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Zhou L, Sun Y, Wang J, Huang H, Luo J, Zhao Q, Xiao M. Trends in patient safety education research for healthcare professional students over the past two decades: a bibliometric and content analysis. MEDICAL EDUCATION ONLINE 2024; 29:2358610. [PMID: 38861669 PMCID: PMC11168337 DOI: 10.1080/10872981.2024.2358610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/17/2024] [Indexed: 06/13/2024]
Abstract
Research and practice in patient safety education have garnered widespread attention; however, a comprehensive bibliometric analysis is lacking. This study aimed to provide a comprehensive understanding of the research focus and research trends in the globalization of the field of patient safety education and to describe the general characteristics of publications. Data on articles and reviews about student safety education were extracted from Web of Science. Microsoft Excel 2019, CiteSpace 6.1.R3, VOSviewer 1.6.18, SATI 3.2, Scimago Graphica, and Pajek were used for quantitative analysis. Collaboration networks of countries, institutions, journals, authors, and keywords were visualized based on publications from January 2000 to September 2022. A total of 573 papers were published between 2000 to 2022, showing an overall increasing trend. The USA, England, and Australia are the top three most prolific countries; Johns Hopkins University, the University of Technology Sydney, and the University of Toronto are the top three most productive institutions; Nurse Education Today, Journal of Nursing Education, and BMC Medical Education are the most productive journals; Based on content analysis five research hotspots focused on: (1) Quality Improvement of Patient safety Teaching and Learning; (2) Patient safety Teaching Content; (3)Specialized Teaching in Patient Safety; (4) Integrating Patient Safety and Clinical Teaching; (5)Patient Safety Teaching Assessment Content. Through keyword clustering analysis, five research hotspots and relevant contents were identified. According to this study, simulation, communication, collaboration, and medication may attract more attention from researchers and educators, and could be the major trend for future study.
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Affiliation(s)
- Lu Zhou
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yinsong Sun
- Orthopaedic Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Wang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Luo
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Urology Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Austen K, Hutchinson M, Hurley J. Promoting speaking-up behaviours among nurses working in the care for older people: A scoping review. J Clin Nurs 2024; 33:3854-3868. [PMID: 38685802 DOI: 10.1111/jocn.17199] [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: 12/19/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
AIM To explore interventions employed to foster speaking-up behaviours of registered nurses (RNs) working in the care of older people. DESIGN Scoping review. METHODS The updated Joann Briggs Institute scoping review methodological guidelines were followed. DATA SOURCES CINAHL, PubMed, PsycINFO, and Scopus were searched. RESULTS A total of 1691 titles and abstracts were screened, resulting in 11 articles that met the inclusion criteria. Analysis focused upon intervention types, methodologies, speaking up strategies, barriers and effectiveness. Education was the most used intervention. CONCLUSION There is a lack of published research on successful interventions to promote speaking-up behaviours in the care of older people, particularly relating to poor care practices. Evidence of speaking-up interventions in the residential aged care setting is absent. This highlights the need to develop strategies to support the RN to lead and enable others to raise care concerns. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Developing strategies that enable staff, care recipients and their families to speak up about care concerns is a vital future area for nursing practice development. Nursing leadership of such strategies is central to improving the quality of care for older people, particularly those living in residential aged care. IMPACT Older people receiving care should feel respected and be treated humanely. Evidence suggests this is often not the case. This review found a paucity of interventions to promote speaking-up about poor care practices among RNs working in the care of older people. Future research needs to address this, to empower RNs and improve the care afforded to older people. REPORTING METHOD The PRISMA-ScR (Tricco et al., Annals of Internal Medicine, 169, 467-473, 2018) were adhered to throughout this scoping review. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in this review.
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Affiliation(s)
- Katrina Austen
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Marie Hutchinson
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
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Dybdal Kayser J, Kjær Ersbøll A, Kolbe M, Østergaard D, Dieckmann P. Medical Students' Speak-Up Barriers: A Randomized Controlled Trial With Written Vignettes. J Patient Saf 2024; 20:323-329. [PMID: 38506474 DOI: 10.1097/pts.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Little is known about medical students' speak-up barriers upon recognizing or becoming aware of risky or deficient actions of others. Improving our knowledge on these helps in preparing student to function in actual health care organizations. The aim was to examine medical students' perceived reasons for silence in respect to different speak-up situations (i.e., vignette content) and to test if vignette difficulty had an effect on reasons indicated. METHODS This study was a randomized, controlled, single-blind trial, with text-based vignettes to investigate speak-up barriers. Vignette contents described speak-up situations that varied systematically with respect to speak-up barrier (i.e., environmental norm, uncertainty, hierarchy) and difficulty (i.e., easy, difficult). For each vignette, participants indicated which speak-up barriers they regarded as important.Descriptive analysis was performed for the study population, the numbers of barriers perceived and rating of vignette difficulty. Logistic regression analysis was used to examine the association between barriers perceived and vignette contents, designed vignette difficulty and subjectively rated vignette difficulty. RESULTS A total of 265 students were included. The response rate was 100%. Different barriers were relevant for the different vignettes and varied in a consistent way with the theme of the vignette. Significantly more speak-up barriers were indicated for participants with the difficult version for vignette 1 (not an environmental norm) and vignette 3 (hierarchy) with odds ratio (OR) = 1.52 and 95% confidence interval (95% CI: 1.33-1.73) and OR = 1.25 (95% CI: 1.09-1.44). For (OR) estimates, confidence intervals were rather large. CONCLUSIONS Perceived barriers for speak-up vary consistently with the characteristics of the situation and more barriers preventing speak-up were related to the difficult versions of the vignettes.
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Affiliation(s)
- Jesper Dybdal Kayser
- From the Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark
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Seidel-Fischer J, Trifunovic-Koenig M, Gerber B, Otto B, Bentele M, Fischer MR, Bushuven S. Interaction between overconfidence effects and training formats in nurses' education in hand hygiene. BMC Nurs 2024; 23:451. [PMID: 38956561 PMCID: PMC11218338 DOI: 10.1186/s12912-024-02020-w] [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: 08/13/2023] [Accepted: 05/16/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Undergraduate training in hand hygiene is a keystone of infection control. Several studies have shown overconfidence effects in hand hygiene practices, which can impair metacognition. We hypothesized that overconfidence might be prevalent in the early education stages of nursing students and that these effects could be reduced through frequent interactive learning formats, such as learning groups. METHODS We conducted a multicenter cross-sectional questionnaire with 196 German nursing students, including general, surgical, and anesthetic nursing specializations. RESULTS Overconfidence was observed in nursing students across all specialties and years of education. The cluster analyses showed three different types of learners: two characterized by overconfidence and one demonstrating justifiable confidence. Furthermore, the moderation analysis indicated that providing feedback and promoting metacognition regarding students' learning achievements could mitigate overplacement, particularly through the frequent implementation of interactive teaching formats. DISCUSSION Despite some limitations, these findings highlight the prevalence of overconfidence effects in nursing students, the presence of different learning profiles, and the importance of incorporating feedback within interactive learning formats concerning hand hygiene. Accordingly, educators need to be trained and supervised to deliver these learning formats and provide feedback to students effectively.
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Affiliation(s)
- Julia Seidel-Fischer
- Academy for Health Care Professionals, Health Care Association District of Constance, Constance, Germany
| | - Milena Trifunovic-Koenig
- Training Center for Emergency Medicine (NOTIS e.V), 78224, Engen, Germany.
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, Rhein-Main University of Applied Sciences, Wiesbaden, Germany.
| | - Bianka Gerber
- Training Center for Emergency Medicine (NOTIS e.V), 78224, Engen, Germany
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee Hospital, Singen, Germany
| | - Baerbel Otto
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
- Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Bentele
- Training Center for Emergency Medicine (NOTIS e.V), 78224, Engen, Germany
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee Hospital, Singen, Germany
| | - Martin R Fischer
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stefan Bushuven
- Training Center for Emergency Medicine (NOTIS e.V), 78224, Engen, Germany
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Namadi F, Alilu L, Habibzadeh H. Nurses' experiences of reporting the medical errors of their colleagues: a qualitative study. BMC Nurs 2024; 23:415. [PMID: 38902743 PMCID: PMC11188494 DOI: 10.1186/s12912-024-02092-8] [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: 03/23/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Medical error is a leading cause of disability and death in healthcare settings and reporting colleagues' medical errors is one of the main strategies for medical error management and an ethical responsibility of all healthcare providers, including nurses. Most studies into reporting colleagues' medical errors used quantitative designs while it seems that using qualitative designs can provide better insight in this area. PURPOSE This study explored nurses' experiences of reporting the medical errors of their colleagues. METHODS This qualitative study was conducted using the conventional content analysis approach. Participants were 22 hospital nurses purposively selected in 2021-2022 from different cities in Iran. Twenty-two in-depth semi-structured interviews were held for data collection. The data were analyzed via Graneheim and Lundman's conventional content analysis and trustworthiness was maintained using the criteria proposed by Guba and Lincoln. FINDINGS The main categories of the study were burnout and intention to leave the profession and growth and development. The two subcategories of the first category were the experience of injury and the experience of violence and the two subcategories of the second category were sense of worthiness and sense of motivation. Moral distress was the most important experience of almost all participants. CONCLUSION Nurses mostly have negative experiences in terms of reporting their colleagues' medical errors. Negative experiences can act as the barriers to report colleagues' errors while positive experiences can act as its facilitators. Improvement of the patient safety culture in healthcare settings and interpersonal relationships among healthcare providers can reduce the negative experiences and promote the positive experiences of reporting colleagues' medical errors.
