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Simon TA, Owais S, Duarte D, Acai A. Chronicling the Transition to Competency-Based Medical Education in a Small Subspeciality Program. J Grad Med Educ 2024; 16:312-317. [PMID: 38882435 PMCID: PMC11173005 DOI: 10.4300/jgme-d-23-00643.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/30/2023] [Accepted: 03/12/2024] [Indexed: 06/18/2024] Open
Abstract
Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.
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Affiliation(s)
- Taryn A Simon
- is a Research Assistant, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sawayra Owais
- is a MD/PhD Candidate, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dante Duarte
- is Assistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, and Geriatric Psychiatrist, Seniors Mental Health Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; and
| | - Anita Acai
- is Assistant Professor and Education Scientist, Department of Psychiatry and Behavioural Neurosciences and McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, and Education Scientist, St. Joseph's Education & Research Centre (SERC), St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Mitchell C, Butler L, Holloway AD, Ra JH, Adapa K, Greenberg C, Marks LB, Ivester T, Mazur L. Analysis of patient safety event report categories at one large academic hospital. FRONTIERS IN HEALTH SERVICES 2024; 4:1337840. [PMID: 38628575 PMCID: PMC11018909 DOI: 10.3389/frhs.2024.1337840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/26/2024] [Indexed: 04/19/2024]
Abstract
Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts.
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Affiliation(s)
- Cody Mitchell
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Logan Butler
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alexa D Holloway
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jin H Ra
- Division of Acute Care Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karthik Adapa
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caprice Greenberg
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lawrence B Marks
- Department of Radiation Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- UNC Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Thomas Ivester
- UNC Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lukasz Mazur
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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In Situ Simulation: A Strategy to Restore Patient Safety in Intensive Care Units after the COVID-19 Pandemic? Systematic Review. Healthcare (Basel) 2023; 11:healthcare11020263. [PMID: 36673631 PMCID: PMC9858645 DOI: 10.3390/healthcare11020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patient safety is a public health problem worldwide. In situ simulation (ISS) arises as a learning strategy that allows health professionals to immerse themselves in a real environment without endangering the patients until they have learned the skills needed, thus increasing the quality of care. This systematic review aimed to verify the efficacy of the use of "in situ simulation" as a method that will allow health professionals to increase patient safety in Intensive Care Units after the situation experienced during the pandemic caused by the COVID-19 virus. METHODS Seven studies were reviewed using the PRISMA methodology for systematic reviews. The CASPe guide was used to assess the quality of the manuscripts. RESULTS The main topics that emerged from this review in relation to in situ simulation were as follows: looking at aspects such as patient self-perception of safety, adverse events, interprofessional communication and health system organization in relation to in situ simulation. CONCLUSIONS The adequate implementation of in situ simulation after the COVID-19 pandemic in ICU services is shown to be an efficient and effective strategy to promote improvement in the attitudes on a culture of safety and teamwork of professionals.
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Alavi NM, Nabizadeh‑Gharghozar Z, Ajorpaz NM. The barriers and facilitators of developing clinical competence among master's graduates of gerontological nursing: a qualitative descriptive study. BMC MEDICAL EDUCATION 2022; 22:500. [PMID: 35761240 PMCID: PMC9235093 DOI: 10.1186/s12909-022-03553-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Clinical competence development is a main goal of specialized nursing courses. Nonetheless, some master's graduates of gerontological nursing programs have inadequate Clinical competence. The aim of this study was to explore the barriers and the facilitators to clinical competence development among the master's graduates of gerontological nursing. METHOD This qualitative descriptive study was conducted in 2020. Participants were twenty nursing master's students, master's graduates, and instructors of gerontological nursing. They were purposively selected from several faculties of nursing and midwifery in Tehran, Isfahan, and Kashan, Iran. Semi-structured interviews were held for data collection and the conventional content analysis proposed by Graneheim and Lundman was used for data analysis. Data were managed using the MAXQDA 10 software. RESULTS The main barriers to clinical competence development were students' neglectfulness towards learning, inefficiency of educational system, and ineffective management. The main facilitators to clinical competence development were effective educational planning and management improvement. CONCLUSION There are different personal, educational, and managerial barriers and facilitators to clinical competence development among master's graduates of gerontological nursing. Effective educational planning and management improvement are needed for clinical competence development among master's students and graduates of gerontological nursing.
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Affiliation(s)
- Negin Masoudi Alavi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Zohreh Nabizadeh‑Gharghozar
- Student Research Committee, Nursing & Midwifery School, Shahid Behshti University of Medical Sciences, Tehran, Iran
| | - Neda Mirbagher Ajorpaz
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Raveendran L, McGuire CS, Gazmin S, Beiko D, Martin LJ. The who, what, and how of teamwork research in medical operating rooms: A scoping review. J Interprof Care 2022; 37:504-514. [PMID: 35543316 DOI: 10.1080/13561820.2022.2058917] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the importance of teamwork in the operating room (OR), teamwork can often be conflated with teamwork components (e.g., communication, cooperation). We reviewed the existing literature pertaining to OR teamwork to understand which teamwork components have been assessed. Following PRISMA guidelines for scoping reviews, 4,233 peer-reviewed studies were identified using MEDLINE and Embase. Eighty-seven studies were included for synthesis and analysis. Using the episodic model of teamwork as an organizing framework, studies were grouped into the following teamwork categories: (a) transition processes (e.g., goal specification), (b) action processes (e.g., coordination), (c) interpersonal processes (e.g., conflict management), (d) emergent states (e.g., psychological safety), or (e) omnibus topics (a combination of higher-order teamwork processes). Results demonstrated that action processes were most frequently explored, followed by transition processes, omnibus topics, emergent states, and interpersonal processes. Although all studies were framed as investigations of teamwork, it is important to highlight that most explored only one or a few constructs under the overarching umbrella of teamwork. We advocate for enhanced specificity with descriptions of OR teamwork, reporting practices pertaining to interprofessional demographics and outcomes, and increased diversity in study design and surgery type to advance understanding of teamwork and its implications.
