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Freedman B, Li WW, Liang Z, Hartin P, Biedermann N. The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38515008 DOI: 10.1111/jan.16111] [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: 09/14/2023] [Revised: 12/15/2023] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
AIM Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety. METHODS A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies. DATA SOURCES Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023. RESULTS The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety. CONCLUSION Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility. REPORTING METHOD This report adheres to PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.
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Affiliation(s)
- Benjamin Freedman
- James Cook University, Townsville, Queensland, Australia
- Townsville University Hospital, Douglas, Townsville, Australia
| | - Wendy Wen Li
- James Cook University, Townsville, Queensland, Australia
| | - Zhanming Liang
- James Cook University, Townsville, Queensland, Australia
| | - Peter Hartin
- James Cook University, Townsville, Queensland, Australia
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Fernández Castillo G, Khalid M, Salas E. Beyond communication: an update on transforming healthcare teams. Front Med (Lausanne) 2024; 11:1282173. [PMID: 38449884 PMCID: PMC10915010 DOI: 10.3389/fmed.2024.1282173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
| | | | - Eduardo Salas
- Making Effective Teams Laboratory, Department of Psychological Science, Rice University, Houston, TX, United States
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Chrouser KL, Partin MR, Gainsburg I, White KM. Examining the surgical stress effects (SSE) framework in practice: A qualitative assessment of perceived sources and consequences of intraoperative stress in surgical teams. Am J Surg 2024; 228:133-140. [PMID: 37689567 DOI: 10.1016/j.amjsurg.2023.08.024] [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: 05/16/2023] [Revised: 07/19/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Surgical adverse events persist despite extensive improvement efforts. Emotional and behavioral responses to stressors may influence intraoperative performance, as illustrated in the surgical stress effects (SSE) framework. However, the SSE has not been assessed using "real world" data. METHODS We conducted semi-structured interviews with all surgical team roles at one midwestern VA hospital and elicited narratives involving intraoperative stress. Two coders inductively identified codes from transcripts. The team identified themes among codes and assessed concordance with the SSE framework. RESULTS Throughout 28 interviews, we found surgical stress was ubiquitous, associated with a variety of factors, including adverse events. Stressors often elicited frustration, anger, fear, and anxiety; behavioral reactions to negative emotions frequently were perceived to degrade individual/team performance and compromise outcomes. Narratives were consistent with the SSE framework and support adding a process outcome (efficiency) and illustrating how adverse events can feedback and acutely increase job demands and stress. CONCLUSION This qualitative study describes narratives of intraoperative stress, finding they are consistent with the SSE while also allowing minor improvements to the current framework.
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Affiliation(s)
- Kristin L Chrouser
- Minneapolis VA Healthcare System, 1 Veterans Dr, Minneapolis, MN, 55417, USA; Department of Urology, University of Michigan, 2800 Plymouth Rd, NCRC Building 16, #147S, Ann Arbor, MI, 48109-2800, USA.
| | - Melissa R Partin
- Minneapolis VA Healthcare System, 1 Veterans Dr, Minneapolis, MN, 55417, USA; Department of Urology, University of Michigan, 2800 Plymouth Rd, NCRC Building 16, #147S, Ann Arbor, MI, 48109-2800, USA; Hennepin Healthcare Research Institute, 701 Park Ave, Ste PP7.700, Minneapolis, MN, 55415, USA.
| | - Izzy Gainsburg
- Harvard Kennedy School, 79 John F. Kennedy St, Cambridge, MA, 02138, USA; Department of Psychology, University of Michigan, 1004 East Hall, 530 Church St Ann Arbor, MI, 48109, USA.
| | - Katie M White
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [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: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Parra DA, Gladkikh M, Jones LM. Factors influencing teamwork in healthcare applicable to interventional and diagnostic radiology. Clin Radiol 2023; 78:897-903. [PMID: 37813757 DOI: 10.1016/j.crad.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/01/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
Teamwork in healthcare has been analysed extensively in the literature, mainly in acute healthcare settings such as the operating room, emergency room, and intensive care unit, with limited evidence related to diagnostic and interventional radiology. Multiple factors that affect teamwork in different domains have been described, such as communication, hierarchy, and distractions. Teamwork is an important patient safety, job satisfaction and patient outcome determinant, with interprofessional and interdisciplinary healthcare education playing a relevant role in the different domains affecting team performance. The aim of this article is to review the literature to describe domains and specific factors that influence teamwork in diagnostic and interventional radiology practice. This is of particular interest for radiologist involved in quality improvement and/or patient safety initiatives development and implementation. The review will conclude with a summary table highlighting the most important factors that, according to the authors, appear relevant to the radiology practice.