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Affiliation(s)
- Farideh Namadi
- Patient Safety Research Center, Clinical Research Institute, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Leyla Alilu
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hossein Habibzadeh
- Patient Safety Research Center, Clinical Research Institute, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Chung S, Hwang JI. [Development of the Hospital Nurses' Silence Behavior Scale]. J Korean Acad Nurs 2024; 54:279-295. [PMID: 38863194 DOI: 10.4040/jkan.23138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/08/2024] [Accepted: 05/01/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE This study aimed to develop a scale to measure hospital nurses' silence behavior and examine its validity and reliability. METHODS A total of 52 preliminary items on hospital nurses' silence behavior were selected using a content validity test by seven experts on 53 candidate items derived from a literature review and in-depth interviews with 14 nurses. A total of 405 hospital nurses participated in a psychometric testing. Data analysis comprised item analysis, exploratory and confirmatory factor analyses, and convergent and discriminant validity tests. Pearson's correlation coefficient was used for assessing concurrent validity, and Cronbach's alpha was used for the reliability test. RESULTS The final scale consisted of nine factors with 31 items, exhibiting acceptable model fit indices, convergent validity, and discriminant validity. The score of the entire scale was positively correlated with the 'Organizational Silence Scale (OSS)-the issues on which nurses remain silent' (r = .60, p < .001) and 'OSS-the reasons why nurses remain silent' (r = .68, p < .001). Cronbach's α of the scale was .92, and α of each subscale ranged from .71 to .90. CONCLUSION The Hospital Nurses' Silence Behavior Scale is a useful tool for assessing multifaceted silence behavior among nurses. It can provide basic data for developing better communication strategies among nurses and other hospital staff.
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Affiliation(s)
- Soojin Chung
- Department of Nursing, Suwon Science College, Hwaseong, Korea
| | - Jee-In Hwang
- College of Nursing Science, Kyung Hee University, Seoul, Korea.
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Ahn S, Kim DE. Adaptation and validation of a Korean version of the speaking up about patient safety questionnaire (KSUPS-Q). BMC Nurs 2024; 23:293. [PMID: 38685014 PMCID: PMC11057173 DOI: 10.1186/s12912-024-01891-3] [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: 10/13/2023] [Accepted: 03/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Speaking up by healthcare providers is an essential assertive communication strategy for ensuring patient safety and preventing incidents. However, more is needed to know about speaking up and instruments to assess it in the Korean context. Therefore, we assessed the psychometric properties of the Korean version of the Speaking Up about Patient Safety Questionnaire (KSUPS-Q) for measuring speaking up-related behavior and climate among nurses. METHODS The translation and adaptation process followed the guidelines of the International Society for Pharmacoeconomics and Outcomes Research and the World Health Organization. Content validity was assessed by a six-member expert panel using the content validity index. In total, 314 nurses participated in an online survey to examine the psychometric properties. Internal consistencies were tested using Cronbach's alpha and McDonald's omega. Confirmatory factor analyses were conducted to examine the subscales' construct. The convergent validity of the speaking up-related climate scale was assessed by testing correlations with teamwork and safety climate domains of the Safety Attitudes Questionnaire. In addition, we investigated the convergent validity of the speaking up-related behavior scale by examining its correlation with the climate scale. RESULTS The reliability of the 11-item behavior scale was satisfactory. Confirmatory factor analysis confirmed that a three-subscale model (perceived concerns, withholding voice, and speaking up) was appropriate (CFI = 0.98, TLI = 0.98, and SRMR = 0.05). Furthermore, the 11-item climate scale demonstrated satisfactory internal consistency. A three-subscale model (psychological safety, encouraging environment, and resignation) was confirmed (CFI = 0.98, TLI = 0.97, and SRMR = 0.05). The convergent validity of the climate scale was verified based on correlations with the teamwork (r = 0.68, p < 0.001) and safety climate (r = 0.68, p < 0.001) domains of the Safety Attitudes Questionnaire. In addition, speaking up-related behavior and climate showed a significant association, indicating that the behavior scale is conceptually valid. CONCLUSIONS This study demonstrates that the KSUPS-Q is a valid and reliable instrument in Korea. This instrument can help nurse managers simultaneously monitor the behavior and climate of their organizations and evaluate the outcomes of interventions to enhance speaking up. Future research is needed to explore diverse factors contributing to speaking up, including clinical roles, team relationships, and supportive culture, to identify areas requiring further improvement.
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Affiliation(s)
- Shinae Ahn
- Department of Nursing, Wonkwang University, Jeonbuk, Republic of Korea
| | - Da Eun Kim
- College of Nursing and Research Institute of Nursing Innovation, Kyungpook National University, Daegu, Republic of Korea.
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Tedone AM, Lanz JJ. Staying silent during a crisis: How workplace factors influence safety decisions in U.S. nurses. Soc Sci Med 2024; 341:116548. [PMID: 38171213 DOI: 10.1016/j.socscimed.2023.116548] [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: 11/04/2022] [Revised: 11/16/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
RATIONALE It is critical for healthcare organizations to promote upward communication of safety information to ensure safety issues experienced on the work floor are promptly identified and addressed, especially during crisis events. OBJECTIVE This study investigates mechanisms through which workplace factors affect nurses' motivation to speak up about safety issues, and ultimately their safety behaviors, in a pandemic work environment. METHOD The work experiences of 152 frontline U.S. nurses were captured across three time-points during the height of a global pandemic. RESULTS Findings indicate that nurses who experienced a greater frequency of pandemic-related demands and/or perceived a greater social risk associated with voicing concerns were more likely to remain silent about safety issues due to job-related constraints or a fear of negatively impacting their reputation, respectively. As a consequence, nurses were more likely to bypass safety protocols while completing work tasks, especially those who had a lower risk propensity. CONCLUSION These findings advance the literature on workplace safety by investigating factors that affect employee communication and ultimately safety workarounds in nurses within the context of a global pandemic.
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Affiliation(s)
| | - Julie J Lanz
- Department of Psychology, University of Nebraska at Kearney, USA
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Kane J, Munn L, Kane SF, Srulovici E. Defining Speaking Up in the Healthcare System: a Systematic Review. J Gen Intern Med 2023; 38:3406-3413. [PMID: 37670070 PMCID: PMC10682351 DOI: 10.1007/s11606-023-08322-0] [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: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Communication issues have been shown to contribute to healthcare errors. For years healthcare professionals have been told to "speak up." What "speak up" means is unclear, as it has been defined and operationalized in many ways. Thus, this study aimed to systematically review the literature regarding definitions and measurements of speaking up in the healthcare system and to develop a single, comprehensive definition and operationalization of the concept. METHODS PubMed, CINAHL, PsychoInfo, and Communication/Mass Media Complete databases were searched from 1999 to 2020. Publications were included if they mentioned speaking up for patient safety or any identified synonyms. Articles that used the term speaking up concerning non-health-related topics were excluded. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 294 articles met the inclusion criteria, yet only 58 articles focused on speaking up. While the most common synonym terms identified were "speak up" and "raise concern," only 43 articles defined speaking up. Accordingly, a modified definition was developed for speaking up-A healthcare professional identifying a concern that might impact patient safety and using his or her voice to raise the concern to someone with the power to address it. DISCUSSION Speaking up is considered important for patient safety. Yet, there has been a lack of agreement on the definition and operationalization of speaking up. This review demonstrates that speaking up should be reconceptualized to provide a single definition for speaking up in healthcare.
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Affiliation(s)
- Julia Kane
- School of Nursing, Fayetteville State University, Fayetteville, NC, USA
| | - Lindsay Munn
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shawn F Kane
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
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Stutz L, Koertgen B, Scheier T, Klaentschi T, Junge H, Kolbe M, Grande B. Improving compliance with isolation measures in the operating room: a prospective simulation study comparing the effectiveness and costs of simulation-based training vs video-based training. J Hosp Infect 2023; 141:167-174. [PMID: 37696472 DOI: 10.1016/j.jhin.2023.07.027] [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: 03/22/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Different isolation measures are required according to the routes of transmission of pathogens. Few studies have compared different forms of hygiene training in terms of efficiency and/or improvement of perception towards hygiene measures. This study aimed to evaluate the benefits of different forms of isolation training in the operating room, and their respective effects on the perception of hygiene measures by comparing simulation training with video-based training. METHODS This multi-centre, prospective, randomized, controlled trial compared hygiene knowledge, psychological safety and perception of training among healthcare workers after in-centre simulation training and conventional video-based training. RESULTS Neither type of training led to a significant improvement in knowledge or perceived psychological safety (F=0.235, P=0.629, η2=0.003). Participants in the simulation group reported higher levels of willingness to speak up in the depicted scenario compared with participants who received video-based training. Participants perceived the simulation-based training significantly more positively than the video-based training. CONCLUSION Clear definition of the goals of training based on the pre-existing level of knowledge of the participants is crucial. For future studies, it would be interesting to investigate the long-term effect and continuing benefits concerning the implementation of hygiene regulations after different types of training.
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Affiliation(s)
- L Stutz
- Institute of Anaesthesiology, Cantonal Hospital Grisons, Chur, Switzerland
| | - B Koertgen
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - T Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - T Klaentschi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - H Junge
- Institute of Anaesthesiology, Cantonal Hospital Grisons, Chur, Switzerland; Grisons Institute for Patient Safety and Simulation, Chur, Switzerland
| | - M Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - B Grande
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
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Barlow M, Watson B, Jones E, Maccallum F, Morse KJ. The influence of professional identity on how the receiver receives and responds to a speaking up message: a cross-sectional study. BMC Nurs 2023; 22:26. [PMID: 36710343 PMCID: PMC9884599 DOI: 10.1186/s12912-023-01178-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Research focused on understanding what enables or hinders health professionals to speak up about a safety concern has been to date predominately atheoretical and speaker focused. However, the role the receiver of the message plays in these often-difficult encounters is highly influential. To date, speaking up programs have created conversational mnemonics that technically should respectfully engage the receiver, yet speaking up remains challenging. This paper utilises Communication Accommodation Theory to explore the impact the communication behaviour and speaker characteristics has on the receiver of a speaking up message, and if these impacts differ between receiver groups (clinical disciplines). METHOD Clinicians (N = 208) from varying disciplines responded to two hypothetical speaking up vignettes, where participants were the receivers of speaking up messages. Analysis of variance was used to explore any potential differences between receiver groups. RESULTS Findings indicated that the level of perceived accommodation and group membership, whether defined by speaker discipline or seniority, collectively influenced how the receiver of a speaking up message evaluated the interaction, which influenced their anticipated response to the speaker. CONCLUSIONS The receiver's perceptions and evaluations of the message, their own professional identity and the presence of others, influenced receivers' anticipated responses. This has direct implications on healthcare speaking up training and provision of care, as the varying clinical disciplines received and responded to the same messages differently.