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Affiliation(s)
| | - Cailie S McGuire
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Stefanie Gazmin
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Darren Beiko
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Luc J Martin
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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Cadieux M, Healy M, Petrusa E, Cooke L, Traeger L, Kesselheim JC, Riva-Cambrin J, Phitayakorn R. Implementation of competence by design in Canadian neurosurgery residency programs. MEDICAL TEACHER 2022; 44:380-387. [PMID: 34726559 DOI: 10.1080/0142159x.2021.1994937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The Royal College of Physicians and Surgeons of Canada (RCPSC) recently redesigned the Canadian neurosurgery residency training curriculum by implementing a competency-based model of training known as Competence by Design (CBD) centered around the assessment of Entrustable Professional Activities (EPAs). This sequential explanatory mixed-methods study evaluated potential benefits and pitfalls of CBD in Canadian neurosurgery residency education. METHODS Two four-month interval surveys were distributed to all Canadian neurosurgery residents participating in CBD. The surveys assessed important educational components: CBD knowledge of key stakeholders, potential system barriers, and educational/psychological impacts on residents. Paired t-tests were done to assess changes over time. Based on longitudinal survey responses, semi-structured interviews were conducted to investigate in-depth residents' experience with CBD in neurosurgery. The qualitative analysis followed an explanatory approach, and a thematic analysis was performed. RESULTS Surveys had 82% average response rate (n = 25). Over time, most residents self-reported that they retrospectively understood concepts around CBD intentions (p = 0.02). Perceived benefits included faculty evaluations with more feedback that was clearer and more objective (53% and 51%). Pitfalls included the amount of time needed to navigate through EPAs (90%) and residents forgetting to initiate EPA forms (71%). There was no significant change over time. During interviews, five key themes were found. Potential solutions identified by residents to enhance their experience included learning analytics data availability, mobile app refinement, and dedicated time to integrate EPAs in the workflow. CONCLUSION This study was the first to assess resident-perceived benefits and pitfalls of the neurosurgery CBD training program in an educational framework context. In general, residents believed that theoretical principles behind CBD were valuable, but that technological ability and having enough time to request EPA assessments were significant barriers to success. Long-term studies are required to determine the definitive outcomes of CBD on residents' performance and ultimately, on patient care.
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Affiliation(s)
- Magalie Cadieux
- Harvard Medical School, Boston, MA, USA
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michael Healy
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lara Cooke
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Lara Traeger
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer C Kesselheim
- Harvard Medical School, Boston, MA, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Roy Phitayakorn
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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Lee A, Finstad A, Tipney B, Lamb T, Rahman A, Devenny K, Abou Khalil J, Kuziemsky C, Balaa F. OUP accepted manuscript. BJS Open 2022; 6:6555348. [PMID: 35348608 PMCID: PMC8963294 DOI: 10.1093/bjsopen/zrac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Human factors (HF) integration can improve patient safety in the operating room (OR), but the depth of current knowledge remains unknown. This study aimed to explore the content of HF training for the operative environment. Methods We searched six bibliographic databases for studies describing HF interventions for the OR. Skills taught were classified using the Chartered Institute of Ergonomics and Human Factors (CIEHF) framework, consisting of 67 knowledge areas belonging to five categories: psychology; people and systems; methods and tools; anatomy and physiology; and work environment. Results Of 1851 results, 28 studies were included, representing 27 unique interventions. HF training was mostly delivered to interdisciplinary groups (n = 19; 70 per cent) of surgeons (n = 16; 59 per cent), nurses (n = 15; 56 per cent), and postgraduate surgical trainees (n = 11; 41 per cent). Interactive methods (multimedia, simulation) were used for teaching in all studies. Of the CIEHF knowledge areas, all 27 interventions taught ‘behaviours and attitudes’ (psychology) and ‘team work’ (people and systems). Other skills included ‘communication’ (n = 25; 93 per cent), ‘situation awareness’ (n = 23; 85 per cent), and ‘leadership’ (n = 20; 74 per cent). Anatomy and physiology were taught by one intervention, while none taught knowledge areas under work environment. Conclusion Expanding HF education requires a broader inclusion of the entirety of sociotechnical factors such as contributions of the work environment, technology, and broader organizational culture on OR safety to a wider range of stakeholders.
