E. Exploring healthcare staff narratives to gain an in-depth understanding of changing multidisciplinary team power dynamics during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:419. [PMID: 37127626 PMCID: PMC10150666 DOI: 10.1186/s12913-023-09406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
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.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland.
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland
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14
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Crafford L, Kusurkar RA, Bronkhorst E, Gous A, Wouters A. Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa. BMC Health Serv Res 2023; 23:290. [PMID: 36978062 PMCID: PMC10044779 DOI: 10.1186/s12913-023-09222-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors. METHODS An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital. RESULTS The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities. CONCLUSION The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.
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Affiliation(s)
- L Crafford
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands.
| | - R A Kusurkar
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - E Bronkhorst
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Ags Gous
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - A Wouters
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Arad D, Finkelstein A, Rozenblum R, Magnezi R. Patient safety and staff psychological safety: A mixed methods study on aspects of teamwork in the operating room. Front Public Health 2022; 10:1060473. [PMID: 36620282 PMCID: PMC9816421 DOI: 10.3389/fpubh.2022.1060473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To predict the amount of teamwork that takes place throughout a surgery, based on performing a preoperative safety standards (surgical safety checklist and surgical count) and to explore factors affecting patient safety and staff psychological safety during a surgery, based on interprofessional teamwork. Methods This mixed methods study included quantitative and qualitative analyses. Quantitative data included 2,184 direct observations of surgical cases with regard to the performance of safety standards during surgeries in 29 hospitals, analyzed using multivariate binary logistic regressions. Qualitative data were obtained from an analysis of 25 semi-structured interviews with operating room (OR) clinicians and risk managers, using an inductive thematic analysis approach. Results Analysis of the OR observations revealed that a lack of teamwork in the preoperative "sign-in" phase doubled the chances of there being a lack of teamwork during surgery [odds ratio = 1.972, 95% confidence interval (CI) 1.741, 2.233, p < 0.001] and during the "time-out" phase (odds ratio = 2.142, 95% CI 1.879, 2.441, p < 0.001). Consistent presence of staff during surgery significantly increased teamwork, by 21% for physicians and 24% for nurses (p < 0.05), but staff turnover significantly decreased teamwork, by 73% for physicians (p < 0.05). Interview data indicated that patient safety and staff psychological safety are related to a perception of a collaborative team role among OR staff, with mutual commitment and effective interprofessional communication. Conclusions Healthcare organizations should consider the key finding of this study when trying to identify factors that affect teamwork during a surgery. Effective preoperative teamwork positively affects intraoperative teamwork, as does the presence of more clinicians participating in a surgery, with no turnover. Other factors include working in a fixed, designated team, led by a surgeon, which functions with effective interprofessional communication that promotes patient safety and staff psychological safety.
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Affiliation(s)
- Dana Arad
- Health System Management Department, Bar-Ilan University, Ramat Gan, Israel,Patient Safety Division, Ministry of Health, Jerusalem, Israel,*Correspondence: Dana Arad ✉
| | - Adi Finkelstein
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Ronen Rozenblum
- Brigham and Women's Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - Racheli Magnezi
- Health System Management Department, Bar-Ilan University, Ramat Gan, Israel
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Muacevic A, Adler JR, Burns P, Fecteau G, Desrochers A, Frasch MG. Factors Determining the Success of the Chronically Instrumented Non-anesthetized Fetal Sheep Model of Human Development: A Retrospective Cohort Study. Cureus 2022; 14:e32632. [PMID: 36660509 PMCID: PMC9845535 DOI: 10.7759/cureus.32632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background The chronically instrumented non-anesthetized fetal sheep (CINAFS) model has been a mainstay of human fetal development research for the past 60 years. As a large "two for one" animal model, involving the instrumentation of the ewe and her fetus, the model poses challenges to implement de novo and maintain overtime at the highest standards of operating procedures to ensure ongoing performance. A common yet conventionally underreported issue researchers face is a high rate of animal loss. Here, we investigate what determines the success of the CINAFS model of human development. Methods We conducted a retrospective cohort analysis consisting of 82 experiments spanning the course of six years. Our team identified 10 variables that we anticipated were likely to influence the experimental outcome, such as the time of year, animal size, and surgical complexity. To evaluate the role of each variable in contributing to the success of the model, a binary logit regression analysis with a Fisher scoring optimization was fit to the data (SAS, V9 engine, release 3.8, SAS Institute, Cary, NC, USA). A higher predictive probability indicates a larger impact by the given variable on the outcome of the experiment. A Wald chi-squared analysis was run on the data to control for confounders and determine significance. Results The single variable identified in this study as determining the success of experiment outcomes using the CINAFS model is the experience level of the team. Conclusion The CINAFS model offers enormous potential to further our understanding of human fetal development and create interventional technologies related to fetal health. However, to improve experimental outcomes using the CINAFS model, stronger communication and training are needed. We discuss the implications of our findings for the successful implementation of this challenging yet scientifically advantageous animal model of human physiology.
