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Felsen A, McClelland A, Kobi M, Bello JA, Burns J. Health Systems Science - A Primer for Radiologists. Acad Radiol 2023; 30:2079-2088. [PMID: 36966069 DOI: 10.1016/j.acra.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery. HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees. The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study.
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Affiliation(s)
- Amanda Felsen
- Albert Einstein College of Medicine, Montefiore New Rochelle Hospital; Bronx, NY
| | - Andrew McClelland
- Department of Radiology, NYU Grossman School of Medicine; New York, NY
| | - Mariya Kobi
- Department of Radiology, Columbia University Medical Center; New York, NY
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center; Bronx, NY; Albert Einstein College of Medicine; Bronx, NY.
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Wallin A, Bazzi M, Ringdal M, Ahlberg K, Lundén M. Radiographers' perception of patient safety culture in radiology. Radiography (Lond) 2023; 29:610-616. [PMID: 37086589 DOI: 10.1016/j.radi.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/10/2023] [Accepted: 04/05/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Radiographers play a central role in patient safety because of their knowledge of and responsibilities in relation to the imaging process. To maintain safe care, the workplace must create a safety culture that enables sustainable safety work. AIM This study aims to describe radiographers' perceptions of the patient safety culture in radiology units in Sweden. METHODS The Swedish Hospital Survey of Patients' Safety Culture (S-HSOPSC) was used to gather descriptive data from 171 Swedish registered radiographers working in five radiology clinics distributed across 15 units. Fifty-one questionnaire items and one open-ended question were analysed, comprising perceptions of the overall safety grade, the frequency of number of reported risks and events, and 14 composites regarding patient safety dimensions. RESULTS The radiographers' concerns surrounding the patient safety culture in their workplaces related to weaknesses regarding the safety dimensions "Staffing", "Frequency of error reporting", "Organizational learning - continuous improvement" and "Executive management support for patient safety". They perceived "Teamwork within the unit" to be a strength. CONCLUSION Despite some weaknesses in the patient safety culture, the radiographers perceived that the overall patient safety level was good, in part because of their ability to spot risks in time. The executive management, however, needed to improve their feedback on safety measures; and another reason for some weaknesses in the patient safety culture could be staffing issues such as lack of time for meetings for continuous improvement. Managers and leaders have a great responsibility to establish a patient safety culture through support and good leadership. IMPLICATIONS FOR PRACTICE An understanding of what creates a safety culture is important to prevent patient safety incidents.
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Affiliation(s)
- A Wallin
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden.
| | - M Bazzi
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - M Ringdal
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - K Ahlberg
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - M Lundén
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden
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Parrott EH, Saeedipour S, Walker CM, Best SR, Harn NR, Ash RM. Transition from Peer Review to Peer Learning: Lessons Learned. Curr Probl Diagn Radiol 2023; 52:223-229. [PMID: 37069021 DOI: 10.1067/j.cpradiol.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Landmark publications, such as To Err is Human, confronted the healthcare community with the egregious toll medical errors played in both patient safety and overall healthcare costs. This heralded a paradigm shift and a call for action by professional organizations to enact methods to ensure physician competency and quality assurance. The American College of Radiology similarly convened a task force to discuss these concerns and how best to address quality assurance in radiology practice, leading to the development of RADPEER, a score-based peer review system. However, critics were quick to point out the deficiencies of this model, highlighting it as punitive and a poor evaluator of physician performance. The recognized deficiencies in score-based peer review prompted the pursuit of an alternate model that would instead emphasize learning and improvement. Peer learning was proposed and highlighted the necessity of an inclusive and collaborative environment where colleagues could discuss case errors as learning opportunities without fear of punitive consequence. This paper explores peer learning, its benefits and challenges, as well as how to identify specific learning opportunities by utilizing case examples.
