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Nataraj N, Tome J, Ratelle JT. Teaming in Graduate Medical Education: Ward Rounds and Beyond. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231225588. [PMID: 38304280 PMCID: PMC10832407 DOI: 10.1177/23821205231225588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Abstract
Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.
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Affiliation(s)
- Neela Nataraj
- Division of Hospital Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - June Tome
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - John T. Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Watari T, Kurihara M, Nishizaki Y, Tokuda Y, Nagao Y. Safety culture survey among medical residents in Japan: a nationwide cross-sectional study. BMJ Open Qual 2023; 12:e002419. [PMID: 37797961 PMCID: PMC10551985 DOI: 10.1136/bmjoq-2023-002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE This study aimed to examine safety culture among Japanese medical residents through a comparative analysis of university and community hospitals and an investigation of the factors related to safety culture. METHOD This nationwide cross-sectional study used a survey to assess first and second-year medical residents' perception of safety culture. We adapted nine key items from the Safety Awareness Questionnaire to the Japanese training environment and healthcare system. Additionally, we explored specific factors relevant to safety culture, such as gender, year of graduation, age, number of emergency room duties per month, average number of admissions per day, incident experience, incident reporting experience, barriers to incident reporting and safety culture. We analysed the data using descriptive statistics and multivariate logistic regression analysis. RESULTS We included 5289 residents (88.6%) from community training hospitals and 679 residents (11.4%) from university hospitals. A comparative analysis of safety culture between the two groups on nine representative questions revealed that the percentage of residents who reported a positive atmosphere at their institution was significantly lower at university hospitals (81.7%) than at community hospitals (87.8%) (p<0.001). The other items were also significantly lower for university hospital residents. After adjusting for multivariate logistic analysis, university hospital training remained significantly and negatively associated with all nine safety culture items. Furthermore, we also found that university hospital residents perceived a significantly lower level of safety culture than community hospital residents. IMPLICATIONS Further research and discussion on medical professionals' perception of safety culture in their institutions as well as other healthcare professionals' experiences are necessary to identify possible explanations for our findings and develop strategies for improvement.
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Affiliation(s)
- Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, Shimane, Japan
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | | - Yasuharu Tokuda
- Muribushi Okinawa Project for Teaching Hospitals, Okinawa, Japan
| | - Yoshimasa Nagao
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Japan
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Klasen JM, Teunissen PW, Driessen EW, Lingard LA. 'It depends': The complexity of allowing residents to fail from the perspective of clinical supervisors. MEDICAL TEACHER 2022; 44:196-205. [PMID: 34634990 DOI: 10.1080/0142159x.2021.1984408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Clinical supervisors acknowledge that they sometimes allow trainees to fail for educational purposes. What remains unknown is how supervisors decide whether to allow failure in a specific instance. Given the high stakes nature of these decisions, such knowledge is necessary to inform conversations about this educationally powerful and clinically delicate phenomenon. MATERIALS AND METHODS 19 supervisors participated in semi-structured interviews to explore how they view their decision to allow failure in clinical training. Following constructivist grounded theory methodology, the iteratively collected data and analysis were informed by theoretical sampling. RESULTS Recalling instances when they considered allowing residents to fail for educational purposes, supervisors characterized these as intuitive, in-the-moment decisions. In their post hoc reflections, they could articulate four factors that they believed influenced these decisions: patient, supervisor, trainee, and environmental factors. While patient factors were reported as primary, the factors appear to interact in dynamic and nonlinear ways, such that supervisory decisions about allowing failure may not be predictable from one situation to the next. CONCLUSIONS Clinical supervisors make many decisions in the moment, and allowing resident failure appears to be one of them. Upon reflection, supervisors understand their decisions to be shaped by recurring factors in the clinical training environment. The complex interplay among these factors renders predicting such decisions difficult, if not impossible. However, having a language for these dynamic factors can support clinical educators to have meaningful discussions about this high-stakes educational strategy.