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Affiliation(s)
- Alex Lee
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Tyler Lamb
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Alvi Rahman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kirsten Devenny
- Saegis, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Jad Abou Khalil
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Craig Kuziemsky
- Office of Research Services and School of Business, MacEwan University, AB, Canada
| | - Fady Balaa
- Correspondence to: Fady Balaa, Division of General Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital – General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada (e-mail: )
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8
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Imani B, Bahadori H, Amiri M. The effects of task-based learning and mentorship on the perceived surgical competency and clinical education condition of surgical technology students. Nurs Midwifery Stud 2022. [DOI: 10.4103/nms.nms_136_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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9
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The Effect of Educational Intervention on the Improvement of Nontechnical Skills in Circulating Nurses. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5856730. [PMID: 34692835 PMCID: PMC8536428 DOI: 10.1155/2021/5856730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/05/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023]
Abstract
Background Nontechnical skills are necessary for clinicians' safe performance and prevention of errors in the operating room. Educational intervention is a useful way to improve these skills, which are a vital area for improvement. Circulating nurses are surgical team members whose work depends heavily on using nontechnical skills. This study is aimed at assessing the effect of an educational intervention on the improvement of circulating nurses' nontechnical skills. Methods This semiexperimental study was conducted on 300 circulating nurses divided into the intervention and no intervention groups each containing 150 participants. The nontechnical skills were assessed using the circulating practitioners' list of nontechnical skills. Then, the intervention group received training regarding these skills, and the two groups were evaluated again. After all, the data were entered into the SPSS 24 software and were analyzed using descriptive statistics and Wilcoxon and Mann–Whitney tests. Furthermore, Kendall's tau, independent sample t-test, and one-way ANOVA were used for assessment of relationship between median scores and demographics. Results The results revealed a significant improvement in the scores of all domains of nontechnical skills in the intervention group (p < 0.05). The highest and lowest improvements were observed in teamwork (42%) and situational awareness (16.7%), respectively. After the intervention, the scores of some of the behaviors were still below the average level or were not improved significantly. Conclusions Circulating nurses' nontechnical skills can be improved by educational interventions. However, regarding the low scores or no improvements in the scores of some behaviors, other intervention types such as policymaking and correcting the existing hierarchies in the operating room can be useful to complete the educational interventions.
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Kulmala J, Rosenberg A, Ngandu T, Hemiö K, Tenkula T, Hyytiä A, Vienola M, Huhtamäki-Kuoppala M, Saarinen A, Korkki S, Laatikainen T, Solomon A, Kivipelto M. Facilitators and barriers to implementing lifestyle intervention programme to prevent cognitive decline. Eur J Public Health 2021; 31:816-822. [PMID: 34448856 PMCID: PMC8505000 DOI: 10.1093/eurpub/ckab087] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Finnish Intervention Study to Prevent Cognitive Impairment and Disability is a randomized controlled trial that has tested the efficacy of a multidomain intervention targeting modifiable risk factors to prevent cognitive impairment/dementia. A combination of healthy diet, physical, social and cognitive activity, and management of cardiovascular risks was shown to be an effective model to promote brain health among older people. The aim of this qualitative study was to explore healthcare professionals' perceptions of facilitators and barriers to implementing this lifestyle programme into health care. METHODS Four semi-structured focus group interviews were conducted among healthcare professionals working in primary care and in non-governmental organizations (N=27). Participants were asked to discuss their perceptions of facilitators and barriers for implementing the multidomain intervention into clinical practice. Interviews were analyzed using content analysis. RESULTS Barriers and facilitators described by the healthcare professionals were related to infrastructure and resources, client's personal characteristics and the lifestyle intervention itself. These main categories included several sub-categories related to knowledge, motivation, resources, individualization and collaboration. The interviewees pointed out that more education on dementia prevention is needed, the work should be coordinated efficiently, resources to provide preventive health care should be adequate and multiprofessional collaboration is needed. CONCLUSIONS Transferring a lifestyle intervention from a trial-setting to real life requires knowledge about the factors that influence effective implementation. Identifying drivers and constraints of successful implementation helps to design and tailor future prevention programmes, increases motivation and adherence and supports system change.
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Affiliation(s)
- Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland.,Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rosenberg
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Katri Hemiö
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tarja Tenkula
- Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
| | - Arja Hyytiä
- Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
| | | | | | | | - Saana Korkki
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Alina Solomon
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Miia Kivipelto
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
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Innovative Work Behavior—A Key Factor in Business Performance? The Role of Team Cognitive Diversity and Teamwork Climate in This Relationship. JOURNAL OF RISK AND FINANCIAL MANAGEMENT 2021. [DOI: 10.3390/jrfm14040185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of our paper is to examine whether the support of innovative work behavior by management is positively related to business performance and at the same time, whether this relationship is mediated by the teamwork climate and cognitive diversity of teams. Cognitive diversity is defined as differences in knowledge and perspective, which arise from professional diversity and account for its positive effects. A teamwork climate represents staff perceptions of collaboration between personnel. Business performance is defined by the level of sales. Our sample consisted of 211 managers of companies operating in Slovakia, and data collection took place in the form of a questionnaire. The main tool for examining the mechanism of operation of the investigated relationships is mediation using regression analysis and the Sobel test to determine the significance of the indirect effect of mediation variables. The findings point to a significant direct relationship between the innovative work behavior of company employees and business performance. The intensity of this relationship can be partly influenced by promoting cognitive diversity, especially in the area of knowledge and ways of thinking. The significant role of a teamwork climate was not demonstrated in the examined model.