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Tasker A, Jones J, Brake S. How effectively has a Just Culture been adopted? A qualitative study to analyse the attitudes and behaviours of clinicians and managers to clinical incident management within an NHS Hospital Trust and identify enablers and barriers to achieving a Just Culture. BMJ Open Qual 2023; 12:e002049. [PMID: 36707123 PMCID: PMC9884909 DOI: 10.1136/bmjoq-2022-002049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/14/2023] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Just Culture aims to improve patient safety by examining the organisational and individual factors that contribute to adverse events, enabling corrective action so that errors are not repeated. This qualitative study aims to: (1) analyse whether the attitudes and behaviours of clinicians and managers are aligned with a Just Culture; (2) identify barriers and enablers to an organisation adopting a Just Culture. METHODOLOGY This qualitative study used interviews and observation of Trust meetings to elicit the attitudes and behaviours of staff. Semistructured interviews were conducted with 13 doctors of all grades, 5 medical students and 2 managers. Five meetings that reviewed clinical incidents and mortality were observed. This was done in a single Hospital Trust in the Midlands, England. Data were thematically analysed using directed and inductive approaches. RESULTS There is evidence of a fair incident management process within the Trust; however, there was no agreed vision of a Just Culture and the majority of the staff were unfamiliar with the term. Negative perspectives relating to clinical incidents and their management persist among staff with many having insecurities regarding being the subject of an investigation and doubts about whether they drive improvement. CONCLUSION This paper examines the significance of these findings and provides recommendations which may have application within other healthcare organisations. Major recommendations include (1) Just Culture: define an agreed vision of what Just Culture means to the Trust; (2) investigations: introduce incident management familiarisation training; (3) Learning Culture: increase face-to-face communication of outcomes of investigations and incident review; (4) investigators: establish an incident investigation team to improve the timeliness and consistency of investigations and the communication and implementation of outcomes.
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Affiliation(s)
- Adam Tasker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Julia Jones
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Simon Brake
- Warwick Medical School, University of Warwick, Coventry, UK
- Rosalind Franklin Laboratory, UK Health Security Agency, London, United Kingdon
- Research & Develpment Division, South Warwickshire Universty Foundation NHS Trust, Warwick, UK
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Abstract
Even before RaDonda Vaught was found guilty of criminally negligent homicide, nurses were fearful of being held individually accountable for systemic errors. Leaders are now faced with repairing the loss of faith in just culture. This article provides an understanding of the erosion of just culture and interventions needed to improve trust.
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Affiliation(s)
- Linda Paradiso
- Linda Paradiso is an assistant professor at CUNY School of Professional Studies in New York, N.Y
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Oliveira A, Slanetz PJ, Catanzano TM, Sarkany D, Siddall K, Johnson K, Jordan SG. Strengthening the Clinical Learning Environment by Mandate-Implementing the ACGME Common Program Requirements. Acad Radiol 2022; 29 Suppl 5:S65-S69. [PMID: 33303348 DOI: 10.1016/j.acra.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/01/2022]
Abstract
RATIONALE Three years ago, the Accreditation Council for Graduate Medical Education (ACGME) introduced updated Common Program Requirements in recognition of the need to further promote resident and faculty member well-being and patient safety. The ACGME acknowledged residencies would need time to comply with new requirements. This grace period, however, concluded as of July 1, 2019, and programs now risk citations for failure to implement new requirements. METHODS AND RESULTS The authors, members of the Association of Program Directors in Radiology Common Program Requirements Ad Hoc committee, developed downloadable resources provided in the Appendix delineating the 2019 Common Program Requirements and offering sample resources as compliant solutions. CONCLUSION The resources offer a national standardized approach to educating trainees in these essential skills and should be especially helpful to programs with access to fewer resources. In addition to achieving compliance, incorporation of these resources into residency training will ensure the next generation of radiologists are equipped to add value while remaining physically and emotionally healthy.