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Affiliation(s)
- D A Parra
- Division of Image Guided Therapy, Diagnostic Imaging Department, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| | - M Gladkikh
- Diagnostic Imaging, McMaster University, Hamilton, ON, Canada
| | - L M Jones
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, UK
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Fujimoto M, Shimamura M, Miyazaki H, Inaba K. Development of a Psychological Scale for Measuring Disruptive Clinician Behavior. J Patient Saf 2023; 19:564-572. [PMID: 37843989 PMCID: PMC10662605 DOI: 10.1097/pts.0000000000001162] [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] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Disruptive clinician behavior worsens communication, information transfer, and teamwork, all of which negatively affect patient safety. Improving safety in medical care requires an accurate assessment of the damage caused by disruptive clinician behavior. Psychometric scales complement case reports, but existing scales have significant limitations. Therefore, this study developed a psychometric scale based on the psychological paradigm to assess disruptive clinician behavior. METHODS The scale was developed through a sequence of steps. First, we used an open-ended questionnaire targeting 712 nurses, content analysis, and content validity assessment by 5 experts to determine valid items for disruptive clinical behavior. Next, an Internet questionnaire survey targeting 1000 health care staff, exploratory factor analysis, and subfactor analysis was conducted to identify necessary and sufficient factors. Then, we calculated difficulty level and discriminative power. We also conducted a field questionnaire survey targeting 84 staff in a hospital. Finally, we calculated ω coefficients and then used confirmatory factor analysis to verify the fit of the hypothesized model. RESULTS Our open-ended survey involving 478 nurses identified 47 codes in 9 categories. The questionnaire survey involving hospital 1000 medical staff identified 6 factors, with 1 factor subdivided into 4 subfactors and 1 into 2 subfactors. The goodness of fit of the hypothesized 10-factor models with factor pairs and groups was confirmed. CONCLUSIONS We developed a psychometric scale measuring subjective assessments of harm covering various disruptive clinician behaviors. The scale complements interviews and case reports by generating valid, reliable scores for various disruptive clinician behaviors in health care institutions.
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Affiliation(s)
- Manabu Fujimoto
- From the Institute for Teaching and Learning, Ritsumeikan University, Kyoto
| | - Mika Shimamura
- Faculty of Nursing and Welfare, Reiwa Health Sciences University, Fukuoka
| | - Hiroaki Miyazaki
- Medical Safety Management Center, Kansai Medical University, Hirakata, Osaka
| | - Kazuto Inaba
- School of Law, Chukyo University, Nagoya, Aichi, Japan
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Ostroff C, Benincasa C, Rae B, Fahlbusch D, Wallwork N. Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention. PLoS One 2023; 18:e0295271. [PMID: 38033091 PMCID: PMC10688855 DOI: 10.1371/journal.pone.0295271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Incivility in surgery is prevalent and negatively impacts effectiveness and staff well-being. The purpose of this study was to a) examine relationships between incivility, team dynamics, and well-being outcomes, and b) explore a low-cost intervention of 'eye' signage in operating theater areas to reduce incivility in surgical teams. A mixed methods design was used in an orthopedic hospital. Surveys of incivility, teamwork, and well-being were administered three months apart in a small private hospital. An intervention of signage with eyes was placed in the theater area after administration of the first survey, using a pretest-posttest design. Participants also responded to an open-ended question about suggestions for improvements at the end of the survey which was then thematically analyzed. At the individual level (n = 74), incivility was statistically significantly related to team dynamics which in turn was significantly related to burnout, stress, and job attitudes. At the aggregate level, reported incivility was statistically significantly lower after the 'eye' sign intervention. Thematic analysis identified core issues of management behaviors, employee appreciation, communication, and work practices. Incivility in surgical teams has significant detrimental associations with burnout, stress, and job attitudes, which occurs through its impact on decreased team dynamics and communication. A simple intervention that evokes perceptions of being observed, such as signage of eyes in theater areas, has the potential to decrease incivility at least in the short term, demonstrating that incivility is amenable to being modified. Additional research on targeted interventions to address incivility are needed to improve teamwork and staff well-being.