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Affiliation(s)
- Melanie Barlow
- Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, QLD Australia
- School of Psychology, University of Queensland, St Lucia, QLD Australia
| | - Bernadette Watson
- School of Psychology, University of Queensland, St Lucia, QLD Australia
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Elizabeth Jones
- School of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan Malaysia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St Lucia, QLD Australia
| | - Kate J. Morse
- College of Nursing & Health Professions, Drexel University, 245 N 15th Street, Mail Stop 501, 4th Floor, Room 4606, Philadelphia, PA 19102 USA
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Lee M, Ong YH, Martimianakis MA. Ideological dilemmas of healthcare professionals who do not speak up at interprofessional team meetings. J Interprof Care 2023; 37:1-10. [PMID: 35285379 DOI: 10.1080/13561820.2022.2037530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In healthcare settings, speaking up is considered essential for patient safety. Indeed, voice opportunities are widely available mandatory mechanisms for speaking up at the routine interprofessional team meetings of our study site. Yet, healthcare professionals in team meetings often do not go beyond straightforward reporting of test results and biomedical-functional parameters, suggesting that members with psycho-social information related to the patient are not participating fully in team meetings. Post-meeting interviews with some of the team members revealed the moments of silence and the ideological contradictions underlying team discussions. We explored silences and contradictions as argumentative meanings inherent in naturally occurring speech. The identification of opposing meanings tells of ideological dilemmas that may explain why healthcare practitioners do not speak up vigorously. We identified three such dilemmas: the ideology of working in teams versus the ideology of working solo; the ideology of autonomy versus the ideology of paternalism; and the ideology of collectivism versus the ideology of individuality. The dilemmas made visible the dimensions of silence as well as silencing as an imposition of silence from above. We suggest focussing on mapping disciplinary and interpretive differences and their effects amongst team members may motivate voice. Further studies should explore the affective dimensions of silence in interprofessional team meetings.
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Affiliation(s)
- Mary Lee
- Health Outcomes & Medical Education Research, National Healthcare Group, Singapore
| | - Yu Han Ong
- Health Outcomes & Medical Education Research, National Healthcare Group, Singapore
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Hoffmann M, Schwarz CM, Schwappach D, Banfi C, Palli C, Sendlhofer G. Speaking up about patient safety concerns: view of nursing students. BMC Health Serv Res 2022; 22:1547. [PMID: 36536431 PMCID: PMC9761031 DOI: 10.1186/s12913-022-08935-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND "Speaking up" is considered an important patient safety behaviour. The main idea is to voice patient safety concerns; however, several studies revealed that the organisational culture can be obstructive. In previous studies, we already identified barriers for doctors, nurses and medical students. In the current study, we explore how nursing students use "speaking up" during their internship in an academic teaching hospital. METHODS Between 2019 and 2020, 212 nursing students were invited to take part in the survey. The validated Speaking Up about Patient Safety Questionnaire (SUPS-Q) was used to assess speaking up behaviours in nursing students. The SUPS-Q consisted of three behaviour related scales (11 items), three culture related scales (11 items), a question regarding barriers to speak up as well as a clinical vignette assessing a hypothetical speaking up situation. RESULTS In total, 118 nursing students took part in the survey (response rate: 56%). Most of them noticed specific safety concerns, observed errors or rule violations. The vignette was seen as very realistic and harmful to the patient. However, the majority responded that they did not speak up and remained silent. They reported a rather discouraging environment and high levels of resignation towards speaking up. However, more advanced students were less likely to speak up than less advanced students (p = 0.027). Most relevant barriers were fear of negative reaction (64%), reaction not predictable (62%) and ineffectiveness (42%). CONCLUSIONS Survey results of nursing students imply that speaking-up behaviours and remaining silent are common behaviours and coexist in the same individual. The clinical vignette and barriers to speaking up revealed that a hierarchical system does not support speaking-up behaviours. Organizational development is needed to foster professional teamwork, support attentive listening, encourage critical thinking, and problem-solving skills.
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Affiliation(s)
- Magdalena Hoffmann
- grid.411580.90000 0000 9937 5566Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036 Graz, Austria ,grid.11598.340000 0000 8988 2476Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Christine Maria Schwarz
- grid.411580.90000 0000 9937 5566Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036 Graz, Austria ,grid.11598.340000 0000 8988 2476Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - David Schwappach
- grid.5734.50000 0001 0726 5157Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Chiara Banfi
- grid.11598.340000 0000 8988 2476Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - Christoph Palli
- grid.452085.e0000 0004 0522 0045Institute of Health Care and Nursing, University of Applied Sciences FH Joanneum, Alte Poststrasse 149, 8020 Graz, Austria
| | - Gerald Sendlhofer
- grid.411580.90000 0000 9937 5566Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036 Graz, Austria ,grid.11598.340000 0000 8988 2476Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
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Bushuven S, Trifunovic-Koenig M, Bentele M, Bentele S, Strametz R, Klemm V, Raspe M. Self-Assessment and Learning Motivation in the Second Victim Phenomenon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16016. [PMID: 36498086 PMCID: PMC9736892 DOI: 10.3390/ijerph192316016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The experience of a second victim phenomenon after an event plays a significant role in health care providers' well-being. Untreated; it may lead to severe harm to victims and their families; other patients; hospitals; and society due to impairment or even loss of highly specialised employees. In order to manage the phenomenon, lifelong learning is inevitable but depends on learning motivation to attend training. This motivation may be impaired by overconfidence effects (e.g., over-placement and overestimation) that may suggest no demand for education. The aim of this study was to examine the interdependency of learning motivation and overconfidence concerning second victim effects. METHODS We assessed 176 physicians about overconfidence and learning motivation combined with a knowledge test. The nationwide online study took place in early 2022 and addressed about 3000 German physicians of internal medicine. Statistics included analytical and qualitative methods. RESULTS Of 176 participants, 83 completed the assessment. Analysis showed the presence of two overconfidence effects and in-group biases (clinical tribalism). None of the effects correlated directly with learning motivation, but cluster analysis revealed three different learning types: highly motivated, competent, and confident "experts", motivated and overconfident "recruitables", and unmotivated and overconfident "unawares". Qualitative analysis revealed four main themes: "environmental factors", "emotionality", "violence and death", and "missing qualifications" contributing to the phenomenon. DISCUSSION We confirmed the presence of overconfidence in second victim management competencies in about 3% of all persons addressed. Further, we could detect the same three learning motivation patterns compared to preceding studies on learning motivation in other medical competencies like life support and infection control. These findings considering overconfidence effects may be helpful for safety managers, medical teachers, curriculum developers and supervisors to create preventive educational curricula on second victim recognition and management.
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Affiliation(s)
- Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78262 Gailingen, Germany
- Institute for Medical Education, University Hospital, LMU Munich, 80336 Munich, Germany
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Milena Trifunovic-Koenig
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78262 Gailingen, Germany
- Training Center for Emergency Medicine (NOTIS e.V.), 78234 Engen, Germany
| | - Michael Bentele
- Training Center for Emergency Medicine (NOTIS e.V.), 78234 Engen, Germany
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee Hospital Singen, 78224 Singen, Germany
| | - Stefanie Bentele
- Training Center for Emergency Medicine (NOTIS e.V.), 78234 Engen, Germany
- Department of Emergency Medicine, University-Hospital Augsburg, University of Augsburg, 86156 Augsburg, Germany
| | - Reinhard Strametz
- Wiesbaden Business School, Rhein Main University of Applied Sciences, 65183 Wiesbaden, Germany
| | - Victoria Klemm
- Wiesbaden Business School, Rhein Main University of Applied Sciences, 65183 Wiesbaden, Germany
| | - Matthias Raspe
- Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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15
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Hu P, Bhuiyan MA, Rahman MK, Hossain MM, Akter S. Impact of COVID-19 pandemic on consumer behavioural intention to purchase green products. PLoS One 2022; 17:e0275541. [PMID: 36260619 PMCID: PMC9581351 DOI: 10.1371/journal.pone.0275541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
This study examined the fear of COVID-19 pandemic and its impact on consumer behavioural intention to purchase green products. The data was collected from consumers of Malaysia in hypermarkets. A total of 491 respondents were analyzed using the partial least square technique. The results indicated that the fear of the COVID-19 epidemic has a significant impact on health concerns, social media information, intolerance of uncertainty, and personal relevance, which in turn affect consumers' behavioural intention to purchase green products. With a serial mediating effect the results identified that fear of COVID-19 epidemic is associated with behavioural intention to purchase the green product. The findings of this study are crucial for understanding the swings in the green product purchase behaviour due to the ongoing uncertainty of COVID-19 crisis.
