|
1
|
Wolman RL, Kras JF. Ethical Approach to the Abusive/Disruptive Physician. Anesthesiol Clin 2024; 42:661-671. [PMID: 39443037 DOI: 10.1016/j.anclin.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
Abusive, intimidating, and disruptive behavior is unprofessional and antithetical to the provision of medical care within a culture of safety. These behaviors affect all members of the health-care team, including trainees, and have shown to result in adverse patient outcomes. When events occur, rapid intervention utilizing structured processes as required by The Joint Commission and consistent with the AMA Code of Medical Ethics needs to be implemented to protect all involved. These processes must allow for an anonymous reporting system, impartial evaluation, and graded response to these behaviors. Unfortunately, anonymity in reporting may result in the weaponization of the system.
Collapse
Affiliation(s)
- Richard L Wolman
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Joseph F Kras
- Department of Anesthesiology, Washington University in St. Louis, 660 N. Euclid, Box 8054, St. Louis, MO 63110, USA
| |
Collapse
|
|
2
|
Zhou Y, Lin J, Liu X, Gao S, Yang F, Xu H. Validity and reliability of the toxic leadership behaviors of nurse managers scale among Chinese nurses. Front Psychol 2024; 15:1363792. [PMID: 38590335 PMCID: PMC10999539 DOI: 10.3389/fpsyg.2024.1363792] [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: 12/31/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Objectives Toxic leadership is increasingly becoming common in the nursing field, but the measurement tools are lacking. Therefore, this study aimed to translate the toxic leadership behaviors of nurse managers (ToxBH-NM) scale into Chinese and test its psychometric properties among Chinese nurses. Methods The data for this study were obtained from a cross-sectional survey of 1,195 nurses. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the structural validity of the ToxBH-NM. The following psychometric properties of the scale were assessed: content validity, criterion validity, internal consistency reliability, and test-retest reliability. Results The Chinese version of the ToxBH-NM (C-ToxBH-NM) scale had two dimensions and 30 items. The correlation coefficients between the scores of each item and the total scores were 0762-0.922 (p < 0.001), and the range of the CR determination values of all the items were 8.610-18.998, with statistical significance (p < 0.001). The total content validity index (CVI) was 0.996, the average CVI was 0.996, and the item-level CVI was 0.875-1.000. Two common factors were identified in the EFA, and 81.074% of the variation was explained cumulatively. The CFA showed that all the fitting indexes reached the standard, and the model fit degree was good. When the Chinese version of the Destructive Leadership Scale was used as calibration, the correlation coefficient was 0.378 (p < 0.001). The Cronbach's alpha coefficients of the overall scale were 0.989 and of the two dimensions were 0.969 and 0.987, respectively, with a split-half reliability of 0.966 and test-retest reliability of 0.978. Conclusion The research results show that the C-ToxBH-NM scale has good reliability and validity and can be used to evaluate the severity of toxic leadership behavior among nursing managers.
Collapse
Affiliation(s)
| | | | | | | | | | - Huili Xu
- Department of Nursing, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| |
Collapse
|
|
3
|
Moreno-Leal P, Leal-Costa C, Díaz-Agea JL, Castaño-Molina MDLÁ, Conesa-Ferrer MB, De Souza-Oliveira AC. Disruptive Behavior and Factors Associated with Patient Safety Climate: A Cross-Sectional Study of Nurses' and Physicians' Perceptions. J Nurs Manag 2024; 2024:5568390. [PMID: 40224803 PMCID: PMC11918647 DOI: 10.1155/2024/5568390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 04/15/2025]
Abstract
Background Few studies have analyzed the negative outcomes of disruptive behaviors in the nurse-physician relationship in patient care and their impact on patient safety. These multicausal studies significantly relate to organizational, institutional, and professional attitudinal risk factors. Aim Analyze healthcare professionals' perceptions of disruptive behavior and factors associated with patient safety climate in the nurse-physician relationship at the hospital level. Methods A multicenter cross-sectional study was conducted with a sample of 370 nurses and physicians assigned to different public hospitals in the Murcia/Spain region, applying the adapted and validated Spanish version of the Nurse-Physician Relationship Scale: Impact of Disruptive Behavior on Patient Care. The analysis used proportions or means (standard deviation (SD)), univariate and multivariate linear regression models, and the chi-square test. Results Disruptive behavior was more prevalent in the ICU (81.6%) and the emergency department (67.8%). Professionals indicate that fear of reprisals is the main barrier to the reporting system. Likewise, stress and frustration are more associated with disruptive behavior and influence the safety climate. Conclusion Professionals indicate that disruptive behaviors can have a negative impact on clinical outcomes. Age and type of service were identified as the most relevant socio-occupational factors. Stress, frustration, and communication problems are the factors that most influence the safety climate.