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Affiliation(s)
- Cheri Ostroff
- University of South Australia Centre for Workplace Excellence, Adelaide, Australia
| | - Chelsea Benincasa
- University of South Australia Rosemary Bryant AO Research Centre, Adelaide, Australia
| | - Belinda Rae
- University of South Australia Centre for Workplace Excellence, Adelaide, Australia
| | - Douglas Fahlbusch
- University of South Australia Clinical and Health Sciences, Adelaide, Australia
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8
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Keller S, Yule S, Smink DS, Zagarese V, Safford S, Valea FA, Beldi G, Henrickson Parker S. Alone Together: Is Strain Experienced Concurrently by Members of Operating Room Teams?: An Event-based Study. ANNALS OF SURGERY OPEN 2023; 4:e333. [PMID: 37746629 PMCID: PMC10513207 DOI: 10.1097/as9.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To identify which strain episodes are concurrently reported by several team members; to identify triggers of strain experienced by operating room (OR) team members during the intraoperative phase. Summary OR teams are confronted with many sources of strain. However, most studies investigate strain on a general, rather than an event-based level, which does not allow to determine if strain episodes are experienced concurrently by different team members. Methods We conducted an event-based, observational study, at an academic medical center in North America and included 113 operations performed in 5 surgical departments (general, vascular, pediatric, gynecology, and trauma/acute care). Strain episodes were assessed with a guided-recall method. Immediately after operations, participants mentally recalled the operation, described the strain episodes experienced and their content. Results Based on 731 guided recalls, 461 strain episodes were reported; these refer to 312 unique strain episodes. Overall, 75% of strain episodes were experienced by a single team member only. Among different categories of unique strain episodes, those triggered by task complexity, issues with material, or others' behaviors were typically experienced by 1 team member only. However, acute patient issues (n = 167) and observations of others' strain (n = 12) (respectively, 58.5%; P < 0.001 and 83.3%; P < 0.001) were often experienced by 2 or more team members. Conclusions and relevance OR team members are likely to experience strain alone, unless patient safety is at stake. This may jeopardize the building of a shared understanding among OR team members.
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Affiliation(s)
- Sandra Keller
- From the Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Switzerland
| | - Steven Yule
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
- STRATUS Center for Medical Simulation, Boston, MA
- Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland
| | - Douglas S. Smink
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
- Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Shawn Safford
- Division of Paediatric Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA
- Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, VA
| | - Fidel A. Valea
- Department of Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Switzerland
| | - Sarah Henrickson Parker
- From the Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA
- Department of Psychology, Virginia Tech, Blacksburg, VA
- Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, VA
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Paquette S, Kilcullen M, Hoffman O, Hernandez J, Mehta A, Salas E, Greilich PE. Handoffs and the challenges to implementing teamwork training in the perioperative environment. Front Psychol 2023; 14:1187262. [PMID: 37397334 PMCID: PMC10310998 DOI: 10.3389/fpsyg.2023.1187262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.
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Affiliation(s)
- Shannon Paquette
- Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
| | - Molly Kilcullen
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Olivia Hoffman
- Division of Critical Care Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jessica Hernandez
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ankeeta Mehta
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Philip E. Greilich
- Department of Anesthesiology and Pain Management, Health System Chief Quality Office, Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
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Arad D, Finkelstein A, Rozenblum R, Magnezi R. Patient safety and staff psychological safety: A mixed methods study on aspects of teamwork in the operating room. Front Public Health 2022; 10:1060473. [PMID: 36620282 PMCID: PMC9816421 DOI: 10.3389/fpubh.2022.1060473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To predict the amount of teamwork that takes place throughout a surgery, based on performing a preoperative safety standards (surgical safety checklist and surgical count) and to explore factors affecting patient safety and staff psychological safety during a surgery, based on interprofessional teamwork. Methods This mixed methods study included quantitative and qualitative analyses. Quantitative data included 2,184 direct observations of surgical cases with regard to the performance of safety standards during surgeries in 29 hospitals, analyzed using multivariate binary logistic regressions. Qualitative data were obtained from an analysis of 25 semi-structured interviews with operating room (OR) clinicians and risk managers, using an inductive thematic analysis approach. Results Analysis of the OR observations revealed that a lack of teamwork in the preoperative "sign-in" phase doubled the chances of there being a lack of teamwork during surgery [odds ratio = 1.972, 95% confidence interval (CI) 1.741, 2.233, p < 0.001] and during the "time-out" phase (odds ratio = 2.142, 95% CI 1.879, 2.441, p < 0.001). Consistent presence of staff during surgery significantly increased teamwork, by 21% for physicians and 24% for nurses (p < 0.05), but staff turnover significantly decreased teamwork, by 73% for physicians (p < 0.05). Interview data indicated that patient safety and staff psychological safety are related to a perception of a collaborative team role among OR staff, with mutual commitment and effective interprofessional communication. Conclusions Healthcare organizations should consider the key finding of this study when trying to identify factors that affect teamwork during a surgery. Effective preoperative teamwork positively affects intraoperative teamwork, as does the presence of more clinicians participating in a surgery, with no turnover. Other factors include working in a fixed, designated team, led by a surgeon, which functions with effective interprofessional communication that promotes patient safety and staff psychological safety.