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Affiliation(s)
- Ping Hu
- School of Economics, South China Business College of Guangdong University of Foreign Studies, Beijing International Aerotropolis Technology Research Institute Guangzhou Branch, Guangzhou, China
| | - Miraj Ahmed Bhuiyan
- School of Economics, Guangdong University of Finance and Economics, Guangzhou, China
| | - Muhammad Khalilur Rahman
- Faculty of Entrepreneurship and Business, and Angkasa-Umk Research Academy, Universiti Malaysia Kelantan, Kota Bharu, Malaysia
| | | | - Shaharin Akter
- Faculty of Business Administration, University of Chittagong, Chittagong, Bangladesh
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16
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Ortiz-López N, Ponce-Arancibia S, Olea-Gangas C, Chacano-Muñoz R, Arancibia-Carvajal S, Solis I. Determinants of the intention to speak up about medical error in primary healthcare settings in Chile. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1202-e1211. [PMID: 34431150 DOI: 10.1111/hsc.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 06/29/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
Medical error frequently occurs in ambulatory care, and healthcare professionals may encounter situations in which they need to speak up to ensure better practice. This study aims to investigate the factors that influenced the intention to speak up about medical errors among healthcare professionals in primary care settings. Data were generated through a national cross-sectional survey of primary healthcare centres in the Republic of Chile. A research instrument was designed using the constructs of the theory of planned behaviour and was analysed using the structural equation model technique. In total, 203 healthcare professionals were recruited between March and May 2020. The model showed that the intention to speak up was directly and positively influenced by attitudes towards speaking up and perceived control (standard deviation [SD] = 0.284 and 0.576, respectively). Subjective norms indirectly and negatively influenced the intention to speak up through attitudes towards speaking up and perceived control (total effect SD = -0.303). The exploratory construct of willingness to change self-behaviour positively influenced the attitude towards behaviour. The intention to speak up strongly influenced the speaking up behaviour (total effect SD = 0.631). The proposed model explained 40% of the variance in behaviour. Based on this model, it was concluded that the intention to speak up strongly influenced the speaking up behaviour and predicted it by 40%. Factors that modify the intention to speak up are expected to influence the occurrence of this behaviour. This knowledge will inform strategies to enhance communication among healthcare professionals, improve speaking up behaviour and improve patient care.
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Affiliation(s)
| | | | | | | | - Sara Arancibia-Carvajal
- Institute of Basic Sciences, Faculty of Engineering and Sciences, Diego Portales University, Santiago, Chile
| | - Ivan Solis
- University of Chile School of Medicine, Santiago, Chile
- Department of Medicine, University of Chile Clinical Hospital, Santiago, Chile
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17
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Trifunovic-Koenig M, Bushuven S, Gerber B, Otto B, Dettenkofer M, Salm F, Fischer MR. Correlation between Overconfidence and Learning Motivation in Postgraduate Infection Prevention and Control Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095763. [PMID: 35565171 PMCID: PMC9100152 DOI: 10.3390/ijerph19095763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 01/27/2023]
Abstract
Introduction: Training in hand hygiene for health care workers is essential to reduce hospital-acquired infections. Unfortunately, training in this competency may be perceived as tedious, time-consuming, and expendable. In preceding studies, our working group detected overconfidence effects in the self-assessment of hand hygiene competencies. Overconfidence is the belief of being better than others (overplacement) or being better than tests reveal (overestimation). The belief that members of their profession are better than other professionals is attributable to the clinical tribalism phenomenon. The study aimed to assess the correlation of overconfidence effects on hand hygiene and their association with four motivational dimensions (intrinsic, identified, external, and amotivation) to attend hand hygiene training. Methods: We conducted an open online convenience sampling survey with 103 health care professionals (physicians, nurses, and paramedics) in German, combining previously validated questionnaires for (a) overconfidence in hand hygiene and (b) learning motivation assessments. Statistics included parametric, nonparametric, and cluster analyses. Results: We detected a quadratic, u-shaped correlation between learning motivation and the assessments of one’s own and others’ competencies. The results of the quadratic regressions with overplacement and its quadratic term as predictors indicated that the model explained 7% of the variance of amotivation (R2 = 0.07; F(2, 100) = 3.94; p = 0.02). Similarly, the quadratic model of clinical tribalism for nurses in comparison to physicians and its quadratic term explained 18% of the variance of amotivation (R2 = 0.18; F(2, 48) = 5.30; p = 0.01). Cluster analysis revealed three distinct groups of participants: (1) “experts” (n1 = 43) with excellent knowledge and justifiable confidence in their proficiencies but still motivated for ongoing training, and (2) “recruitables” (n2 = 43) who are less competent with mild overconfidence and higher motivation to attend training, and (3) “unawares” (n3 = 17) being highly overconfident, incompetent (especially in assessing risks for incorrect and omitted hand hygiene), and lacking motivation for training. Discussion: We were able to show that a highly rated self-assessment, which was justified (confident) or unjustified (overconfident), does not necessarily correlate with a low motivation to learn. However, the expert’s learning motivation stayed high. Overconfident persons could be divided into two groups: motivated for training (recruitable) or not (unaware). These findings are consistent with prior studies on overconfidence in medical and non-medical contexts. Regarding the study’s limitations (sample size and convenience sampling), our findings indicate a need for further research in the closed populations of health care providers on training motivation in hand hygiene.
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Affiliation(s)
- Milena Trifunovic-Koenig
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance (GLKN), 78315 Konstanz, Germany; (M.T.-K.); (M.D.); (F.S.)
| | - Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance (GLKN), 78315 Konstanz, Germany; (M.T.-K.); (M.D.); (F.S.)
- Hegau-Jugendwerk Hospital Gailingen, Health Care Association District of Constance (GLKN), 78262 Konstanz, Germany
- Institute of Medical Education, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany;
- Correspondence: or ; Tel.: +49-(0)-7732-88-870
| | - Bianka Gerber
- Institute of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee-Hospital Singen, Health Care Association District of Constance (GLKN), 78224 Singen, Germany;
| | - Baerbel Otto
- Institute of Medical Education, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany;
- Institute of Laboratory Medicine, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany;
| | - Markus Dettenkofer
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance (GLKN), 78315 Konstanz, Germany; (M.T.-K.); (M.D.); (F.S.)
| | - Florian Salm
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance (GLKN), 78315 Konstanz, Germany; (M.T.-K.); (M.D.); (F.S.)
| | - Martin R. Fischer
- Institute of Medical Education, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany;
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Niederhauser A, Schwappach DLB. Speaking up or remaining silent about patient safety concerns in rehabilitation: A cross‐sectional survey to assess staff experiences and perceptions. Health Sci Rep 2022; 5:e631. [PMID: 35509405 PMCID: PMC9059171 DOI: 10.1002/hsr2.631] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/04/2022] [Accepted: 04/17/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - David L. B. Schwappach
- Swiss Patient Safety Foundation Zurich Switzerland
- Institute of Social and Preventive Medicine (ISPM) University Bern Bern Switzerland
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19
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Watson BM, Wu XI. Sentinel Events and Miscommunication What do we know in 2021: A Language and Social Psychology Framework. HEALTH COMMUNICATION 2022:1-10. [PMID: 35209746 DOI: 10.1080/10410236.2022.2031451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The paper explored the extent to which hospital appointed official root cause analysis (RCA) panels consider antecedent and proximal events when they investigate communication related sentinel events (CRSEs) in hospitals. It also explored which CRSEs are most common in the hospital setting in Hong Kong and the communication modes most commonly associated with CRSEs. The data consisted of Risk Alert and Annual Report on SEs issued by the Hong Kong Hospital Authority from October 2007 to September 2017. Over the period studied, there were 379 reported sentinel events (SEs). In 186 of these SEs we identified communication as a contributing factor. We examined the RCA panels' reports on contributing factors and subsequent recommendations in these 186 SEs and found that their recommendations only highlighted the proximal contributing factors and not antecedent factors that may be relevant. RCA panels most often recommended that communication should be enhanced or documentation improved. We propose that it is time to review the RCA process to recognize that many CRSEs may occur because of antecedent factors that result from the complex hospital organizational structure and its associated hierarchical culture. We suggest two ways forward, 1) applying a language and social psychology perspective to the investigations of CRSEs and, 2) the involvement of experts from different disciplines who can work with clinicians during RCA investigations.
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Affiliation(s)
- Bernadette M Watson
- Department of English and Communication, The International Research Centre for the Advancement of Health Communication, The Hong Kong Polytechnic University
| | - Xiaoyan Ivy Wu
- Department of English and Communication, The International Research Centre for the Advancement of Health Communication, The Hong Kong Polytechnic University
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20
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Eng TY, Eng NL, Jenkins CA, Grota PG. "Did you wash your hands?": a prospective study of patient empowerment to prompt hand washing by healthcare providers. J Infect Prev 2021; 22:195-202. [PMID: 34659457 DOI: 10.1177/17571774211012767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hand hygiene is paramount in preventing the spread of healthcare-associated infections especially during disease epidemics. Compliance rates with hand hygiene policies remain below 50% internationally and may be lower in the outpatient care setting. This study assessed the impact of the patient empowerment model on hand hygiene compliance among healthcare providers. Methods From October 2016 to May 2017, patients from a large ambulatory oncology centre were prospectively enrolled. Patients were instructed to observe healthcare providers for hand hygiene compliance and to remind healthcare providers where it was not observed during at least three consecutive encounters. Healthcare provider reactions to this intervention were rated by patients. Patients' hand hygiene knowledge and beliefs were objectively elicited pre and post-study. Results Thirty patients with a median age of 52 years (range 5-91) completed the study for a total of 190 healthcare provider encounters. When initial hand hygiene was not observed, patients offered a reminder in 71 (37.4%) encounters, did not offer a reminder in 73 (38.4%) encounters and forgot to offer a reminder in 24 (14.2%) encounters. Patients perceived positive or neutral reactions in 76.8% of encounters and negative or surprised reactions in 23.2% of encounters. Healthcare provider compliance improved from 11.6% to 48.9% with intervention. Patient hand hygiene knowledge improved by 16% following the study. Conclusions Patient-empowered hand hygiene may be a useful adjunct for improving hand hygiene compliance among healthcare providers and improving patient hand hygiene knowledge, although it may confer an emotional burden on patients.