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Schmidt E, Lo HS, Saghir A. Peer learning in emergency radiology: effects on learning, error identification, and radiologist experience. Emerg Radiol 2022; 29:655-661. [PMID: 35391565 DOI: 10.1007/s10140-022-02040-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE We established and evaluated a peer learning program in an emergency radiology (ER) division. Peer learning is an alternative to peer review focusing on non-punitive error reporting to mitigate consequences of inevitable human error. The central component is the peer learning conference, where cases are presented, key teaching points are discussed, and process improvement ideas are solicited. METHODS We established a prior imaging-based case identification system and a bimonthly remote videoconference where ER faculty discuss 5-15 cases selected for learning or process improvement opportunities. Case identification and conference characteristics were captured. A survey focused on learning and performance outcomes was administered to faculty initially and showed improved scores after 6 months. RESULTS Cases selected for conference favored perception errors (46%), with great calls (17%) and process improvement (15%) the next most common categories. A variety of anatomical regions were represented, with abdominal (35%) and musculoskeletal (29%) most common. Error detection was improved over peer review. All participants find the system easy to use and prefer peer learning to peer review for learning and process improvement. CONCLUSION A peer learning program can be successfully implemented within a busy academic emergency radiology division, as evidenced by increasing buy-in and engagement scores over time. When tied to a departmental peer learning infrastructure, interdisciplinary expertise and robust case identification can be leveraged to increase learning opportunities.
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Affiliation(s)
- Eric Schmidt
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Hao S Lo
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Amina Saghir
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, 01605, USA.
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Kunst M, Elentuck D, Broder J. Leveraging the Peer Learning Conference to Establish and Maintain a Peer Learning Program. Curr Probl Diagn Radiol 2022; 51:686-690. [DOI: 10.1067/j.cpradiol.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022]
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Schafer LE, Perry H, Fishman MD, Jakomin BV, Slanetz PJ. Incorporating Peer Learning Into Your Breast Imaging Practice. JOURNAL OF BREAST IMAGING 2021; 3:491-497. [PMID: 38424796 DOI: 10.1093/jbi/wbab043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 03/02/2024]
Abstract
Traditional score-based peer review has come under scrutiny in recent years, as studies have demonstrated it to be generally ineffective at improving quality. Many practices and programs are transitioning to a peer learning model to replace or supplement traditional peer review. Peer learning differs from traditional score-based peer review in that the emphasis is on sharing learning opportunities and creating an environment that fosters discussion of errors in a nonpunitive forum with the goal of improved patient care. Creating a just culture is central to fostering successful peer learning. In a just culture, mistakes can be discussed without shame or fear of retribution and the focus is on systems improvement rather than individual blame. Peer learning, as it pertains to breast imaging, can occur in many forms and venues. Examples of the various formats in which peer learning can occur include through individual colleague interaction, as well as divisional, multidisciplinary, department-wide, and virtual conferences, and with the assistance of artificial intelligence. Incorporating peer learning into the practice of breast imaging aims to reduce delayed diagnoses of breast cancer and optimize patient care.
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Affiliation(s)
- Leah E Schafer
- Boston Medical Center and Boston University School of Medicine, Department of Radiology, Boston, MA, USA
| | - Hannah Perry
- University of Vermont Medical Center and Larner College of Medicine at the University of Vermont, Department of Radiology, Burlington, VT, USA
| | - Michael Dc Fishman
- Boston Medical Center and Boston University School of Medicine, Department of Radiology, Boston, MA, USA
| | - Bernadette V Jakomin
- Boston Medical Center and Boston University School of Medicine, Department of Radiology, Boston, MA, USA
| | - Priscilla J Slanetz
- Boston Medical Center and Boston University School of Medicine, Department of Radiology, Boston, MA, USA
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Shah BJ, Portnoy B, Chang D, Napp M. Just Culture for Medical Students: Understanding Response to Providers in Adverse Events. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11167. [PMID: 34277933 PMCID: PMC8266940 DOI: 10.15766/mep_2374-8265.11167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/30/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Individual and organizational response to an adverse event is a key part of the life cycle of a patient safety event. Just culture is a safety concept that emphasizes system drivers of human behavior. We developed a learning activity for medical students to teach and discuss just culture as part of a patient safety curriculum. METHODS This small-group, discussion-based learning activity was aimed at third-year medical students. Over 5 years, 628 students participated in it. The session had three components: a presession case-based survey, a didactic lecture, and a facilitated small-group discussion. Participants evaluated the session using our institution's standard learner assessment. They also took a postcourse test that contained multiple-choice questions relating to the session. RESULTS On a 5-point Likert scale (1 = poor, 3 = good, 5 = excellent), students rated the large-group lecture (3.2) and small-group discussion (3.2) moderately. Over 85% of students answered all knowledge items on a course posttest correctly. DISCUSSION This learning activity provides an easy-to-implement case-based discussion to introduce the concepts of just culture.