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Affiliation(s)
- Dana Arad
- Health System Management Department, Bar-Ilan University, Ramat Gan, Israel,Patient Safety Division, Ministry of Health, Jerusalem, Israel,*Correspondence: Dana Arad ✉
| | - Adi Finkelstein
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Ronen Rozenblum
- Brigham and Women's Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - Racheli Magnezi
- Health System Management Department, Bar-Ilan University, Ramat Gan, Israel
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11
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Semmer NK, Zapf D. Psychische Belastung und Beanspruchung: Die Bedeutung der Valenz und der sozialen Realität. Anmerkungen zu Ferreira und Vogt (2021). ZEITSCHRIFT FÜR ARBEITSWISSENSCHAFT 2022; 76:375-384. [PMID: 35789775 PMCID: PMC9243850 DOI: 10.1007/s41449-022-00321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 10/24/2022]
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12
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Association Between Surgeon and Anesthesiologist Sex Discordance and Postoperative Outcomes: A Population-Based Cohort Study. Ann Surg 2022; 276:81-87. [PMID: 35703460 DOI: 10.1097/sla.0000000000005495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the effect of surgeon-anesthesiologist sex discordance on postoperative outcomes. SUMMARY BACKGROUND DATA Optimal surgical outcomes depend on teamwork, with surgeons and anesthesiologists forming two key components. There are sex and gender-based differences in interpersonal communication and medical practice which may contribute to patients' perioperative outcomes. METHODS We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007-2019 in Ontario, Canada. We assessed the association between differences in sex between surgeon and anesthesiologists (sex discordance) on the primary endpoint of adverse postoperative outcome, defined as death, readmission, or complication within 30-days following surgery using generalized estimating equations. RESULTS Among 1,165,711 patients treated by 3,006 surgeons and 1,477 anesthesiologists, 791,819 patients were treated by sex concordant teams (male surgeon/male anesthesiologist: 747,327 and female surgeon/female anesthesiologist: 44,492) while 373,892 were sex discordant (male surgeon/female anesthesiologist: 267,330 and female surgeon/male anesthesiologist: 106,562). Overall, 12.3% of patients experienced one or more adverse postoperative outcomes of whom 1.3% died. Sex discordance between surgeon and anesthesiologist was not associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR] 1.00, 95% confidence interval [CI] 0.97-1.03). CONCLUSIONS We did not demonstrate an association between intraoperative surgeon and anesthesiologist sex discordance on adverse postoperative outcomes in a large patient cohort. Patients, clinicians, and administrators may be reassured that physician sex discordance in operating room teams is unlikely to clinically meaningfully affect patient outcomes after surgery.
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13
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Disruptive behavior in the operating room: Systemic over individual determinants. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Marques-Quinteiro P, van Dijk H, Peterson DR, Adamovic M, Buengeler C, Santos CM. A Model of Leadership Transitions in Teams. GROUP & ORGANIZATION MANAGEMENT 2022. [DOI: 10.1177/10596011221082394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Teams with shared leadership arrangements are ubiquitous in twenty-first century organizations. Although transitions in leadership are a common and key feature of such teams, there is little insight into how and when leadership arrangements transition over time. Bridging the shared leadership and team adaptation literatures, we present a model of Leadership Transitions in Teams to describe the adaptive process through which teams intentionally modify the existing leadership arrangement. The basic assumption underlying this model is that leadership transitions occur when there is a mismatch between the team’s needs and its current leadership arrangement. Such a mismatch results from an anticipated or observed change. If it is anticipated, team members can democratically discuss and try out a new leadership arrangement, preventing mismatch and thus lowered team effectiveness. In contrast, if the mismatch has already occurred, teams are more likely to adopt a less democratic process—either a coalition-based or intervening-based process—to change the leadership arrangement in their team to counteract faltering team effectiveness. We propose that the ways in which leadership transition episodes can unfold and relate to team effectiveness will depend on the type (determined by the timing of the leadership transition episode in relation to the change), approach (determined by the extent to which there is consensus on if and how to change the leadership transition episode), and boundary conditions of leadership transition episodes. We advance an agenda for research on leadership transitions in teams and outline practical implications for teams with shared leadership structures.