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Affiliation(s)
- Jennifer M Klasen
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland
| | - Pim W Teunissen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Erik W Driessen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Lorelei A Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
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Bord S, Sass I, Hayms G, Moskowitz K, Baruch H, Basis F. Involvement and skepticism towards the JCI Accreditation process among hospital's four sectors employees: suggestions for cultural change. Isr J Health Policy Res 2021; 10:74. [PMID: 34906237 PMCID: PMC8670208 DOI: 10.1186/s13584-021-00507-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementing the JCI Accreditation process as an organizational culture may face resistance. However, the skepticism and involvement of different hospital sectors (medical, nursing, paramedical, and administrative/logistic) in the process may vary. Conducting organizational change needs tools to decrease resistance. OBJECTIVES To investigate the attitudes, cultural norms, and satisfaction of the different sectors regarding the accreditation process, and to suggest ways to integrate the process as part of the organizational culture. MATERIALS AND METHODS A cross-sectional survey was conducted among 462 respondents (187 nurses, 95 physicians, 92 administrative, 88 paramedical) at Rambam Health Care Campus, a tertiary hospital in Israel. The hospital employees' attitudes, cultural norms, and satisfaction were assessed. ANOVA tests were used to examine the differences among the different sectors. The association between the satisfaction from the process and the preferred type of training was examined using Pearson's correlation coefficient. RESULTS Significant differences were found among the sectors in the scores related to attitude, cultural norms, and satisfaction from the accreditation process (F (3, 456) = 17.95, p < 0.001, η2 = 0.10). Gabriel post-hoc test revealed significantly lower scores between the medical and paramedical sectors. A positive correlation was found between the degree of satisfaction with the process and the satisfaction with the training type. Frontal education and video demonstrations were rated significantly higher among all 10 training types. CONCLUSIONS More efforts should be made to increase involvement among physicians and paramedical teams in the accreditation process. Each sector leadership involvement is essential for their involvement too. Early involvement of the Israeli Medical Association in the process might have achieved better physicians' collaboration. Frontal education and video demonstrations may help decrease skepticism and increase positive attitudes.
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Affiliation(s)
- Shiran Bord
- Health Systems Management, The Max Stern Yezreel Valley College, Yezraeel Valley, Israel
| | - Inna Sass
- JCI Accreditation, Rambam Health Care Campus, Haifa, Israel
| | - Gila Hayms
- Nursing Sector, Rambam Health Care Campus, Haifa, Israel
| | - Kobi Moskowitz
- Hospital Administration, Rambam Health Care Campus, Haifa, Israel
| | - Hagar Baruch
- Nursing sector, Rambam Health Care Campus, Haifa, Israel
| | - Fuad Basis
- JCI Accreditation, Technion Faculty of Medicine, Rambam Health Care Campus, Haifa, Israel
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Fox MD, Bump GM, Butler GA, Chen LW, Buchert AR. Making Residents Part of the Safety Culture: Improving Error Reporting and Reducing Harms. J Patient Saf 2021; 17:e373-e378. [PMID: 28141697 DOI: 10.1097/pts.0000000000000344] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Reporting medical errors is a focus of the patient safety movement. As frontline physicians, residents are optimally positioned to recognize errors and flaws in systems of care. Previous work highlights the difficulty of engaging residents in identification and/or reduction of medical errors and in integrating these trainees into their institutions' cultures of safety. METHODS The authors describe the implementation of a longitudinal, discipline-based, multifaceted curriculum to enhance the reporting of errors by pediatric residents at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center. The key elements of this curriculum included providing the necessary education to identify medical errors with an emphasis on systems-based causes, modeling of error reporting by faculty, and integrating error reporting and discussion into the residents' daily activities. The authors tracked monthly error reporting rates by residents and other health care professionals, in addition to serious harm event rates at the institution. RESULTS The interventions resulted in significant increases in error reports filed by residents, from 3.6 to 37.8 per month over 4 years (P < 0.0001). This increase in resident error reporting correlated with a decline in serious harm events, from 15.0 to 8.1 per month over 4 years (P = 0.01). CONCLUSIONS Integrating patient safety into the everyday resident responsibilities encourages frequent reporting and discussion of medical errors and leads to improvements in patient care. Multiple simultaneous interventions are essential to making residents part of the safety culture of their training hospitals.