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Lentz CM, De Lind Van Wijngaarden RAF, Willeboordse F, Hooft L, van der Laan MJ. Dedicated teams to optimize quality and safety of surgery: A systematic review. Int J Qual Health Care 2022; 34:6749998. [PMID: 36299250 PMCID: PMC9606443 DOI: 10.1093/intqhc/mzac078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/31/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background A dedicated operating team is defined as a surgical team consisting of the same group of people working together over time, optimally attuned in both technical and/or communicative aspects. This can be achieved through technical and/or communicative training in a team setting. A dedicated surgical team may contribute to the optimization of healthcare quality and patient safety within the perioperative period. Method A systematic review was conducted to evaluate the effects of a dedicated surgical team on clinical and performance outcomes. MEDLINE and Embase were searched on 23 June 2022. Both randomized controlled trials (RCTs) and non-randomized studies (NRSs) were included. Primary outcomes were mortality, complications and readmissions. Secondary outcomes were costs and performance measures. Results Fourteen studies were included (RCTs n = 1; NRSs n = 13). Implementation of dedicated operating teams was associated with improvements in mortality, turnover time, teamwork, communication and costs. No significant differences were observed in readmission rates and length of hospital stay. Results regarding duration, glitch counts and complications of surgery were inconclusive. Limitations include study conduct and heterogeneity between studies. Conclusions The institution of surgical teams who followed communicative and/or technical training appeared to have beneficial effects on several clinical outcome measures. Dedicated teams provide a feasible way of improving healthcare quality and patient safety. A dose–response effect of team training was reported, but also a relapse rate, suggesting that repetitive training is of major concern to high-quality patient care. Further studies are needed to confirm these findings, due to limited level of evidence in current literature. Prospero registration number CRD42020145288
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Affiliation(s)
- C M Lentz
- Address reprint requests to: C.M. Lentz, Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands. Tel: +31611171984; E-mail:
| | - R A F De Lind Van Wijngaarden
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands,Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - F Willeboordse
- Knowledge Institute of Medical Specialists, Mercatorlaan 1200, Utrecht 3528 BL, The Netherlands
| | - L Hooft
- Cochrane Netherlands/Julius Center for Health Sciences and Primary Care, University, Utrecht Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - M J van der Laan
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
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AORN Position Statement on a Healthy Perioperative Practice Environment. AORN J 2021. [DOI: 10.1002/aorn.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sillero Sillero A, Buil N. Enhancing Interprofessional Collaboration in Perioperative Setting from the Qualitative Perspectives of Physicians and Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010775. [PMID: 34682520 PMCID: PMC8535564 DOI: 10.3390/ijerph182010775] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 12/16/2022]
Abstract
Communication failures were a leading cause of sentinel events in the operation room due to frequently the communication breakdown occurs between physicians and nurses. This study explored the perspectives of surgical teams (nurses, physicians, and anaesthesiologists) on interprofessional collaboration and improvement strategies. A surgical team comprising eight perioperative nurses, four surgeons, and four anaesthesiologists from a university-affiliated hospital participated in this qualitative and phenomenological research from December 2018 to April 2019. Data were collected in in-depth interviews and were used in a thematic analysis according to Colaizzi to extract themes and categorised codes with the ATLAS.ti software. The result is presented in three generic categories: Barrier-like disruptive behaviours and lack of coordination of care; consequences by safety threats to the patient; overcoming barriers by shared decision making among professionals, flattened hierarchies, and teamwork/communication training. The conclusion is that different teams’ perspectives can facilitate genuine reflection, discussion, and implementation of targeted interventions to improve operating room interprofessional collaboration and overcome barriers and their consequences. Currently, there is a need to change towards interprofessional collaboration for optimal patient outcomes and to ensure all professionals’ expectations are met.
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Affiliation(s)
- Amalia Sillero Sillero
- Nursing School of Mar (ESimar), University of Pompeu Fabra, 08003 Barcelona, Spain
- Correspondence:
| | - Neus Buil
- Department of Perioperative Nursing, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
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