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Affiliation(s)
- Pedro Marques-Quinteiro
- TRIE, Escola de Ciências Económicas e das Organizações, Universidade Lusófona de Humanidades e Tecnologia, Lisboa, Portugal
| | - Hans van Dijk
- Department of Organization Studies, Tilburg University, Tilburg, The Netherlands
| | - David R. Peterson
- College of Business, James Madison University, St. Harrisonburg, VA, USA
| | - Mladen Adamovic
- Department of Human Resource Management & Employment Relations, King's Business School, King's College London
- Department of Management & International Business, Auckland Business School, University of Auckland
| | | | - Catarina M. Santos
- Maastricht University School of Business and Economics, Department of Organization, Strategy, and Entrepreneurship, Maastricht, the Netherlands
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15
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Hunukumbure AD, Leedham-Green KE, Rajamanoharan A, Patel K, Tang A, Das S. Twelve tips for surgeons to maximise medical student learning in the operating theatre. MEDICAL TEACHER 2022; 44:257-262. [PMID: 33827368 DOI: 10.1080/0142159x.2021.1908975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Theatre-based learning is an essential component of undergraduate surgical education and offers a wide range of learning opportunities. However, studies have demonstrated that medical students have not always benefited from this holistic learning environment due to many reasons, including intimidation, hierarchies within the surgical environment and fear of making mistakes. The lead surgical educator's approach is an important influence on the experience and learning of their medical students. These twelve tips are aimed at surgical educators with undergraduate teaching responsibilities. This guidance is based upon evidence from literature and established theories of teaching and learning, supplemented by qualitative interviews with surgeons and medical students. The resulting tips were checked and refined by surgical teaching fellows. These learner-centred tips provide guidance on thorough induction, managing mutual expectations and approaches that optimise teaching and learning in the operating theatre. They are designed to support surgical educators in improving their students' engagement and learning experiences in this setting.
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Affiliation(s)
| | | | | | - Kirtan Patel
- Hillingdon Hospital NHS Foundation Trust, Uxbridge, UK
| | - Alison Tang
- Hillingdon Hospital NHS Foundation Trust, Uxbridge, UK
| | - Saroj Das
- Hillingdon Hospital NHS Foundation Trust, Uxbridge, UK
- Imperial College London, London, UK
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16
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Abi-Jaoudé JG, Kennedy-Metz LR, Dias RD, Yule SJ, Zenati MA. Measuring and Improving Emotional Intelligence in Surgery: A Systematic Review. Ann Surg 2022; 275:e353-e360. [PMID: 34171871 PMCID: PMC8683575 DOI: 10.1097/sla.0000000000005022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Evaluate how emotional intelligence (EI) has been measured among surgeons and to investigate interventions implemented for improving EI. SUMMARY BACKGROUND EI has relevant applications in surgery given its alignment with nontechnical skills. In recent years, EI has been measured in a surgical context to evaluate its relationship with measures such as surgeon burnout and the surgeon-patient relationship. METHODS A systematic review was conducted by searching MEDLINE, EMBASE, CINAHL, and PSYCINFO databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MeSH terms and keywords included "emotional intelligence," "surgery," and "surgeon." Eligible studies included an EI assessment of surgeons, surgical residents, and/or medical students within a surgical context. RESULTS The initial search yielded 4627 articles. After duplicate removal, 4435 articles were screened by title and abstract and 49 articles proceeded to a full-text read. Three additional articles were found via hand search. A total of 37 articles were included. Studies varied in surgical specialties, settings, and outcome measurements. Most occurred in general surgery, residency programs, and utilized self-report surveys to estimate EI. Notably, EI improved in all studies utilizing an intervention. CONCLUSIONS The literature entailing the intersection between EI and surgery is diverse but still limited. Generally, EI has been demonstrated to be beneficial in terms of overall well-being and job satisfaction while also protecting against burnout. EI skills may provide a promising modifiable target to achieve desirable outcomes for both the surgeon and the patient. Future studies may emphasize the relevance of EI in the context of surgical teamwork.