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Fruhen L, Carpini JA, Parker SK, Leung Y, Flemming AFS. Perceived barriers to multiprofessional team briefings in operating theatres: a qualitative study. BMJ Open 2020; 10:e032351. [PMID: 32041853 PMCID: PMC7044864 DOI: 10.1136/bmjopen-2019-032351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study investigates perceived barriers towards the implementation of multiprofessional team briefings (MPTB) in operating theatres, as well as ways to overcome these perceived barriers. Previous research shows that MPTB can enhance teamwork and communication, but are underused in operating theatres. By adopting a multilevel systems perspective, this study examines perceived barriers and solutions for MPTB implementation. DESIGN Participants completed open-ended survey questions. Responses were coded via qualitative content analysis. The analysis focused on themes in the responses and the systems level at which each barrier and solution operates. SETTING Four tertiary hospitals in Australia. PARTICIPANTS 103 operating theatre staff, including nurses, surgeons, anaesthetists, technicians and administrators. RESULTS Participants identified barriers and solutions at the organisational (15.81% of barriers; 74.10% of solutions), work group (61.39% of barriers; 25.09% of solutions) and individual level (22.33% of barriers; 0% of solutions). Of all the perceived barriers to MPTB occurrence, a key one is getting everyone into the room at the same time . Matching of perceived barriers and solutions shows that higher systems-level solutions can address lower level barriers, thereby showing the relevance of implementing such wider reaching solutions to MPTB occurrence (including work practices at occupational level and above) as well as addressing more local issues. CONCLUSIONS Successful MPTB implementation requires changes at various systems levels. Practitioners can strategically prepare and plan for systems-based strategies to overcome barriers to MPTB implementation. Future research can build on this study's findings by directly examining higher systems-level barriers and solutions via detailed case analyses.
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Affiliation(s)
- Laura Fruhen
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Sharon K Parker
- Future of Work Institute, Curtin University, Perth, Western Australia, Australia
| | - Yee Leung
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Adrian F S Flemming
- Faculty of Health and Medical Sciences, Surgery, The University of Western Australia, Crawley, Western Australia, Australia
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13
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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Bleakley A. Invoking the Medical Humanities to Develop a #MedicineWeCanTrust. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1422-1424. [PMID: 31299677 DOI: 10.1097/acm.0000000000002870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Trust is a complex phenomenon that resists easy definition, but it is easily recognizable, or rather its absence is impossible to miss. The author draws inspiration from the #MedsWeCanTrust movement to advocate for #MedicineWeCanTrust. Trust can be seen as a "soft," "tender-minded," optimistic condition fighting for survival in a "hard," "tough-minded," or jaundiced medicine. Modern medicine is traditionally patriarchal, individualistic, and resistant to encouraging democratic, collaborative habits as it socializes its young into hierarchical structures or eats them whole. Yet trust is a health intervention and essential for the innovative expansion of medical culture as it encourages authentic democracy, interprofessional clinical teamwork, and patient-centeredness. Increases in trust lead to greater tolerance of uncertainty, one of the primary goals of medical education. Recent curriculum development work has shown that the medical humanities offer a superb delivery mechanism for ensuring democratic habits in medicine that align with social justice agendas, key to addressing links between social inequalities and compromised physical and mental health. Where lack of trust is associated with cynicism in doctors, increasing trust loosens dependence upon suffocating control mechanisms. This allows medicine to take on the moral concerns and uncertainties of an adulthood that also promises emotional warmth, guidance, support, and improved communication between colleagues and with patients. Medicine must embrace trust as the matrix of health care, and the medical humanities can educate for values such as tolerance of uncertainty and ambiguity as a basis for engendering trust.
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Affiliation(s)
- Alan Bleakley
- A. Bleakley is emeritus professor of medical education and medical humanities, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom
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Kim MS, Seok JH, Kim BM. Mediating role of the perceived benefits of using a medication safety system in the relationship between transformational leadership and the medication-error management climate. J Res Nurs 2019; 25:22-34. [PMID: 34394603 DOI: 10.1177/1744987118824621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Evidence indicates that applying technology to medication safety will improve the quality of medical services and enhance the medication-error management climate. The perceived benefits of using the medication safety system are an important factor for adopting a system. Aims The purpose of this study was to investigate the mediating role of the perceived benefits of using a medication safety system in the relationship between transformational leadership and the medication-error management climate. Methods A total of 153 staff nurses from 11 secondary or tertiary hospitals in Korea were included. Descriptive statistics, t-tests, analysis of variance, Pearson correlations and multiple regression analyses were used. Results Transformational leadership was significantly correlated with the perceived benefits of the system use (r = .17, p = .032) and medication-error management climate (r = .55, p < .001). The perceived benefit of using the medication safety system was a mediator between transformational leadership and the medication-error management climate. Conclusions When chief executive officers construct and implement a medication safety system in their hospitals, transformational leadership can enhance the perceived benefits of system use, which is an important factor that contributes to a positive medication-error management climate.