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Affiliation(s)
- Tony Y Eng
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - Nina L Eng
- School of Medicine, Emory University, Atlanta, USA
| | - Carol A Jenkins
- Department of Radiation Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, USA
| | - Patti G Grota
- Office of Faculty Excellence, School of Nursing, UT Health San Antonio, San Antonio, USA
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21
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Richard A, Pfeiffer Y, Schwappach DDL. Development and Psychometric Evaluation of the Speaking Up About Patient Safety Questionnaire. J Patient Saf 2021; 17:e599-e606. [PMID: 28858000 DOI: 10.1097/pts.0000000000000415] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Speaking up about safety concerns by staff is important to prevent medical errors. Knowledge about healthcare workers' speaking up behaviors and perceived speaking up climate is useful for healthcare organizations (HCOs) to identify areas for improvement. The aim of this study was to develop a short questionnaire allowing HCOs to assess different aspects of speaking up among healthcare staff. METHODS Healthcare workers (n = 523) from 2 Swiss hospitals completed a questionnaire covering various aspects of speak up-related behaviors and climate. Psychometric testing included descriptive statistics, correlations, reliabilities (Cronbach α), principal component analysis, and t tests for assessing differences in hierarchical groups. RESULTS Principal component analysis confirmed the structure of 3 speaking up behavior-related scales, that is, frequency of perceived concerns (concern scale, α = 0.73), withholding voice (silence scale, α = 0.76), and speaking up (speak up scale, α = 0.85). Concerning speak up climate, principal component analysis revealed 3 scales (psychological safety, α = 0.84; encouraging environment, α = 0.74; resignation, α = 0.73). The final survey instrument also included items covering speaking up barriers and a vignette to assess simulated behavior. A higher hierarchical level was mostly associated with a more positive speak up-related behavior and climate. CONCLUSIONS Patient safety concerns, speaking up, and withholding voice were frequently reported. With this questionnaire, we present a tool to systematically assess and evaluate important aspects of speaking up in HCOs. This allows for identifying areas for improvement, and because it is a short survey, to monitor changes in speaking up-for example, before and after an improvement project.
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Akamine Y, Imafuku R, Saiki T, Lee-Jayaram J, Berg BW, Suzuki Y. Physicians' perceptions of followership in resuscitation in Japan and the USA: a qualitative study. BMJ Open 2021; 11:e047860. [PMID: 34373302 PMCID: PMC8354256 DOI: 10.1136/bmjopen-2020-047860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While leadership is accepted as a crucial aspect of a successful resuscitation team, the role of followership has not been sufficiently explored. This study aims to explore physicians' perceptions of common favourable followership in resuscitation teams in two different countries. DESIGN A qualitative study with interviews and a reflexive thematic analysis. SETTING The authors individually interviewed critical care and emergency physicians whose clinical experience exceeded 6 years in Japan and the USA. PARTICIPANTS A total of 18 physicians participated in a face-to-face, semistructured and in-depth interviews. RESULTS Five themes and nine subthemes related to followership in resuscitation were identified. Under technical skills, two themes (being knowledgeable and skilled) and three subthemes (understanding guidelines/algorithms, clinical course and being competent with procedural skills), were generated. Under non-technical skills, three themes (assuming roles, team communication and flattening hierarchy) and six subthemes (taking roles spontaneously, calm tone of voice, sharing information, closed-loop communication, respectful attitude and speaking up), were generated. Each generated theme involved commonly perceived favourable attributes of followership in resuscitation teams by experienced critical care and emergency physicians in both countries. CONCLUSIONS This study clarified physicians' perception of common favourable followership attributes in resuscitation teams, both in Japan and in the USA. The results of this study shed light on followership-focused resuscitation education, where followership skills are generally underestimated.
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Affiliation(s)
- Yoko Akamine
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Rintaro Imafuku
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Takuya Saiki
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Jannet Lee-Jayaram
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Benjamin W Berg
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Yasuyuki Suzuki
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
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Grailey KE, Murray E, Reader T, Brett SJ. The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. BMC Health Serv Res 2021; 21:773. [PMID: 34353319 PMCID: PMC8344175 DOI: 10.1186/s12913-021-06740-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. METHODS We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. RESULTS We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. DISCUSSION This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual's psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified.
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Affiliation(s)
- K. E. Grailey
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - E. Murray
- Said Business School, University of Oxford, Oxford, UK
| | - T. Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - S. J. Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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Grailey K, Leon-Villapalos C, Murray E, Brett S. Exploring the factors that promote or diminish a psychologically safe environment: a qualitative interview study with critical care staff. BMJ Open 2021; 11:e046699. [PMID: 34348949 PMCID: PMC8340293 DOI: 10.1136/bmjopen-2020-046699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to quantify the presence of psychological safety (defined as an environment 'safe for interpersonal risk taking') in critical care staff, exploring the ways in which this manifested. DESIGN Qualitative interview study incorporating a short quantitative survey. SETTING Three intensive care units within one National Health Service Trust in London. PARTICIPANTS Thirty participants were recruited from all levels of seniority and roles within the multidisciplinary team. A purposive sampling technique was used, with recruitment ceasing at the point of thematic saturation. INTERVENTIONS Semistructured interviews explored attitudes towards psychological safety and contained a quantitative assessment measuring the climate of psychological safety present. RESULTS Twenty-eight participants agreed that it was easy to ask for help, with 20 agreeing it is safe to take a risk on the team, demonstrating a strong perception of psychological safety in this group.Our thematic analysis highlighted areas where the context influenced an individual's psychological safety including personality, culture and leadership. Possible negative consequences of psychological safety included distraction and fatigue for the team leader. We demonstrated that speaking up can be influenced by motivations other than patient safety, such as undermining or self-promotion. CONCLUSIONS Our data demonstrate reassuring levels of psychological safety within the participants studied. This allowed us to explore in depth the participant experience of working within a psychologically safe environment. We add to the current literature by uniquely demonstrating there can be negative consequences to a psychologically safe environment in the healthcare setting. We expand on the influence of context on psychological safety by developing a model, allowing leaders to identify which elements of context can be modified in order to promote speaking up. Team leaders can use these data to help foster a culture of openness, innovation and error prevention while minimising the risk of negative implications.
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Affiliation(s)
- Kate Grailey
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Eleanor Murray
- Said Business School, University of Oxford Said Business School, Oxford, UK
| | - Stephen Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030915. [PMID: 33494448 PMCID: PMC7908168 DOI: 10.3390/ijerph18030915] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022]
Abstract
Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mistakes, mutual understanding, and debriefings of conflict situations are reported to improve collaboration. Additionally, emergency trainings, trainings in precise communication, and handovers are proposed to reduce risks for pAEs. Furthermore, the participants reported time-constraints and understaffing as a huge burden that hinders safe communication. Concluding, safety culture and organizational management are closely entwined and strategies should address various levels of which communication trainings are promising.
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Bushuven S, Dettenkofer M, Sippel S, Koenig S, Bushuven S, Schneider-Brachert W. Speaking up behavior and cognitive bias in hand hygiene: Competences of German-speaking medical students. PLoS One 2020; 15:e0239444. [PMID: 32986726 PMCID: PMC7521694 DOI: 10.1371/journal.pone.0239444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Infection prevention and speaking up on errors are core qualities of health care providers. Heuristic effects (e.g. overconfidence) may impair behavior in daily routine, while speaking up can be inhibited by hierarchical barriers and medical team factors. Aim of this investigation was to determine, how medical students experience these difficulties for hand hygiene in daily routine. Methods On the base of prior investigations we developed a questionnaire with 5-point Likert ordinal scaled items and free text entries. This was tested for validity and reliability (Cronbach’s Alpha 0.89). Accredited German, Swiss and Austrian universities were contacted and medical students asked to participated in the anonymous online survey. Quantitative statistics used parametric and non-parametric tests and effect size calculations according to Lakens. Qualitative data was coded according to Janesick. Results 1042 undergraduates of 12 universities participated. All rated their capabilities in hand hygiene and feedback reception higher than those of fellow students, nurses and physicians (p<0.001). Half of the participants rating themselves to be best educated, realized that faulty hand hygiene can be of lethal effect. Findings were independent from age, sex, academic course and university. Speaking-up in case of omitted hand hygiene was rated to be done seldomly and most rare on persons of higher hierarchic levels. Qualitative results of 164 entries showed four main themes: 1) Education methods in hand hygiene are insufficient, 2) Hierarchy barriers impair constructive work place culture 3) Hygiene and feedback are linked to medical ethics and 4) There is no consequence for breaking hygiene rules. Discussion Although partially limited by the selection bias, this study confirms the overconfidence-effects demonstrated in post-graduates in other settings and different professions. The independence from study progress suggests, that the effect occurs before start of the academic course with need for educational intervention at the very beginning. Qualitative data showed that used methods are insufficient and contradictory work place behavior in hospitals are frustrating. Even 20 years after “To err is human”, work place culture still is far away from the desirable.