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Affiliation(s)
- Joanne G. Abi-Jaoudé
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Lauren R. Kennedy-Metz
- Medical Robotics and Computer Assisted Surgery Lab, Boston, MA, USA; Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiac Surgery, VA Boston Healthcare System, West Roxbury, MA, USA
| | - Roger D. Dias
- Human Factors and Cognitive Engineering Lab, Boston, MA, USA; STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven J. Yule
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland; and Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco A. Zenati
- Medical Robotics and Computer Assisted Surgery Lab, Boston, MA, USA; Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiac Surgery, VA Boston Healthcare System, West Roxbury, MA, USA
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17
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Tay YX, Wei YM, Chong L. “Operating Theatre radiography not for the faint of heart”: How can we support our radiographers? J Med Imaging Radiat Sci 2022; 53:196-202. [DOI: 10.1016/j.jmir.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
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18
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Disruptive Behavior at Hospitals and Factors Associated to Safer Care: A Systematic Review. Healthcare (Basel) 2021; 10:healthcare10010019. [PMID: 35052183 PMCID: PMC8775368 DOI: 10.3390/healthcare10010019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Disruptive behavior creates a dysfunctional culture that has a negative impact on work relations and influences the quality of care and safety of the patient. The objective of the present work is to provide the best methodological quality scientific evidence available on disruptive behavior at a hospital, the aspect associated with the safety of the patient, and its impact on quality of care. For this, we included studies that addressed the prevalence of disruptive behaviors observed in the area of hospital health and its professionals. The selection, eligibility, data extraction and evaluation of the risk of bias stages were conducted by two researchers, and any discrepancies were solved by a third researcher. The data presented show that disruptive behaviors are frequently observed in the daily life of health professionals, and compromise the quality of care, the safety of the patient, and can lead to adverse effects. The results presented indicate that the appearance of disruptive behaviors compromises the quality of care, the safety of the patient, and the appearance of adverse effects, and can also affect the physical and mental health of the health professionals. PROSPERO registration number: CRD42021248798.
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Abstract
PURPOSE OF REVIEW This review addresses the importance of some of the human factors for intraoperative patient safety with particular focus on the active failures. These are the mishaps or sentinel events related to decisons taken and actions performed by the individual at the delivery end of a system. Such sentinel events may greatly affect intraoperative patient safety. RECENT FINDINGS Intimidating, aggressive and disruptive communication is a cause of adverse staff interaction, which may then represent an important patient safety threat. Also, anaesthesiologist's physical and mental state and limitations may interfere with patient safety. SUMMARY The concept of physician well being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Creating optimal safe conditions for patients, therefore, requires actions at both the personal level and the working conditions. Also, initiatives to ban rude and dismissive communication should be implemented in order to further improve intraoperative patient safety.
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Affiliation(s)
- Stefan De Hert
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
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20
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Joshi T, Budhathoki P, Adhikari A, Poudel A, Raut S, Shrestha DB. Improving Medical Education: A Narrative Review. Cureus 2021; 13:e18773. [PMID: 34804650 PMCID: PMC8592289 DOI: 10.7759/cureus.18773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/05/2022] Open
Abstract
With the advancement in basic and clinical sciences, medical education is also constantly evolving. The Accreditation Council for Graduate Medical Education (ACGME) has endorsed six core competencies to improve teaching and learning. This narrative review was conducted after searching the article databases (PubMed, PubMed Central, Embase, and Scopus) about the core competencies such as medical knowledge (problem-based learning), interpersonal communication, patient care, professionalism, practice-based learning and improvement, and system-based care endorsed by ACGME. We included randomized and quasi-experimental trials, cohorts, and case-control studies in this narrative review. In a problem-based learning modality, a real-life scenario is allocated to a group of students. Studies have shown that it is more effectively demonstrated by a better post-test score, improved concentration, and application of knowledge. Interpersonal communication skills promote collaboration with interdisciplinary teams, work quality, and patient adherence to treatment. Professionalism is a human attribute that creates a pleasant work environment and is an essential trait that improves patients' adherence to treatment. In system-based care, patients are benefitted through a well-structured plan of care. Finally, in practice-based learning, medical trainees learn to systematically evaluate the pattern of care and practice the best modality to improve the overall patient care and physician satisfaction. These core competencies need to be incorporated into all levels of medical training.