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Affiliation(s)
- Myoung Soo Kim
- Professor, Department of Nursing, Pukyong National University, Busan, Republic of Korea
| | - Ji Hye Seok
- Pukyong National University, Busan, Republic of Korea
| | - Bo Min Kim
- Department of Nursing, Bong Seng Memorial Hospital, Busan, Republic of Korea
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Evaluation of a pilot interprofessional education programme for eating disorder training in mental health services. Ir J Psychol Med 2018; 35:289-299. [PMID: 30501664 DOI: 10.1017/ipm.2015.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an Interprofessional Education (IPE) programme in eating disorders for mental health practitioners using a case-based learning approach. METHODS A total of 25 mental health clinicians were asked to evaluate their IPE programme as part of training for the National Clinical Programme in Eating Disorders. They completed a Readiness for Interprofessional Learning Scale (RIPLS), a learner reaction questionnaire after each session and a final open evaluation at 4 months. Non-parametric statistical analysis was employed to analyse learner attitudes and reactions, and qualitative information was coded. RESULTS A total of 23 (92%) clinicians from five disciplines participated. Baseline attitudes towards IPE were positive on all RIPLS subscales, and those with prior IPE experience had most positive views as to its benefits for teamwork and patient care (p=0.036). Learner reactions on content, delivery, outcome and structure indicated that individual learning experience was strongly positively endorsed. Change in clinical practice behaviour was reported in terms of communication, clinical activity, outcome evaluation and confidence. Barriers included other demands on time, organisational support, not having enough patients or co-workers to practice skills, and knowledge differentials between learners. CONCLUSIONS IPE using a case based learning approach is an effective and acceptable means of developing specialist training across existing service, team and professional boundaries. It has potential for positive impact on knowledge, clinical behaviour and service delivery. Recommendations include the introduction of IPE group guidelines, wider circulation of learning points and content, and the use of self-competency ratings and reflective logs.
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Jaffrey S. Getting in the Flo: My year as a scholar. J Perioper Pract 2018; 29:161-165. [PMID: 30212285 DOI: 10.1177/1750458918791122] [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: 11/15/2022]
Abstract
In November 2016, I was awarded an Emerging Leaders Scholarship from the Florence Nightingale Foundation to help me positively impact patient care and also improve how I lead change within my organisation. This article highlights some of the learning experiences over the last year and the impact that the Scholarship has had.
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Affiliation(s)
- Sakina Jaffrey
- Day Surgery and Main Theatres, Ashford Hospital, Ashford and St Peters NHS Trust, Ashford, UK
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18
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Sundler AJ, Johansson E, Johansson L, Hedén L. Incidents reported by nurse anaesthetists in the operating room. J Interprof Care 2018; 32:699-705. [DOI: 10.1080/13561820.2018.1500452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Annelie J. Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | | | - Linda Johansson
- Anaesthesia and intensive care unit, Hallands Sjukhus, Varberg, Sweden
| | - Lena Hedén
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Willassen ET, Jacobsen ILS, Tveiten S. Safe Surgery Checklist, Patient Safety, Teamwork, and Responsibility-Coequal Demands? A Focus Group Study. Glob Qual Nurs Res 2018; 5:2333393618764070. [PMID: 29623287 PMCID: PMC5881961 DOI: 10.1177/2333393618764070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 12/22/2022] Open
Abstract
The use of World Health Organization’s (WHO’s) Safe Surgery checklist is an established practice worldwide and contributes toward ensuring patient safety and collaborative teamwork. The aim of this study was to elucidate operating room nurses’ and operating room nursing students’ experiences and opinions about execution of and compliance with checklists. We chose a qualitative design with semistructured focus group discussions. Qualitative content analysis was conducted. Two main themes were identified; the Safe Surgery checklists have varied influence on teamwork and patient safety, and taking responsibility for executing the checks on the Safe Surgery checklist entails practical and ethical challenges. The experiences and opinions of operating room nurses and their students revealed differences of practices and attitudes toward checklist compliance and the intentions of checklist procedures. These differences are related to cultural and professional distances between team members and their understanding of the Safe Surgery checklists as a tool for patient safety.