Collapse
Affiliation(s)
- Pedro Moreno-Leal
- Catholic University of Murcia, Faculty of Nursing, 30107 Guadalupe, Murcia, Spain
| | - César Leal-Costa
- University of Murcia, Faculty of Nursing, 30120 El Palmar, Murcia, Spain
| | | | | | | | | |
Collapse
|
|
4
|
Kumar M, Das D, Mulvey TM, Sadeghi N. Physician Disruptive Behavior Compromising Safe Care Delivery. JCO Oncol Pract 2024; 20:329-334. [PMID: 38175994 DOI: 10.1200/op.23.00513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024] Open
Abstract
The negative impact and management of disruptive behavior are discussed in the article by Monika Kumar, et al.
Collapse
Affiliation(s)
- Monika Kumar
- University of Texas Southwestern Medical Center, Dallas, TX
- VA North Texas Health Care System, Dallas, TX
| | | | - Therese M Mulvey
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Navid Sadeghi
- University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| |
Collapse
|
|
5
|
Peisah C, Williams B, Hockey P, Lees P, Wright D, Rosenstein A. Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System. Healthcare (Basel) 2023; 11:2455. [PMID: 37685490 PMCID: PMC10487014 DOI: 10.3390/healthcare11172455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
We have always had and will always have "disruptive" or "dysfunctional" doctors behaving unprofessionally within healthcare institutions. Disruptive physician behaviour (also called "unprofessional behaviour") was described almost 150 years ago, but remains a persistent, wicked problem in healthcare, largely fuelled by systemic inaction. In this Commentary, we aim to explore the following aspects from a systemic lens: (i) the gaps in understanding systemic resistance and difficulty in addressing this issue; and (ii) pragmatic approaches to its management in the healthcare system. In doing so, we hope to shift the systemic effect from nihilism and despair, to one of hopeful realism about disruptive or unprofessional behaviour. We suggest that solutions lie in cultural change to ensure systemic awareness, responsiveness and early intervention, and an understanding of what systemic failure looks like in this context. Staff education, policies and procedures that outline a consistent reporting and review process including triaging the problem, its source, its effects, and the attempted solutions, are also crucial. Finally, assessment and intervention from appropriately mental-health-trained personnel are required, recognising that this is a complex mental health problem. We are not doing anyone any favours by ignoring, acting as bystanders, or otherwise turning a blind eye to disruptive or unprofessional behaviour; otherwise, we share culpability.