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Affiliation(s)
- Brijen J. Shah
- Associate Dean for GME in Quality Improvement and Patient Safety, Departments of Medicine/Gastroenterology, Geriatrics, and Medical Education, Icahn School of Medicine at Mount Sinai
| | - Bonnie Portnoy
- Vice President for Risk Management and Patient Safety, Mount Sinai Health System
| | - Dennis Chang
- Associate Professor of Medicine, Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine in St. Louis
| | - Marc Napp
- Deputy Chief Medical Officer, Mount Sinai Health System
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Broder JC, Scheirey CD, Wald C. Step by Step: A Structured Approach for Proposing, Developing and Implementing a Radiology Peer Learning Program. Curr Probl Diagn Radiol 2021; 50:457-460. [PMID: 33663894 DOI: 10.1067/j.cpradiol.2021.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/22/2022]
Abstract
Similar to the experiences of other radiology practices, our radiology staff members felt that scored peer review identified few errors/learning opportunities while undermining team collegiality. They desired a more effective way to promote team collegiality and foster lifelong learning. We describe the steps our department took to transition from a peer review system to a peer learning program.
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Affiliation(s)
- Jennifer C Broder
- Vice Chair Quality and Safety, Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA.
| | - Christopher D Scheirey
- Vice Chair Operations, Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA
| | - Christoph Wald
- Chair, Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA
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Larson DB, Broder JC, Bhargavan-Chatfield M, Donnelly LF, Kadom N, Khorasani R, Sharpe RE, Pahade JK, Moriarity AK, Tan N, Siewert B, Kruskal JB. Transitioning From Peer Review to Peer Learning: Report of the 2020 Peer Learning Summit. J Am Coll Radiol 2020; 17:1499-1508. [DOI: 10.1016/j.jacr.2020.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/05/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
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Wasserman JA, Redinger M, Gibb T. Responding to Unprofessional Behavior by Trainees - A "Just Culture" Framework. N Engl J Med 2020; 382:773-777. [PMID: 32074428 DOI: 10.1056/nejmms1912591] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason A Wasserman
- From the Departments of Foundational Medical Studies and Pediatrics, Oakland University William Beaumont School of Medicine, Rochester (J.A.W.), and the Program in Medical Ethics, Humanities, and Law (M.R., T.G.), and the Department of Psychiatry (M.R.), Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo - both in Michigan
| | - Michael Redinger
- From the Departments of Foundational Medical Studies and Pediatrics, Oakland University William Beaumont School of Medicine, Rochester (J.A.W.), and the Program in Medical Ethics, Humanities, and Law (M.R., T.G.), and the Department of Psychiatry (M.R.), Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo - both in Michigan
| | - Tyler Gibb
- From the Departments of Foundational Medical Studies and Pediatrics, Oakland University William Beaumont School of Medicine, Rochester (J.A.W.), and the Program in Medical Ethics, Humanities, and Law (M.R., T.G.), and the Department of Psychiatry (M.R.), Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo - both in Michigan
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