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Affiliation(s)
| | | | - Sidsel Tveiten
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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20
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St Pierre M, Gall C, Breuer G, Schüttler J. [Does annual simulation training influence the safety climate of a university hospital? : Prospective 5‑year investigation using dimensions of the safety attitude questionnaire]. Anaesthesist 2017; 66:910-923. [PMID: 28971216 DOI: 10.1007/s00101-017-0371-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simulation-based training with a focus on non-technical skills can have a positive influence on safety relevant attitudes of participants. If an organization succeeds in training sufficient staff, it may experience a positive change in the safety climate. As the effects of a single training are of a transient nature, annual training sessions may lead to an incremental improvement of safety relevant attitudes of employees over time. In spring 2012 the Department of Anesthesia at the University Hospital of Erlangen established an annual simulation-based training for staff members (e.g. consultants, trainee anesthetists and nurse anesthetists). OBJECTIVE The study aimed to test whether an annual simulation-based training would result in an incremental longitudinal improvement in attitudes towards teamwork, safety and stress recognition. METHODS A survey comprising three domains (teamwork climate, safety climate and stress recognition) of the safety attitudes questionnaire (SAQ) and items addressing briefing and speaking up was distributed to all participants in an annual in-house simulation training. Participants filled out the questionnaire in the morning of each training day. The attitudes were measured before the first training series in 2012, 6 months after the first training and then every year (2013-2016). Participants generated a personalized identification code which allowed individuals to be anonymously tracked over time. Results of the 5‑point Likert scale were transformed to a 100-point scale. Results were calculated at the group level and at the individual level. Univariable linear regression was used to calculate mean changes per year. RESULTS Over a period of 5 years (2012-2016) a total of 255 individuals completed the questionnaire. Each year, 14-20% of all nurse anesthetists and 81-90% of all anesthetists participated in the simulation-based training. As a result of annual staff turnover 16-24% of participants were new staff members. A personalized code allowed the before and after comparison of 99 staff members who had participated twice or more. Physicians had a higher mean score for teamwork climate before the first training (+8.7 p < 0.001). Mean teamwork climate and safety climate scores before the first training increased over a period of 5 years (3.11 for teamwork climate, p < 0.001 and 2.73 for safety climate, p < 0.001). Repeat participation led to a bigger mean change of individual attitudes in nurse anesthetists: teamwork climate 5.2 (nurses) vs. 1.4 (physicians) and safety climate 5.3 (nurses) vs. 2.8 (physicians) without reaching significance. Participants acknowledged the importance of briefings but confirmed their existence in less than half of the cases. The frequency of briefings increased over the 5‑year period. There were no changes in attitude towards speaking up. CONCLUSION Over a 5-year period, small positive changes in attitudes towards teamwork and safety occurred. Low participation of nurse anesthetists as well as personnel turnover may have weakened the impact of simulation-based training on the safety climate.
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Affiliation(s)
- M St Pierre
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
| | - C Gall
- Lehrstuhl für Medizininformatik, Biometrie & Epidemiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - G Breuer
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Schüttler
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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Paltved C, Bjerregaard AT, Krogh K, Pedersen JJ, Musaeus P. Designing in situ simulation in the emergency department: evaluating safety attitudes amongst physicians and nurses. Adv Simul (Lond) 2017; 2:4. [PMID: 29450005 PMCID: PMC5806390 DOI: 10.1186/s41077-017-0037-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 01/21/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This intervention study aimed to enhance patient safety attitudes through the design of an in situ simulation program based on a needs analysis involving thematic analysis of patient safety data and short-term ethnography. The study took place at an Emergency Department (ED) in the Central Region of Denmark. Research suggests that poor handover communication can increase the likelihood of critical incidents and adverse events in the ED. Furthermore, simulation is an effective strategy for training handover communication skills. Research is lacking, however, on how to use patient safety data and a needs analysis to the design of in situ simulation communication training. METHODS This is a prospective pre-post study investigating the interventional effects of in situ simulation. It used a three-pronged strategy: (1) thematic analysis of patient safety data consisting of reported critical incidents and adverse events, (2) a needs analysis based on short-term ethnography in the ED, and (3) pre-post evaluation using the validated Safety Attitudes Questionnaire (SAQ) and the Trainee Reactions Score. RESULTS Sixteen different healthcare teams participated composed by 9 physicians and 30 nurses. In the SAQ, participating staff scored their safety attitudes in six categories (n = 39). Two measures where significantly higher for the post-SAQ than those for the pre-SAQ: teamwork climate (p < 0.001) and safety climate (p < 0.05). The Trainee Reactions Score showed that the training was positively evaluated. CONCLUSIONS This study designed a feasible strategy for implementing in situ simulation based on a needs analysis of critical incidents and adverse events and short-term ethnography.
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Affiliation(s)
- Charlotte Paltved
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- Corporate HR MidtSim, the Central Region of Denmark, Aarhus, Denmark
| | - Anders Thais Bjerregaard
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- Corporate HR MidtSim, the Central Region of Denmark, Aarhus, Denmark
| | - Kristian Krogh
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jonas Juul Pedersen
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- Corporate HR MidtSim, the Central Region of Denmark, Aarhus, Denmark
| | - Peter Musaeus
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- CESU, Centre for Health Sciences Education, Aarhus University, Palle Juul Jensens Boulevard 82, Aarhus N, 8200 Aarhus, Denmark
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Johnson A, Nguyen H, Groth M, Wang K, Ng JL. Time to change: a review of organisational culture change in health care organisations. JOURNAL OF ORGANIZATIONAL EFFECTIVENESS-PEOPLE AND PERFORMANCE 2016. [DOI: 10.1108/joepp-06-2016-0040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The culture of an organization shapes the attitudes and behaviors of employees and plays a key role in driving organizational outcomes. Yet, it is enormously challenging to manage or change. The purpose of this paper is to review the recent literature on culture change interventions in health care organizations to identify the common themes underpinning these interventions.
Design/methodology/approach
The paper is developed from an extensive review of the literature on culture change interventions in health care from 2005 to 2015, building on previous reviews and highlighting examples of good practice.
Findings
All culture change interventions included in the review used processes and techniques that can be classified into Lewin’s (1951) three stage model of change. These include providing evidence for the need for change through data, a range of successful change strategies, and strategies for embedding the culture change into business as usual.