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Affiliation(s)
- Tilak Joshi
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | | | - Anurag Adhikari
- Intensive Care Unit, Nepal Korea Friendship Municipality Hospital, Madhyapur Thimi, NPL
| | - Ayusha Poudel
- Department of Emergency Medicine, Alka Hospital Pvt. Ltd., Kathmandu, NPL
| | - Sumit Raut
- Department of Internal Medicine, Kathmandu Medical College, Kathmandu, NPL
| | - Dhan B Shrestha
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
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21
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Paige JT, Garbee DD, Bonanno LS, Kerdolff KE. Qualitative Analysis of Effective Teamwork in the Operating Room (OR). JOURNAL OF SURGICAL EDUCATION 2021; 78:967-979. [PMID: 33160940 DOI: 10.1016/j.jsurg.2020.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/28/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To conduct focus group interviews with operating room (OR) personnel to determine components of effective teamwork to inform a revision of a teamwork assessment instrument. DESIGN Qualitative research study targeting OR personnel using semi-structured focus group interviews of interprofessional OR personnel. Responses were digitally recorded and transcribed. Qualitative analysis was undertaken by 2 reviewers who identified major themes related to effective teamwork. Inter-coder agreement was employed to confirm findings and themes. SETTING Major academic medical center and Level 1 Trauma Center in Southeastern United States. PARTICIPANTS Fifteen OR staff members including surgeons, an anesthesiologist, nurse anesthetists, circulating nurses, and scrub technicians. RESULTS Three focus groups involving 15 individuals (2 surgeons, 1 anesthesiologist, 8 nurse anesthetists, 2 circulating nurses, and 2 surgical technologists) were conducted over a 1-month period in 2017. Four major themes related to effective teamwork emerged from analysis: (1) Smooth flow, (2) United effort, (3) Communication, and (4) Positive attitude. CONCLUSIONS Among the OR team members, agreement regarding effective teamwork centers around the concepts of smooth procedural flow, unified effort, clear communication, and positive attitude of the team. These findings have helped refine a teamwork instrument to increase its utility for formative use in the clinical environment.
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Affiliation(s)
- J T Paige
- LSU Health New Orleans School of Medicine, New Orleans, Louisiana.
| | - D D Garbee
- LSU Health New Orleans School of Nursing, New Orleans, Louisiana
| | - L S Bonanno
- LSU Health New Orleans School of Nursing, New Orleans, Louisiana
| | - K E Kerdolff
- LSU Health New Orleans School of Medicine, New Orleans, Louisiana
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22
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Pavithra A. Towards developing a comprehensive conceptual understanding of positive hospital culture and approaches to healthcare organisational culture change in Australia. J Health Organ Manag 2021; ahead-of-print. [PMID: 33837683 DOI: 10.1108/jhom-10-2020-0385] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE The key aim of this narrative literature review, therefore, is to identify the key conceptual categories that inform the construction of positive person-centred culture within hospitals, and how these frameworks are brought to bear upon organisational culture within healthcare systems in Australia. DESIGN/METHODOLOGY/APPROACH This narrative review presents a thematic synthesis of literature identified through a systematic search protocol undertaken across 19 academic databases and Google Scholar as an additional search tool. Thematic qualitative analysis was performed on the research results to determine the common themes within the diverse literature presented within this study. FINDINGS Culture change interventions in hospitals attempt to address the problem of widespread unprofessional behaviour within healthcare systems. However, diverse definitions and seemingly fragmented approaches to understanding and enacting organisational culture change present a significant hurdle in achieving cohesive and sustainable healthcare reform. This narrative literature review offers a comprehensive conceptual view of the key approaches that inform positive person-centred culture within hospital settings. In total, three primary dimensions, belonging, behaving and being, aligned against organisational goals, individual behaviours and worker as well as organisational identity were identified. Other individual and group interactional dynamics that give rise to negative organisational culture are further analysed to understand the fault lines along which existing culture change interventions are typically operationalised. RESEARCH LIMITATIONS/IMPLICATIONS This review is not exhaustive and is limited in its methodological scope. The central values and themes identified within the literature are integral to designing humanised healthcare systems. However, owing to the qualitative nature and contextual variability of these factors, these themes do not lend themselves to replicable quantification. SOCIAL IMPLICATIONS This analysis contributes to foundational research efforts towards transforming healthcare practice to be more aligned with humanised and equitable values within increasingly complex healthcare organisational settings. Designing culture change interventions that align more suitably with the values-driven categories identified in this literature review may increase the effectiveness and sustainability of these interventions and reform efforts at organisational and systemic levels. ORIGINALITY/VALUE This article presents a comprehensive framework to approach healthcare organisational reform through shared and equitable models of operation, management and governance rather than continuing to promote narrowly defined outcomes derived from commodified models of healthcare practice.
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Affiliation(s)
- Antoinette Pavithra
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Sydney, Australia
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23
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Zapf D, Kern M, Tschan F, Holman D, Semmer NK. Emotion Work: A Work Psychology Perspective. ANNUAL REVIEW OF ORGANIZATIONAL PSYCHOLOGY AND ORGANIZATIONAL BEHAVIOR 2021. [DOI: 10.1146/annurev-orgpsych-012420-062451] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Emotion work, the management of feelings and emotional displays in response to emotion work requirements, can have both positive and negative effects on well-being and performance. Adopting a work psychology perspective and drawing on work stress and work design literatures, we outline an expanded model of emotion work, regarding emotion work requirements as job characteristics and as part of broader task requirements. The challenge-hindrance stressors framework helps explain positive effects of emotion work in terms of professional role fulfillment. We emphasize the importance of negative events and negative emotions for outcomes of surface acting conditions, and we highlight the often-neglected role of automatic emotion regulation in emotion work. Research on culture suggests that existing results are mostly valid for Western cultures. Practical and research implications refer to a stronger emphasis on conditions at work in general, including stressors and resources, which together determine the meaning of emotion work conditions.