Collapse
Affiliation(s)
- Carmelle Peisah
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Betsy Williams
- Professional Renewal Center, Lawrence, KS 66049, USA;
- Continuing Medical Education Wales Behavioral Assessment, Lawrence, KS 66049, USA
- Department of Psychiatry, School of Medicine, University of Kansas, Kansas City, KS 66045, USA
| | - Peter Hockey
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Western Sydney Local Health District, Sydney, NSW 2145, Australia;
| | - Peter Lees
- Faculty of Medical Leadership and Management, London WC1R 4SG, UK;
| | - Danette Wright
- Western Sydney Local Health District, Sydney, NSW 2145, Australia;
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
| | - Alan Rosenstein
- Internal Medicine, Health Care Behavioral Management, San Francisco, CA 94118, USA;
| |
Collapse
|
|
6
|
Cross-Cultural Adaptation of the Instrument "Nurse-Physician Relationship Survey: Impact of Disruptive Behavior in Patient Care" to the Spanish Context. Healthcare (Basel) 2022; 10:healthcare10101834. [PMID: 36292281 PMCID: PMC9601643 DOI: 10.3390/healthcare10101834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Disruptive behavior in the healthcare context has an impact on patient care, healthcare personnel, and the health organization, and it also influences the therapeutic relationship, communication process, and adverse events. However, there is a lack of instruments that could be used for its analysis in the hospital care environment in the Spanish context. The objective of the study was to culturally adapt and perform a content validation of the tool “Nurse−Physician Relationship Survey: Impact of Disruptive Behavior on Patient Care”, to the Spanish content (Spain). An instrumental study was conducted, which included an analysis of conceptual and semantic equivalence. A panel of experts analyzed the translations, by analyzing the Content Validity Index (CVI) of the group of items in the scale through the Relevance Index (RI) and the Pertinence Index (PI). Only a single item obtained an RI value of 0.72, although with PI value of 0.81, with consensus reached for not deleting this item. The CVI of all the items was >0.80 for the mean value of the RI, as well as the PI. The instrument was adapted to the Spanish context and is adequate for evaluating the disruptive behaviors on nurse−physician relationships and its impact on patient care. However, the importance of continuing the analysis of the rest of the psychometric properties in future studies is underlined.
Collapse
|
|
7
|
Disruptive behavior in the operating room: Systemic over individual determinants. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
|
8
|
Abstract
OBJECTIVES This study's objective was to explore the possible triggers of clinicians' disruptive behavior and to consider whether the type of trigger resulting in disruptive behavior differed by type of clinician, clinician characteristics, professional role, and ethnic background. METHODS Using data collected from 1559 clinicians working at an urban academic medical center in the United States, we examined intrapersonal, interpersonal, and organizational triggers. In addition, we measured 3 subscales of disruptive behavior including incivility, psychological aggression, and violence. Multivariate regression and logit models were used to examine the relationship between triggers and disruptive behavior. RESULTS We found that higher levels of intrapersonal, interpersonal, and organizational triggers related to a greater frequency of disruptive behaviors after controlling for clinician characteristics. Among nurses, all 3 types of triggers were significantly related to disruptive behaviors with the same direction and magnitude of difference. However, in the physician/affiliate group, only intrapersonal and interpersonal triggers were statistically significant factors for disruptive behavior. CONCLUSIONS In the present study, important triggers were found to contribute to clinicians' disruptive behaviors. Strategies to prevent disruptive behaviors should be multipronged and reflect intrapersonal and interpersonal features for both clinician groups. For nurses, organizational triggers should be addressed through process and system improvements. Because disruptive behavior continues to be frequent among clinicians, efforts to implement evidence-based practices to prevent disruptive behaviors must continue, and future research should evaluate them.
Collapse
|
|
9
|
McKenzie L, Shaw L, Jordan JE, Alexander M, O'Brien M, Singer SJ, Manias E. Factors Influencing the Implementation of a Hospitalwide Intervention to Promote Professionalism and Build a Safety Culture: A Qualitative Study. Jt Comm J Qual Patient Saf 2019; 45:694-705. [PMID: 31471212 DOI: 10.1016/j.jcjq.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is widespread recognition that creating a safety culture supports high-quality health care. However, the complex factors affecting cultural change interventions are not well understood. This study examines factors influencing the implementation of an intervention to promote professionalism and build a safety culture at an Australian hospital. METHODS The study was completed midway into the three-year intervention and involved collecting qualitative data from two sources. First, face-to-face interviews were conducted pre- and mid-intervention with a purposely selected sample. Second, a survey with three open-ended questions was completed one year into the intervention by clinical and patient support staff. Data from interviews and survey questions were analyzed using a combination of inductive and deductive approaches. RESULTS A total of 25 participants completed preintervention interviews, and 24 took part mid-intervention. Of the 2,047 staff who completed the survey (61% response rate), 59.1% of respondents answered at least one open-ended question. Multiple interrelated factors were identified as enhancing intervention implementation. These include sustaining a favorable implementation climate, leaders consistently demonstrating behaviors that support a safety culture, increasing compatibility of working conditions with intervention aims, building confidence in systems to address unprofessional behaviors, and responding to evolving needs. CONCLUSION Strengthening safety culture remains an enduring challenge, but this study yields valuable insights into factors influencing implementation of a multifaceted behavior change intervention. The findings provide a basis for practical strategies that health care leaders seeking cultural improvements can employ to enhance the delivery of similar interventions and address potential impediments to success.