Practical implications
There is no “one size fits all” recipe for culture change. Rather, attention to context with key features including diagnosis and evaluation of culture, a combination of support from leaders and others in the organization, and strategies to embed the culture change are important for the change process to happen.
Originality/value
The authors provide an important insight into the key principles and features of culture change interventions to provide practitioners with guidance on the process within health care and other organizations.
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Mirbagher Ajorpaz N, Zagheri Tafreshi M, Mohtashami J, Zayeri F. Mentoring in Training of Operating Room Students: A Systematic Review. J Nurs Educ 2016. [DOI: 10.21859/jne-05037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
This article has summarised a critical discussion of the human factors that contributed to the death of a patient from a failure to respond appropriately to a 'can't intubate, can't ventilate' scenario. The contributory factors included the clinical team's inability to communicate, prioritise tasks and demonstrate effective leadership and assertive followership. The film Just a routine operation has now been in circulation for several years. When a system is designed and introduced with the intention of making a change to clinical practice, it can quickly become just another component of an organisation's architecture and complacency around its use can develop. This article has been written specifically for perioperative practitioners to renew the debate around the human factors that contribute to patient harm. By critically discussing Just a routine operation and attempting to review why the incident occurred, this article has attempted to emphasise that some of the conditions and behaviours that contributed to the death of Elaine Bromiley may be latent within our organisations and teams, and may continue to contribute to failures that affect patient safety.
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Bezemer J, Korkiakangas T, Weldon SM, Kress G, Kneebone R. Unsettled teamwork: communication and learning in the operating theatres of an urban hospital. J Adv Nurs 2015; 72:361-72. [DOI: 10.1111/jan.12835] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
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Carvalho PA, Göttems LBD, Pires MRGM, de Oliveira MLC. Safety culture in the operating room of a public hospital in the perception of healthcare professionals. Rev Lat Am Enfermagem 2015; 23:1041-8. [PMID: 26625994 PMCID: PMC4664003 DOI: 10.1590/0104-1169.0669.2647] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/07/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the perception of healthcare professionals about the safety culture in the operating room of a public hospital, large-sized, according to the domains of the Safety Attitudes Questionnaire (SAQ). METHOD Descriptive, cross-sectional and quantitative research, with the application of the SAQ to 226 professionals. Descriptive data analysis, instrument consistency and exploratory factor analysis. RESULTS Participants were distributed homogeneously between females (49.6%) and males (50.4%); mean age of 39.6 (SD±9.9) years and length of professional experience of 9.9 (SD ± 9.2) years. And Cronbach's α of 0.84. It was identified six domains proposed in the questionnaire: stress perception (74.5) and job satisfaction (70.7) showed satisfactory results; teamwork environment (59.1) and climate of security (48.9) presented scores below the minimum recommended (75); unit's management perceptions (44.5), hospital management perceptions (34.9) and working conditions (41.9) presented the lowest averages. CONCLUSIONS The results showed that, from the perspective of the professionals, there is weakness in the values, attitudes, skills and behaviors that determine the safety culture in a healthcare organization.
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Affiliation(s)
| | - Leila Bernarda Donato Göttems
- PhD, Adjunct Professor, Escola Superior de Ciências da Saúde, Fundação
de Ensino e Pesquisa em Ciências da Saúde, Secretaria de Estado de Saúde, Brasília, DF,
Brazil
| | | | - Maria Liz Cunha de Oliveira
- PhD, Adjunct Professor, Fundação de Ensino e Pesquisa em Ciências da
Saúde, Secretaria de Estado de Saúde, Brasília, DF, Brazil
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Sacks GD, Shannon EM, Dawes AJ, Rollo JC, Nguyen DK, Russell MM, Ko CY, Maggard-Gibbons MA. Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture. BMJ Qual Saf 2015; 24:458-67. [DOI: 10.1136/bmjqs-2014-003764] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/05/2015] [Indexed: 01/12/2023]
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Wallin CJ, Kalman S, Sandelin A, Färnert ML, Dahlstrand U, Jylli L. Creating an environment for patient safety and teamwork training in the operating theatre: A quasi-experimental study. MEDICAL TEACHER 2015; 37:267-276. [PMID: 25180879 DOI: 10.3109/0142159x.2014.947927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Positive safety and a teamwork climate in the training environment may be a precursor for successful teamwork training. This pilot project aimed to implement and test whether a new interdisciplinary and team-based approach would result in a positive training climate in the operating theatre. METHOD A 3-day educational module for training the complete surgical team of specialist nursing students and residents in safe teamwork skills in an authentic operative theatre, named Co-Op, was implemented in a university hospital. Participants' (n=22) perceptions of the 'safety climate' and the 'teamwork climate', together with their 'readiness for inter-professional learning', were measured to examine if the Co-Op module produced a positive training environment compared with the perceptions of a control group (n=11) attending the conventional curriculum. RESULTS The participants' perceptions of 'safety climate' and 'teamwork climate' and their 'readiness for inter-professional learning' scores were significantly higher following the Co-Op module compared with their perceptions following the conventional curriculum, and compared with the control group's perceptions following the conventional curriculum. CONCLUSION The Co-Op module improved 'safety climate' and 'teamwork climate' in the operating theatre, which suggests that a deliberate and designed educational intervention can shape a learning environment as a model for the establishment of a safety culture.