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Affiliation(s)
- Stefan Bushuven
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee Hospital Singen and Hegau Jugendwerk Gailingen, Healthcare Association Constance (GLKN), Radolfzell, Germany
- Institute for Hospital Hygiene and Infection Prevention, Healthcare Association Constance (GLKN), Radolfzell, Germany
- Institute for Didactics and Educational Research in Medicine, Clinic of the University Munich, LMU Munich, Munich, Germany
- * E-mail:
| | - Markus Dettenkofer
- Institute for Hospital Hygiene and Infection Prevention, Healthcare Association Constance (GLKN), Radolfzell, Germany
| | - Sonia Sippel
- Institute of Medical Teaching and Medical Education Research, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sarah Koenig
- Institute of Medical Teaching and Medical Education Research, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefanie Bushuven
- Clinic for Orthopedics, Hand- and Trauma surgery, Hegau-Bodensee-Hospital Singen, Healthcare Association Constance (GLKN), Radolfzell, Germany
| | - Wulf Schneider-Brachert
- Department of Infection Control and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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27
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Doo E, Kim M. Effects of hospital nurses' internalized dominant values, organizational silence, horizontal violence, and organizational communication on patient safety. Res Nurs Health 2020; 43:499-510. [DOI: 10.1002/nur.22067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 08/08/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Eun‐Young Doo
- Department of Nursing Myongji Hospital Goyang‐si Gyeonggi‐do Republic of Korea
| | - Miyoung Kim
- College of Nursing Ewha Womans University Seoul Republic of Korea
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28
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Krenz HL, Burtscher MJ. Investigating voice in action teams: a critical review. COGNITION, TECHNOLOGY & WORK (ONLINE) 2020; 23:605-624. [PMID: 34720736 PMCID: PMC8550263 DOI: 10.1007/s10111-020-00646-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/25/2020] [Indexed: 06/13/2023]
Abstract
Team communication is considered a key factor for team performance. Importantly, voicing concerns and suggestions regarding work-related topics-also termed speaking up-represents an essential part of team communication. Particularly in action teams in high-reliability organizations such as healthcare, military, or aviation, voice is crucial for error prevention. Although research on voice has become more important recently, there are inconsistencies in the literature. This includes methodological issues, such as how voice should be measured in different team contexts, and conceptual issues, such as uncertainty regarding the role of the voice recipient. We tried to address these issues of voice research in action teams in the current literature review. We identified 26 quantitative empirical studies that measured voice as a distinct construct. Results showed that only two-thirds of the articles provided a definition for voice. Voice was assessed via behavioral observation or via self-report. Behavioral observation includes two main approaches (i.e., event-focused and language-focused) that are methodologically consistent. In contrast, studies using self-reports showed significant methodological inconsistencies regarding measurement instruments (i.e., self-constructed single items versus validated scales). The contents of instruments that assessed voice via self-report varied considerably. The recipient of voice was poorly operationalized (i.e., discrepancy between definitions and measurements). In sum, our findings provide a comprehensive overview of how voice is treated in action teams. There seems to be no common understanding of what constitutes voice in action teams, which is associated with several conceptual as well as methodological issues. This suggests that a stronger consensus is needed to improve validity and comparability of research findings.
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Affiliation(s)
| | - Michael J. Burtscher
- University of Zurich, Zurich, Switzerland
- ZHAW Zurich University of Applied Sciences, Zurich, Switzerland
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Cognitive bias in professional hand hygiene and feedback: A national online-survey on overconfidence in Germany. Infect Control Hosp Epidemiol 2020; 40:943-946. [PMID: 31294685 DOI: 10.1017/ice.2019.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To evaluate learning motivation barriers in infection control and feedback competences, we conducted a national online survey in Germany. Among 767 healthcare workers, overconfidence effects could be detected independent from age, gender, profession, education, and hospital-size. The identified effects may impair learning motivation relevant for supervisors and educators in infection control.
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Darawad MW, Mansour M, Al-Niarat T. Organisational empowerment and assertive communication behaviours: a survey of Jordanian newly qualified nurses. ACTA ACUST UNITED AC 2020; 29:419-425. [PMID: 32279560 DOI: 10.12968/bjon.2020.29.7.419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Newly qualified nurses (NQNs) face several challenges in their early years of practice. Being empowered and able to speak up against unsafe practice are two important pillars for practising nursing safely and competently. Little research has examined the potential correlation between those two dimensions in the context of NQNs in Jordan. AIMS To investigate the correlation between NQNs' perceived structural empowerment in their work setting and their willingness to challenge unsafe practice in some hypothetical clinical scenarios. METHODS A cross-sectional survey involved 233 NQNs, who completed a self-administered questionnaire between January and March 2016. FINDINGS Participants reported moderate levels of both perceived structural empowerment and willingness to speak up against unsafe practice. There was a statistically significant positive correlation between the total structural empowerment score and the mean score for speaking up against unsafe practice. CONCLUSION The findings highlight the impact of peer, managerial and overall organisational support on enabling NQNs to become more empowered and assertive. Concrete, collaborative and organisation-wide efforts must be considered to foster greater empowerment of NQNs, but also revisiting work priorities to include supporting and advocating assertive communication skills among the more vulnerable of the newly qualified cohort.
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Affiliation(s)
| | - Mansour Mansour
- Associate Professor, Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Tahany Al-Niarat
- Research Assistant, Princess Muna College of Nursing, Mutah University, Amman, Jordan
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Blenkinsopp J, Snowden N, Mannion R, Powell M, Davies H, Millar R, McHale J. Whistleblowing over patient safety and care quality: a review of the literature. J Health Organ Manag 2020; 33:737-756. [PMID: 31625824 DOI: 10.1108/jhom-12-2018-0363] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to review existing research on whistleblowing in healthcare in order to develop an evidence base for policy and research. DESIGN/METHODOLOGY/APPROACH A narrative review, based on systematic literature protocols developed within the management field. FINDINGS The authors identify valuable insights on the factors that influence healthcare whistleblowing, and how organizations respond, but also substantial gaps in the coverage of the literature, which is overly focused on nursing, has been largely carried out in the UK and Australia, and concentrates on the earlier stages of the whistleblowing process. RESEARCH LIMITATIONS/IMPLICATIONS The review identifies gaps in the literature on whistleblowing in healthcare, but also draws attention to an unhelpful lack of connection with the much larger mainstream literature on whistleblowing. PRACTICAL IMPLICATIONS Despite the limitations to the existing literature important implications for practice can be identified, including enhancing employees' sense of security and providing ethics training. ORIGINALITY/VALUE This paper provides a platform for future research on whistleblowing in healthcare, at a time when policymakers are increasingly aware of its role in ensuring patient safety and care quality.
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Affiliation(s)
- John Blenkinsopp
- Department of Leadership and HRM, Northumbria University , Newcastle upon Tyne, UK
| | - Nick Snowden
- Hull University Business School, University of Hull , Hull, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham , Birmingham, UK
| | - Martin Powell
- Health Services Management Centre, University of Birmingham , Birmingham, UK
| | - Huw Davies
- University of Saint Andrews , Saint Andrews, UK
| | - Ross Millar
- Health Services Management Centre, University of Birmingham , Birmingham, UK
| | - Jean McHale
- Birmingham Law School, University of Birmingham , Birmingham, UK
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Patient Safety Over Power Hierarchy: A Scoping Review of Healthcare Professionals' Speaking-up Skills Training. J Healthc Qual 2020; 42:249-263. [PMID: 32149868 DOI: 10.1097/jhq.0000000000000257] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Communication failures in healthcare constitute a major root cause of adverse events and medical errors. Considerable evidence links failures to raise concerns about patient harm in a timely manner with errors in medication administration, hygiene and isolation, treatment decisions, or invasive procedures. Expressing one's concern while navigating the power hierarchy requires formal training that targets both the speaker's emotional and verbal skills and the receiver's listening skills. We conducted a scoping review to examine the scope and components of training programs that targeted healthcare professionals' speaking-up skills. Out of 9,627 screened studies, 14 studies published between 2005 and 2018 met the inclusion criteria. The majority of the existing training exclusively relied on one-time training, mostly in simulation settings, involving subjects from the same profession. In addition, most studies implicitly referred to positional power as defined by titles; few addressed other forms of power such as personal resources (e.g., expertise, information). Almost none addressed the emotional and psychological dimensions of speaking up. The existing literature provides limited evidence identifying effective training components that positively affect speaking-up behaviors and attitudes. Future opportunities include examining the role of healthcare professionals' conflict engagement style or leaders' behaviors as factors that promote speaking-up behaviors.
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Schwappach DLB, Niederhauser A. Speaking up about patient safety in psychiatric hospitals - a cross-sectional survey study among healthcare staff. Int J Ment Health Nurs 2019; 28:1363-1373. [PMID: 31609065 PMCID: PMC6919932 DOI: 10.1111/inm.12664] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 12/02/2022]
Abstract
Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up-related behaviour and climate for the first time in psychiatric hospitals. A cross-sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up-related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up-related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%-65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13-25% of HCWs, and speaking up was reported by 53%-72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self-reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure.
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Affiliation(s)
- David L B Schwappach
- Swiss Patient Safety Foundation, Zürich, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University Bern, Bern, Switzerland
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34
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Novak A. Improving safety through speaking up: An ethical and financial imperative. J Healthc Risk Manag 2019; 39:19-27. [PMID: 30977243 DOI: 10.1002/jhrm.21360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Fostering a culture that empowers staff to speak up when concerned about the quality or safety of patient care is both an ethically1 and economically2 responsible endeavor. The Michigan Health & Hospital Association (MHA) Keystone Center has implemented the Speak-Up! Award program that acknowledges frontline health care staff for voicing their concerns and making care safer. The objective of this effort was to advance patient safety in Keystone Center member organizations through widespread, measurable culture improvement. After extensive data collection and analysis, there was a discernable improvement in culture survey results across a 2-year period coinciding with the launch and sustainment of the award program. Furthermore, in an effort to demonstrate the power of speaking up among staff, the Keystone Center applied a cost-savings framework to the types of harm avoided. Results from the cost-savings analysis suggest that each instance of speaking up by staff saves patients, families, and health care organizations an average of more than $13,000. METHODS Keystone Center Speak-Up! Award nominations were submitted through an electronic form that collects open, closed, and Likert-type question responses, producing a data array on type and severity of harm prevented, as well as the difficulty and magnitude of the decision to speak up. All data were then coded by harm type and subsequently applied to a tailored version of the cost-savings estimation framework used in the Great Lakes Partnership for Patients Hospital Improvement and Innovation Network. Safety culture was measured through the use of a survey instrument called the Safety, Communication, Operational Reliability, and Engagement (SCORE) instrument. RESULTS The Keystone Center Speak-Up! Award program received 416 nominations across the 2-year study period, of which 62% (n = 258) were coded as a specific harm type. Adverse drug events (n = 153), imaging errors (n = 42), and specimen errors (n = 27) were the most common harm types prevented by speaking up. After applying the cost-savings framework to these data, it is estimated that for every instance of speaking up, approximately $13,000 in total expenses were avoided, which is in line with the findings from a report on the economic impact of medical errors sponsored by the Society of Actuaries.3 Furthermore, culture survey results improved by 6% between 2015 and 2017, coinciding with the Keystone Center Speak-Up! Award program. CONCLUSIONS The Keystone Center Speak-Up! Award has proven to be a valuable tool in recognizing staff awareness and willingness to raise concerns about quality and safety in health care. Data analysis from this program presents evidence that fostering a psychologically safe culture of speaking up yields fiscal and humanistic returns, both of which are crucial to sustainable, meaningful progress in safety and quality. However, further research is required to adequately gauge the degree to which safety culture improvement is proportional to cost savings.