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Affiliation(s)
| | - Gregory M Bump
- Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center
| | - Gabriella A Butler
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center
| | | | - Andrew R Buchert
- Department of Pediatrics, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Tocco Tussardi I, Benoni R, Moretti F, Tardivo S, Poli A, Wu AW, Rimondini M, Busch IM. Patient Safety in the Eyes of Aspiring Healthcare Professionals: A Systematic Review of Their Attitudes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147524. [PMID: 34299975 PMCID: PMC8306767 DOI: 10.3390/ijerph18147524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022]
Abstract
A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers' wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional students, new graduates, newly registered health professionals, resident trainees) and assess potential differences in this population related to years of study, specialties, and gender. We screened four electronic databases up to 20 February 2020 and additional sources, including weekly e-mailed search alerts up to 18 October 2020. Two independent reviewers conducted the search, study selection, quality rating, data extraction, and formal narrative synthesis, involving a third reviewer in case of dissent. We retrieved 6606 records, assessed 188 full-texts, and included 31 studies. Across articles, healthcare students and young professionals showed overwhelmingly positive patient safety attitudes in some areas (e.g., teamwork climate, error inevitability) but more negative perceptions in other domains (e.g., safety climate, disclosure responsibility). Women tend to report more positive attitudes. To improve safety culture in medical settings, health professions educators and institutions should ensure education and training on patient safety.
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Affiliation(s)
- Ilaria Tocco Tussardi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (I.T.T.); (R.B.); (S.T.); (A.P.)
| | - Roberto Benoni
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (I.T.T.); (R.B.); (S.T.); (A.P.)
| | - Francesca Moretti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (F.M.); (I.M.B.)
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (I.T.T.); (R.B.); (S.T.); (A.P.)
| | - Albino Poli
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (I.T.T.); (R.B.); (S.T.); (A.P.)
| | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Michela Rimondini
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (F.M.); (I.M.B.)
- Correspondence:
| | - Isolde Martina Busch
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (F.M.); (I.M.B.)
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Baldo AH, Elnimeri MK, Haroun HM, Salah ET. Sudanese paediatric residents' perception towards training environment in Sudan Medical Specialisation Board, 2020. Sudan J Paediatr 2020; 20:126-135. [PMID: 32817733 DOI: 10.24911/sjp.106-1582975463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The training environment is a determinant of learning outcomes. Paediatric residents spend most of their training programme activities in hospitals and related health centres. Measurement of the educational environment for residents is important to detect strengths and weaknesses and to ensure quality training.The overall aim is to determine the perception of postgraduate paediatric residents of a hospital educational environment. A descriptive cross-sectional study was conducted by using the modified Postgraduate Hospital Educational Environment Measure (PHEEM) to evaluate the training environment of paediatric residents in Sudan who spent 4 years of training after the curriculum was updated in 2014. PHEEM questionnaire was used to collect data from 150 final-year paediatric residents. Additional data about the programme were collected using checklists. Data were analysed using Statistical Package for the Social Science version 23. Of 101 residents who completed the forms, 19 (18.8%) were male and 82 (81.2%) were female. The total Cronbach's alpha score was 0.894. The total scale score was 74/160, which indicated an overall suboptimal response. The overall score was 74.66, autonomy score was 25.75, teachers score was 29.17 and social support score was 19.73. The overall mean ranged between 0.9604 and 2.9109. There were no significant differences between male and female responses. The examination results showed high scores despite the suboptimal educational environment. Perception of the training environment by residents showed suboptimal responses. All subscales showed problems that needed attention and urgent interventions. The social subscale score was the lowest and needed special attention with regard to the large number of females. It is vital to evaluate the whole training in order to make decisions about the weaknesses for improvements and continuation.
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Affiliation(s)
| | | | - Huda Mohamed Haroun
- Department of Pediatrics, Faculty of Medicine, University of Gezira, Wad Medani, Sudan
| | - Emuntasir Taha Salah
- Department of Pediatrics, Faculty of Medicine, The National Ribat University, Khartoum, Sudan
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Myers LC, Gartland RM, Skillings J, Heard L, Bittner EA, Einbinder J, Metlay JP, Mort E. An Examination of Medical Malpractice Claims Involving Physician Trainees. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1215-1222. [PMID: 31833853 DOI: 10.1097/acm.0000000000003117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To identify patient-, provider-, and claim-related factors of medical malpractice claims in which physician trainees were directly involved in the harm events. METHOD The authors performed a case-control study using medical malpractice claims closed between 2012-2016 and contributed to the Comparative Benchmarking System database by teaching hospitals. Using the service extender flag, they classified claims as cases if physician trainees were directly involved in the harm events. They classified claims as controls if they were from the same facilities, but trainees were not directly involved in the harm events. They performed multivariable regression with predictor variables being patient and provider characteristics. The outcome was physician trainee involvement in harm events. RESULTS From the original pool of 30,973 claims, there were 581 cases and 2,610 controls. The majority of cases involved residents (471, 81%). Cases had a statistically significant higher rate of having a trainee named as defendants than controls (184, 32% vs 233, 9%; P < .001). The most common final diagnosis for cases was puncture or laceration during surgery (62, 11%). Inadequate supervision was a contributing factor in 140 (24%) cases overall, with the majority (104, 74%) of these claims being procedure related. Multivariable regression analysis revealed that trainees were most likely to be involved in harm events in specialties such as oral surgery/dentistry and obstetrics-gynecology (OR = 7.99, 95% CI 2.93, 21.83 and OR = 1.85, 95% CI 1.24, 2.66, respectively), when performing procedures (OR = 1.58, 95% CI 1.27, 1.96), or when delivering care in the emergency room (OR = 1.65, 95% CI 1.43, 1.91). CONCLUSIONS Among claims involving physician trainees, procedures were common and often associated with inadequate supervision. Training directors of surgical specialties can use this information to improve resident supervision policies. The goal is to reduce the likelihood of future harm events.