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De Korne DF, Van Wijngaarden JDH, Van Dyck C, Hiddema UF, Klazinga NS. Evaluation of aviation-based safety team training in a hospital in The Netherlands. J Health Organ Manag 2015; 28:731-53. [PMID: 25420354 DOI: 10.1108/jhom-01-2013-0008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to evaluate the implementation of a broad-scale team resource management (TRM) program on safety culture in a Dutch eye hospital, detailing the program's content and procedures. Aviation-based TRM training is recognized as a useful approach to increase patient safety, but little is known about how it affects safety culture. DESIGN/METHODOLOGY/APPROACH Pre- and post-assessments of the hospitals' safety culture was based on interviews with ophthalmologists, anesthesiologists, residents, nurses, and support staff. Interim observations were made at training sessions and in daily hospital practice. FINDINGS The program consisted of safety audits of processes and (team) activities, interactive classroom training sessions by aviation experts, a flight simulator session, and video recording of team activities with subsequent feedback. Medical professionals considered aviation experts inspiring role models and respected their non-hierarchical external perspective and focus on medical-technical issues. The post-assessment showed that ophthalmologists and other hospital staff had become increasingly aware of safety issues. The multidisciplinary approach promoted social (team) orientation that replaced the former functionally-oriented culture. The number of reported near-incidents greatly increased; the number of wrong-side surgeries stabilized to a minimum after an initial substantial reduction. RESEARCH LIMITATIONS/IMPLICATIONS The study was observational and the hospital's variety of efforts to improve safety culture prevented us from establishing a causal relation between improvement and any one specific intervention. ORIGINALITY/VALUE Aviation-based TRM training can be a useful to stimulate safety culture in hospitals. Safety and quality improvements are not single treatment interventions but complex socio-technical interventions. A multidisciplinary system approach and focus on "team" instead of "profession" seems both necessary and difficult in hospital care.
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Havyer RDA, Wingo MT, Comfere NI, Nelson DR, Halvorsen AJ, McDonald FS, Reed DA. Teamwork assessment in internal medicine: a systematic review of validity evidence and outcomes. J Gen Intern Med 2014; 29:894-910. [PMID: 24327309 PMCID: PMC4026505 DOI: 10.1007/s11606-013-2686-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/17/2013] [Accepted: 10/02/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. DATA SOURCES We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. STUDY ELIGIBILITY Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. STUDY APPRAISAL AND SYNTHESIS METHODS Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. RESULTS Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. LIMITATIONS Review is limited to quantitative assessments of teamwork in internal medicine. CONCLUSIONS There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes.
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Weller J, Boyd M. Making a Difference Through Improving Teamwork in the Operating Room: A Systematic Review of the Evidence on What Works. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0050-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Courtenay M, Nancarrow S, Dawson D. Interprofessional teamwork in the trauma setting: a scoping review. HUMAN RESOURCES FOR HEALTH 2013; 11:57. [PMID: 24188523 PMCID: PMC3826522 DOI: 10.1186/1478-4491-11-57] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/21/2013] [Indexed: 05/20/2023]
Abstract
Approximately 70 to 80% of healthcare errors are due to poor team communication and understanding. High-risk environments such as the trauma setting (which covers a broad spectrum of departments in acute services) are where the majority of these errors occur. Despite the emphasis on interprofessional collaborative practice and patient safety, interprofessional teamworking in the trauma setting has received little attention. This paper presents the findings of a scoping review designed to identify the extent and nature of this literature in this setting. The MEDLINE (via OVID, using keywords and MeSH in OVID), and PubMed (via NCBI using MeSH), and CINAHL databases were searched from January 2000 to April 2013 for results of interprofessional teamworking in the trauma setting. A hand search was conducted by reviewing the reference lists of relevant articles. In total, 24 published articles were identified for inclusion in the review. Studies could be categorized into three main areas, and within each area were a number of themes: 1) descriptions of the organization of trauma teams (themes included interaction between team members, and leadership); 2) descriptions of team composition and structure (themes included maintaining team stability and core team members); and 3) evaluation of team work interventions (themes included activities in practice and activities in the classroom setting).Descriptive studies highlighted the fluid nature of team processes, the shared mental models, and the need for teamwork and communication. Evaluative studies placed a greater emphasis on specialized roles and individual tasks and activities. This reflects a multiprofessional as opposed to an interprofessional model of teamwork. Some of the characteristics of high-performing interprofessional teams described in this review are also evident in effective teams in the community rehabilitation and intermediate care setting. These characteristics may well be pertinent to other settings, and so provide a useful foundation for future investigations.
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Affiliation(s)
- Molly Courtenay
- School of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
- University of California, Davis, Betty Irene Moore School of Nursing, UC Davis Health System, 4610 X Street, #4202, Sacramento, CA 95817, USA
| | - Susan Nancarrow
- Southern Cross University, School of Health and Human Sciences, Lismore, Australia
| | - David Dawson
- Lawrence J. Ellison Ambulatory Care Center, University of California, Davis, Sacramento, CA, USA
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