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Affiliation(s)
- Dieter Zapf
- Department of Psychology, Goethe University Frankfurt, 60629 Frankfurt am Main, Germany;,
- Alliance Manchester Business School, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Marcel Kern
- Department of Psychology, Goethe University Frankfurt, 60629 Frankfurt am Main, Germany;,
| | - Franziska Tschan
- Institute of Work and Organizational Psychology, University of Neuchâtel, 2000 Neuchâtel, Switzerland
| | - David Holman
- Alliance Manchester Business School, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Norbert K. Semmer
- Department of Psychology, University of Bern, 3012 Bern, Switzerland
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24
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Keller S, Yule S, Smink DS, Zagarese V, Safford S, Parker SH. Episodes of strain experienced in the operating room: impact of the type of surgery, the profession and the phase of the operation. BMC Surg 2020; 20:318. [PMID: 33287776 PMCID: PMC7720529 DOI: 10.1186/s12893-020-00937-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Strain episodes, defined as phases of higher workload, stress or negative emotions, occur everyday in the operating room (OR). Accurate knowledge of when strain is most intense for the different OR team members is imperative for developing appropriate interventions. The primary goal of the study was to investigate temporal patterns of strain across surgical phases for different professionals working in the OR, for different types of operations. Methods We developed a guided recall method to assess the experience of strain from the perspective of operating room (OR) team members. The guided recall was completed by surgeons, residents, anesthesiologists, circulating nurses and scrub technicians immediately after 113 operations, performed in 5 departments of one hospital in North America. We also conducted interviews with 16 surgeons on strain moments during their specific operation types. Strain experiences were related to surgical phases and compared across different operation types separately for each profession in the OR. Results We analyzed 693 guided recalls. General linear modeling (GLM) showed that strain varied across the phases of the operations (defined as before incision, first third, middle third and last third) [quadratic (F = 47.85, p < 0.001) and cubic (F = 8.94, p = 0.003) effects]. Phases of operations varied across professional groups [linear (F = 4.14, p = 0.001) and quadratic (F = 14.28, p < 0.001) effects] and surgery types [only cubic effects (F = 4.92, p = 0.001)]. Overall strain was similar across surgery types (F = 1.27, p = 0.28). Surgeons reported generally more strain episodes during the first and second third of the operations; except in vascular operations, where no phase was associated with significantly higher strain levels, and emergency/trauma surgery, where strain episodes occurred primarily during the first third of the operation. Other professional groups showed different strain time patterns. Conclusions Members of the OR teams experience strain differently across the phases of an operation. Thus, phases with high concentration requirements may highly vary across OR team members and no single phase of an operation can be defined as a “sterile cockpit” phase for all team members.
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Affiliation(s)
- Sandra Keller
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
| | - Steven Yule
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.,STRATUS Center for Medical Simulation, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland, UK
| | - Douglas S Smink
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vivian Zagarese
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Shawn Safford
- Division of Paediatric Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, VA, USA
| | - Sarah Henrickson Parker
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.,Department of Psychology, Virginia Tech, Blacksburg, VA, USA.,Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, VA, USA
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25
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Keller S, Yule S, Zagarese V, Henrickson Parker S. Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open 2020; 10:e035471. [PMID: 32513884 PMCID: PMC7282335 DOI: 10.1136/bmjopen-2019-035471] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous. DESIGN Systematic literature review of quantitative and qualitative empirical studies. DATA SOURCES Database searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020. ELIGIBILITY CRITERIA Original empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care. DATA EXTRACTION AND SYNTHESIS Of the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020. RESULTS Based on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership. CONCLUSIONS Although a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.
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Affiliation(s)
- Sandra Keller
- Center for Surgery and Public Health (CSPH), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven Yule
- Center for Surgery and Public Health (CSPH), Brigham and Women's Hospital, Boston, Massachusetts, USA
- STRATUS Center for Medical Simulation, Boston, Massachusetts, USA
- Department of surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Vivian Zagarese
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
| | - Sarah Henrickson Parker
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
- Fralin Biomedical Research Institute (FBRI) at Virginia Tech Carilion, Roanoke, Virginia, USA
- Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, Virginia, USA
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