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Affiliation(s)
- Laura C Myers
- L.C. Myers is a research fellow, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-2872-3388
| | - Rajshri M Gartland
- R.M. Gartland is a surgical resident, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jillian Skillings
- J. Skillings is data analyst, Controlled Risk Insurance Company, Boston, Massachusetts
| | - Lisa Heard
- L. Heard is senior program director, Patient Safety and Education, Controlled Risk Insurance Company, Boston, Massachusetts
| | - Edward A Bittner
- E.A. Bittner is associate professor of anesthesia, Harvard Medical School, and program director, Critical Care Anesthesiology Fellowship, Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan Einbinder
- J. Einbinder is instructor of medicine, Harvard Medical School, member, Division of General Internal Medicine, Brigham and Women's Hospital, and assistant vice president, Advanced Data Analytics and Coding, Controlled Risk Insurance Company, Boston, Massachusetts
| | - Joshua P Metlay
- J.P. Metlay is professor, Department of Medicine, Harvard Medical School, professor of health policy and management, Harvard School of Public Health, and chief, General Internal Medicine Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth Mort
- E. Mort is assistant professor in health care policy, Harvard Medical School, member, Division of General Internal Medicine, and chief quality officer, Massachusetts General Hospital, Boston, Massachusetts
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Klasen JM, Lingard LA. Allowing failure for educational purposes in postgraduate clinical training: A narrative review. MEDICAL TEACHER 2019; 41:1263-1269. [PMID: 31280625 DOI: 10.1080/0142159x.2019.1630728] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Educational domains such as pedagogy or psychology have embraced the philosophy that "allowing failure" in training and practice is essential to learn. In clinical training, however, allowing learners to fail is not explicitly discussed as a strategy, possibly due to the negative implications for patients. Therefore, we do not know whether clinical supervisors allow trainees to fail for educational purposes and, if so, how this supervisory strategy is used. Methods: To inform research on this topic, we conducted a narrative review to understand what was known about this educational strategy in postgraduate medicine. Results: Analyzing the selected literature, we found no studies directly exploring the question of clinical supervisors allowing failure as an educational strategy. However, related literature on resident errors suggested that trainees perceived their own errors to be highly instructive and that factors such as a sense of responsibility and emotional response influenced the educational impact of these errors. Conclusions: The lack of discussion in the medical education literature regarding allowing failure for learning suggests that we need research into the nature and extent of this supervisory strategy which may hold educational benefits but must be employed in a manner that upholds patient safety and safeguards trainee resilience.
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Affiliation(s)
- Jennifer M Klasen
- Clarunis, Center for Abdominal Surgery, University Hospital Basel , Basel , Switzerland
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Healthcare Professional's Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis. ScientificWorldJournal 2018; 2018:9156301. [PMID: 30104917 PMCID: PMC6076892 DOI: 10.1155/2018/9156301] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 12/20/2022] Open
Abstract
Objective To assess the culture of patient safety in studies that employed the hospital survey on patient safety culture (HSOPS) in hospitals around the world. Method We searched MEDLINE, EMBASE, SCOPUS, CINAHL, and SciELO. Two researchers selected studies and extracted the following data: year of publication, country, percentage of physicians and nurses, sample size, and results for the 12 HSOPS dimensions. For each dimension, a random effects meta-analysis with double-arcsine transformation was performed, as well as meta-regressions to investigate heterogeneity, and tests for publication bias. Results 59 studies with 755,415 practitioners surveyed were included in the review. 29 studies were conducted in the Asian continent and 11 in the United States. On average studies scored 9 out of 10 methodological quality score. Of the 12 HSOPS dimensions, six scored under 50% of positivity, with “nonpunitive response to errors” the lowest one. In the meta-regression, three dimensions were shown to be influenced by the proportion of physicians and five by the continent where survey was held. Conclusions The HSOPS is widely used in several countries to assess the culture of patient safety in hospital settings. The culture of culpability is the main weakness across studies. Encouraging event reporting and learning from errors should be priorities in hospitals worldwide.