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Affiliation(s)
- Adam Novak
- Michigan Health and Hospital Association Keystone Center, Okemos, MI
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35
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Kolbe M, Boos M. Laborious but Elaborate: The Benefits of Really Studying Team Dynamics. Front Psychol 2019; 10:1478. [PMID: 31316435 PMCID: PMC6611000 DOI: 10.3389/fpsyg.2019.01478] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
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Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Margarete Boos
- Institute for Psychology, University of Göttingen, Göttingen, Germany
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36
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Weller JM, Long JA. Creating a climate for speaking up. Br J Anaesth 2019; 122:710-713. [DOI: 10.1016/j.bja.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/04/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022] Open
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Bushuven S, Juenger J, Moeltner A, Dettenkofer M. Overconfidence in infection control proficiency. Am J Infect Control 2019; 47:545-550. [PMID: 30528170 DOI: 10.1016/j.ajic.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Infection control partially depends on hygiene and communication skills. Unfortunately, motivation for continuous training is lower than desired. Many health care providers (HCPs) do not recognize the need for training but express this need for others. This is attributable to heuristic errors, such as the overconfidence effect. The aim of this study was to quantify the flawed self-assessment in infection-control. METHODS In this cross-sectional multicenter study, 255 HCPs of different specialties participated in the 29-item, 5-point Likert scale questionnaire, assessing perceived proficiency in hand hygiene and communication skills for both themselves and others (colleagues, trainees, and supervisors of their own specialty and HCPs of others). RESULTS 222 of 255 surveys could be analyzed. Respondents rated themselves to be better trained in handhygiene (P < .001) than trainees, colleagues, and supervisors; the same was seen for feedback skills (P < .001). HCPs of other specialties were consistently rated worse in all aspects (P < .001). CONCLUSION Results show an overplacement effect in infection prevention skills. The belief of being well educated creates a subjective conviction that no further education in hand hygiene is needed. Thus, HCPs may face motivation barriers that require specialized programs to overcome these beliefs.
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Schwappach D, Sendlhofer G, Häsler L, Gombotz V, Leitgeb K, Hoffmann M, Jantscher L, Brunner G. Speaking up behaviors and safety climate in an Austrian university hospital. Int J Qual Health Care 2019; 30:701-707. [PMID: 29701770 DOI: 10.1093/intqhc/mzy089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/09/2018] [Indexed: 12/22/2022] Open
Abstract
Objective To analyze speaking up behavior and safety climate with a validated questionnaire for the first time in an Austrian university hospital. Design Survey amongst healthcare workers (HCW). Data were analyzed using descriptive statistics, Cronbach's alpha was calculated as a measure of internal consistencies of scales. Analysis of variance and t-tests were used. Setting The survey was conducted in 2017. Participants About 2.149 HCW from three departments were asked to participate. Intervention To measure speaking up behavior and safety climate. Main Outcome Measure To explore psychological safety, encouraging environment and resignation towards speaking up. Results About 859 evaluable questionnaires were returned (response rate: 40%). More than 50% of responders perceived specific concerns about patient safety within the last 4 weeks and observed a potential error or noticed rule violations. For the different items, between 16% and 42% of HCW reported that they remained silent though concerns for safety. In contrast, between 96% and 98% answered that they did speak up in certain situations. The psychological safety for speaking up was lower for HCW with a managerial function (P < 0.001). HCW with managerial functions perceived the environment as less encouraging to speak up (P < 0.05) than HCW without managerial function. Conclusions We identified speaking up behaviors for the first time in an Austrian university hospital. Only moderately frequent concerns were in conflict with frequent speaking up behaviors. These results clearly show that a paradigm shift is needed to increase speaking up culture.
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Affiliation(s)
- David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lynn Häsler
- Swiss Patient Safety Foundation, Zurich, Switzerland
| | - Veronika Gombotz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Karina Leitgeb
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Magdalena Hoffmann
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lydia Jantscher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Noort MC, Reader TW, Gillespie A. Walking the Plank: An Experimental Paradigm to Investigate Safety Voice. Front Psychol 2019; 10:668. [PMID: 31001165 PMCID: PMC6454216 DOI: 10.3389/fpsyg.2019.00668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/11/2019] [Indexed: 11/28/2022] Open
Abstract
The investigation of people raising or withholding safety concerns, termed safety voice, has relied on report-based methodologies, with few experiments. Generalisable findings have been limited because: the behavioural nature of safety voice is rarely operationalised; the reliance on memory and recall has well-established biases; and determining causality requires experimentation. Across three studies, we introduce, evaluate and make available the first experimental paradigm for studying safety voice: the “Walking the plank” paradigm. This paradigm presents participants with an apparent hazard (walking across a weak wooden plank) to elicit safety voice behaviours, and it addresses the methodological shortfalls of report-based methodologies. Study 1 (n = 129) demonstrated that the paradigm can elicit observable safety voice behaviours in a safe, controlled and randomised laboratory environment. Study 2 (n = 69) indicated it is possible to elicit safety silence for a single hazard when safety concerns are assessed and alternative ways to address the hazard are absent. Study 3 (n = 75) revealed that manipulating risk perceptions results in changes to safety voice behaviours. We propose a distinction between two independent dimensions (concerned-unconcerned and voice-silence) which yields a 2 × 2 safety voice typology. Demonstrating the need for experimental investigations of safety voice, the results found a consistent mismatch between self-reported and observed safety voice. The discussion examines insights on conceptualising and operationalising safety voice behaviours in relationship to safety concerns, and suggests new areas for research: replicating empirical studies, understanding the behavioural nature of safety voice, clarifying the personal relevance of physical harm, and integrating safety voice with other harm-prevention behaviours. Our article adds to the conceptual strength of the safety voice literature and provides a methodology and typology for experimentally examining people raising safety concerns.
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Affiliation(s)
- Mark C Noort
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
| | - Tom W Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
| | - Alex Gillespie
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
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Schwappach D, Sendlhofer G. Speaking Up about Patient Safety in Perioperative Care: Differences between Academic and Nonacademic Hospitals in Austria and Switzerland. J INVEST SURG 2019; 33:730-738. [PMID: 30644786 DOI: 10.1080/08941939.2018.1554016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose of the Study: In perioperative care, communication about patient safety concerns is both difficult and valuable. Research into speaking up has mostly been conducted in single countries; the aim of this study was to compare speaking up-related climate and behaviors in academic and nonacademic hospitals. Materials and Methods: The study is based on two surveys conducted in Austria and Switzerland. The Swiss survey was conducted in five nonacademic hospitals, the Austrian survey in one university hospital. Results: 768 questionnaires were returned (nonacademic: n = 360; response rate: 37%; academic: n = 408; response rate: 32%). There were differences (p < 0.001) concerning speaking up episodes (at least one episode of speaking up in the past four weeks) between nonacademic hospitals (68%) and the academic hospital (96%). Withholding voice was reported by 32% of nonacademic and 43% of academic staff (p = 0.003). The speak up-related climate in the Swiss sample was more positive. Nurses compared to doctors scored higher on all items of the "resignation scale." Important differences emerged in ratings of a clinical scenario of missed hand disinfection: Nonacademic health-care workers perceived the risk of harm for patients higher compared to academic (5.3 vs. 2.5; p < 0.001). Responders higher in hierarchy felt better with speaking up in nonacademic hospitals. Conclusions: The study is one of the first to address differences in academic and nonacademic hospitals in speaking up behaviors and demonstrated differences. This analysis helps to put local data in perspective and to target further activities for improvement.
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Affiliation(s)
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, Landeskrankenhaus-Universitatsklinikum Graz, Graz, Austria.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Research Unit for Safety in Health, Medizinische Universitat Graz, Graz, Austria
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Bell SK, Roche SD, Mueller A, Dente E, O'Reilly K, Sarnoff Lee B, Sands K, Talmor D, Brown SM. Speaking up about care concerns in the ICU: patient and family experiences, attitudes and perceived barriers. BMJ Qual Saf 2018; 27:928-936. [PMID: 30002146 PMCID: PMC6225795 DOI: 10.1136/bmjqs-2017-007525] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about patient/family comfort voicing care concerns in real time, especially in the intensive care unit (ICU) where stakes are high and time is compressed. Experts advocate patient and family engagement in safety, which will require that patients/families be able to voice concerns. Data on patient/family attitudes and experiences regarding speaking up are sparse, and mostly include reporting events retrospectively, rather than pre-emptively, to try to prevent harm. We aimed to (1) assess patient/family comfort speaking up about common ICU concerns; (2) identify patient/family-perceived barriers to speaking up; and (3) explore factors associated with patient/family comfort speaking up. METHODS In collaboration with patients/families, we developed a survey to evaluate speaking up attitudes and behaviours. We surveyed current ICU families in person at an urban US academic medical centre, supplemented with a larger national internet sample of individuals with prior ICU experience. RESULTS 105/125 (84%) of current families and 1050 internet panel participants with ICU history completed the surveys. Among the current ICU families, 50%-70% expressed hesitancy to voice concerns about possible mistakes, mismatched care goals, confusing/conflicting information and inadequate hand hygiene. Results among prior ICU participants were similar. Half of all respondents reported at least one barrier to voicing concerns, most commonly not wanting to be a 'troublemaker', 'team is too busy' or 'I don't know how'. Older, female participants and those with personal or family employment in healthcare were more likely to report comfort speaking up. CONCLUSION Speaking up may be challenging for ICU patients/families. Patient/family education about how to speak up and assurance that raising concerns will not create 'trouble' may help promote open discussions about care concerns and possible errors in the ICU.