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Chakravorty I. General Medical Council trainee survey: implications for hospital doctors. Br J Hosp Med (Lond) 2018; 79:64-65. [DOI: 10.12968/hmed.2018.79.2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Indranil Chakravorty
- Deputy Postgraduate Dean, Health Education England North London, Stewart House, London WC1B 5DN
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Radiology Research in Quality and Safety: Current Trends and Future Needs. Acad Radiol 2017; 24:263-272. [PMID: 28193376 DOI: 10.1016/j.acra.2016.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 01/29/2023]
Abstract
Promoting quality and safety research is now essential for radiology as reimbursement is increasingly tied to measures of quality, patient safety, efficiency, and appropriateness of imaging. This article provides an overview of key features necessary to promote successful quality improvement efforts in radiology. Emphasis is given to current trends and future opportunities for directing research. Establishing and maintaining a culture of safety is paramount to organizations wishing to improve patient care. The correct culture must be in place to support quality initiatives and create accountability for patient care. Focused educational curricula are necessary to teach quality and safety-related skills and behaviors to trainees, staff members, and physicians. The increasingly complex healthcare landscape requires that organizations build effective data infrastructures to support quality and safety research. Incident reporting systems designed specifically for medical imaging will benefit quality improvement initiatives by identifying and learning from system errors, enhancing knowledge about safety, and creating safer systems through the implementation of standardized practices and standards. Finally, validated performance measures must be developed to accurately reflect the value of the care we provide for our patients and referring providers. Common metrics used in radiology are reviewed with focus on current and future opportunities for investigation.
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Bump GM, Coots N, Liberi CA, Minnier TE, Phrampus PE, Gosman G, Metro DG, McCausland JB, Buchert A. Comparing Trainee and Staff Perceptions of Patient Safety Culture. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:116-122. [PMID: 27276009 DOI: 10.1097/acm.0000000000001255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The Accreditation Council for Graduate Medical Education implemented the Clinical Learning Environment Review (CLER) program to evaluate and improve the learning environment in teaching hospitals. Hospitals receive a report after a CLER visit with observations about patient safety, among other domains, the accuracy of which is unknown. Thus, the authors set out to identify complementary measures of trainees' patient safety experience. METHOD In 2014, they administered the Hospital Survey on Patient Safety Culture to residents and fellows and general staff at 10 hospitals in an integrated health system. The survey measured perceptions of patient safety in 12 domains and incorporated two outcome measures (number of medical errors reported and overall patient safety). Domain scores were calculated and compared between trainees and staff. RESULTS Of 1,426 trainees, 926 responded (65% response rate). Of 18,815 staff, 12,015 responded (64% response rate). Trainees and staff scored five domains similarly-communication openness, facility management support for patient safety, organizational learning/continuous improvement, teamwork across units, and handoffs/transitions of care. Trainees scored four domains higher than staff-nonpunitive response to error, staffing, supervisor/manager expectations and actions promoting patient safety, and teamwork within units. Trainees scored three domains lower than staff-feedback and communication about error, frequency of event reporting, and overall perceptions of patient safety. CONCLUSIONS Generally, trainees had comparable to more favorable perceptions of patient safety culture compared with staff. They did identify opportunities for improvement though. Hospitals can use perceptions of patient safety culture to complement CLER visit reports to improve patient safety.
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Affiliation(s)
- Gregory M Bump
- G.M. Bump is associate professor of medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. N. Coots is administrative fellow, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. C.A. Liberi is director of patient safety, Wolff Center for Quality, Safety, and Innovation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. T.E. Minnier is chief quality officer, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. P.E. Phrampus is associate professor of emergency medicine and anesthesiology, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. G. Gosman is associate professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. D.G. Metro is professor of anesthesiology, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. J.B. McCausland is associate professor, Departments of Medicine and Emergency Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. A. Buchert is assistant professor of pediatrics, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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