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Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie D Roche
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Erica Dente
- Patient and Family Advisory Council, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kristin O'Reilly
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Barbara Sarnoff Lee
- Department of Social Work, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kenneth Sands
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Samuel M Brown
- Center for Humanizing Critical Care, Intermountain Medical Center, Murray, Utah, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Mansour M, Mattukoyya R. A Cross-Sectional Survey of British Newly Graduated Nurses' Experience of Organization Empowerment and of Challenging Unsafe Practices. J Contin Educ Nurs 2018; 49:474-481. [DOI: 10.3928/00220124-20180918-08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/22/2018] [Indexed: 11/20/2022]
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Schwappach DL. Speaking up about hand hygiene failures: A vignette survey study among healthcare professionals. Am J Infect Control 2018; 46:870-875. [PMID: 29650487 DOI: 10.1016/j.ajic.2018.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Speaking up by healthcare professionals (HCPs) is an important resource to reduce risks to patient safety. Due to complex tradeoffs, HCPs are often reluctant to voice their concerns. A survey investigated HCPs' likelihood to speak up. METHODS A cross-sectional survey study among HCPs in 5 Swiss hospitals addressed speaking-up behaviors, safety climate, and likelihood to speak up about poor hand hygiene practice described in a vignette. Likelihood to speak up was analyzed using a multilevel regression model. RESULTS Of surveyed HCPs (n = 1217), 56% reported that they would speak up to a colleague with poor hand hygiene practice. Nurses as compared to doctors rated the situation as more realistic (5.25 vs 4.32, P < .001), felt more discomfort with speaking up (4.00 vs 3.34, P < .001), and reported a slightly lower likelihood of speaking up (4.41 vs 4.77, P < .001). Clinical function (hierarchy) was strongly associated with speaking-up behavior (P < .001). Higher risk of harm to the patient (P < .001) and higher frequencies of past speaking-up behaviors (P = .006) were positively associated with the likelihood to speak up. Higher frequencies of past withholding voice (P = .013) and higher levels of resignation (P = .008) were both associated with a lower likelihood to speak up. CONCLUSIONS Infection control interventions should empower HCPs to speak up about non-adherence with prevention practices by addressing authority gradients and risk perceptions and by focusing on resignation.
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Mannion R, Blenkinsopp J, Powell M, McHale J, Millar R, Snowden N, Davies H. Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06300] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
There is compelling evidence to suggest that some (or even many) NHS staff feel unable to speak up, and that even when they do, their organisation may respond inappropriately.
Objectives
The specific project objectives were (1) to explore the academic and grey literature on whistleblowing and related concepts, identifying the key theoretical frameworks that can inform an understanding of whistleblowing; (2) to synthesise the empirical evidence about the processes that facilitate or impede employees raising concerns; (3) to examine the legal framework(s) underpinning whistleblowing; (4) to distil the lessons for whistleblowing policies from the findings of Inquiries into failings of NHS care; (5) to ascertain the views of stakeholders about the development of whistleblowing policies; and (6) to develop practical guidance for future policy-making in this area.
Methods
The study comprised four distinct but interlocking strands: (1) a series of narrative literature reviews, (2) an analysis of the legal issues related to whistleblowing, (3) a review of formal Inquiries related to previous failings of NHS care and (4) interviews with key informants.
Results
Policy prescriptions often conceive the issue of raising concerns as a simple choice between deciding to ‘blow the whistle’ and remaining silent. Yet research suggests that health-care professionals may raise concerns internally within the organisation in more informal ways before utilising whistleblowing processes. Potential areas for development here include the oversight of whistleblowing from an independent agency; early-stage protection for whistleblowers; an examination of the role of incentives in encouraging whistleblowing; and improvements to criminal law to protect whistleblowers. Perhaps surprisingly, there is little discussion of, or recommendations concerning, whistleblowing across the previous NHS Inquiry reports.
Limitations
Although every effort was made to capture all relevant papers and documents in the various reviews using comprehensive search strategies, some may have been missed as indexing in this area is challenging. We interviewed only a small number of people in the key informant interviews, and our findings may have been different if we had included a larger sample or informants with different roles and responsibilities.
Conclusions
Current policy prescriptions that seek to develop better whistleblowing policies and nurture open reporting cultures are in need of more evidence. Although we set out a wide range of issues, it is beyond our remit to convert these concerns into specific recommendations: that is a process that needs to be led from elsewhere, and in partnership with the service. There is also still much to learn regarding this important area of health policy, and we have highlighted a number of important gaps in knowledge that are in need of more sustained research.
Future work
A key area for future research is to explore whistleblowing as an unfolding, situated and interactional process and not just a one-off act by an identifiable whistleblower. In particular, we need more evidence and insights into the tendency for senior managers not to hear, accept or act on concerns about care raised by employees.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - John Blenkinsopp
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, UK
| | - Martin Powell
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jean McHale
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | - Ross Millar
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | | | - Huw Davies
- School of Management, University of St Andrews, St Andrews, UK
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Edrees HH, Ismail MNM, Kelly B, Goeschel CA, Berenholtz SM, Pronovost PJ, Al Obaidli AAK, Weaver SJ. Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates. Int J Qual Health Care 2018; 29:948-960. [PMID: 29186417 DOI: 10.1093/intqhc/mzx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. Design, setting, participants, intervention A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. Main outcome measures Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. Results A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. Conclusions Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.
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Affiliation(s)
- Hanan H Edrees
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,National Guard Health Affairs, Quality and Patient Safety/King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Mohd Nasir Mohd Ismail
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
| | - Bernadette Kelly
- SEHA (Abu Dhabi Health Services Company), Das Tower, Sultan Bin Zayed St, Abu Dhabi, UAE
| | - Christine A Goeschel
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.,Medstar Health, 3007 Tilden St NW, Washington, DC 20008, USA
| | - Sean M Berenholtz
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Peter J Pronovost
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | | | - Sallie J Weaver
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
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Impact of a Successful Speaking Up Program on Health-Care Worker Hand Hygiene Behavior. Pediatr Qual Saf 2017; 2:e035. [PMID: 30229171 PMCID: PMC6132482 DOI: 10.1097/pq9.0000000000000035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/01/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Health-care worker (HCW) hand hygiene (HH) is the cornerstone of efforts to reduce hospital infections but remains low. Real-time mitigation of failures can increase process reliability to > 95% but has been challenging to implement for HH. Objective: To sustainably improve HCW HH to > 95%. Methods: A hospital-wide quality improvement initiative to improve HH was initiated in February 2012. HCW HH behavior was measured by covert direct observation utilizing multiple-trained HCW volunteers. HH compliance was defined as correct HH performed before and after contact with the patient or the patient’s care area. Interventions focusing on leadership support, HCW knowledge, supply availability, and culture change were implemented using quality improvement science methodology. In February 2014, the hospital began the Speaking Up for Safety Program, which trained all HCWs to identify and mitigate HH failures at the moment of occurrence and addressed known barriers to speaking up. Results: Between January 1, 2012, and January 31, 2016, there were 30,514 HH observations, averaging 627 observations per month (9% attending physicians, 12% resident physicians, 46% nurses, 33% other HCW types). HCW HH gradually increased from 75% to > 90% by December 2014. After the Speaking Up for Safety Program, HCW HH has been > 95% for 20 months. Physician HH compliance has been above 90% for over a year. Conclusion: Creating a specific process for staff to speak up and prevent HH failures, as part of a multimodal improvement effort, can sustainably increase HCW HH above 95%.
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Williams B, Beovich B, Flemming G, Donovan G, Patrick I. Exploration of difficult conversations among Australian paramedics. Nurs Health Sci 2017. [PMID: 28631343 DOI: 10.1111/nhs.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous studies indicate that healthcare professionals find it challenging to engage in difficult conversations regarding concerning behavior of colleagues. As a result, these conversations are often avoided. The inability to have these difficult conversations is associated with poorer patient outcomes, staff commitment, discretionary effort, and employee satisfaction. This descriptive study used an online questionnaire to examine responses of paramedics employed by Ambulance Victoria (Australia) regarding difficult conversations between colleagues about concerning behavior of co-workers. The results suggest that, like other healthcare professions, many paramedics find it challenging to raise these concerns. To the best knowledge of the authors, this is the first study of its type to be undertaken within the paramedic profession and provides a platform for further research within this and other health professions.
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Affiliation(s)
- Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | - Bronwyn Beovich
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | | | | | - Ian Patrick
- Clinical and Community Services Ambulance Victoria, Victoria, Australia
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Martinez W, Lehmann LS, Thomas EJ, Etchegaray JM, Shelburne JT, Hickson GB, Brady DW, Schleyer AM, Best JA, May NB, Bell SK. Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents. BMJ Qual Saf 2017; 26:869-880. [DOI: 10.1136/bmjqs-2016-006284] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 11/04/2022]
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„Speaking Up“ statt tödlichem Schweigen im Krankenhaus. GIO-GRUPPE-INTERAKTION-ORGANISATION-ZEITSCHRIFT FUER ANGEWANDTE ORGANISATIONSPSYCHOLOGIE 2016. [DOI: 10.1007/s11612-016-0343-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Fagan A, Parker V, Jackson D. A concept analysis of undergraduate nursing students speaking up for patient safety in the patient care environment. J Adv Nurs 2016; 72:2346-57. [DOI: 10.1111/jan.13028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Anthea Fagan
- School of Health; University of New England; Armidale NSW Australia
| | - Vicki Parker
- School of Health; University of New England; Armidale NSW Australia
- Hunter New England Area Health Service; Valentine NSW Australia
| | - Debra Jackson
- School of Health; University of New England; Armidale NSW Australia
- Oxford Brookes University and Oxford University Hospitals; UK
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