Collapse
|
|
10
|
Redeker GA, Kessler GZ, Kipper LM. Lean information for lean communication: Analysis of concepts, tools, references, and terms. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2019. [DOI: 10.1016/j.ijinfomgt.2018.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
|
11
|
Bérastégui P, Jaspar M, Ghuysen A, Nyssen AS. Fatigue-related risk management in the emergency department: a focus-group study. Intern Emerg Med 2018; 13:1273-1281. [PMID: 29777436 DOI: 10.1007/s11739-018-1873-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/06/2018] [Indexed: 11/30/2022]
Abstract
Fatigue has major implications on both patient safety and healthcare practitioner's well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e. fatigue reduction), or reducing the likelihood that a fatigued operator will make an error (i.e. fatigue proofing). Recent progress mainly focussed on fatigue reduction strategies such as reducing work hours. Yet it has to be recognized that such approach has not wholly overcome the experience of fatigue. Our purpose is to investigate individual proofing and reduction strategies used by emergency physicians to manage fatigue-related risk. 25 emergency physicians were recruited for the study. Four focus groups were formed which consisted of an average of six individuals. Qualitative data were collected using a semi-structured discussion guide unfolding in two parts. First, the participants were asked to describe how on-the-job fatigue affected their efficiency at work. A mind map was progressively drawn based upon the participants' perceived effects of fatigue. Second, participants were asked to describe any strategies they personally used to cope with these effects. We used inductive qualitative content analysis to reveal content themes for both fatigue effects and strategies. Emergency physicians reported 28 fatigue effects, 12 reduction strategies and 21 proofing strategies. Content analysis yielded a further classification of proofing strategies into self-regulation, task re-allocation and error monitoring strategies. There is significant potential for the development of more formal processes based on physicians' informal strategies.
Collapse
Affiliation(s)
- Pierre Bérastégui
- Cognitive Ergonomics Laboratory (LECIT), Department of Work Psychology, University of Liège, Sart-Tilman B31, 4000, Liege, Belgium.
| | - Mathieu Jaspar
- Cognitive Ergonomics Laboratory (LECIT), Department of Work Psychology, University of Liège, Sart-Tilman B31, 4000, Liege, Belgium
| | - Alexandre Ghuysen
- Emergency Department, University Hospital Centre of Liège, Liege, Belgium
| | - Anne-Sophie Nyssen
- Cognitive Ergonomics Laboratory (LECIT), Department of Work Psychology, University of Liège, Sart-Tilman B31, 4000, Liege, Belgium
| |
Collapse
|
|
12
|
de Leon J, Wise TN, Balon R, Fava GA. Dealing with Difficult Medical Colleagues. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:5-11. [PMID: 29306944 DOI: 10.1159/000481200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
| | | | | | | |
Collapse
|
|
13
|
|
|
14
|
Oliveira RM, Silva LMSD, Guedes MVC, Oliveira ACDS, Sánchez RG, Torres RAM. Analyzing the concept of disruptive behavior in healthcare work: an integrative review*. Rev Esc Enferm USP 2016; 50:695-704. [DOI: 10.1590/s0080-623420160000500021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/23/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To analyze the concept of disruptive behavior in healthcare work. METHOD An integrative review carried out in the theoretical phase of a qualitative research substantiated by the theoretical framework of the Hybrid Model of Concept Development. The search for articles was conducted in the CINAHL, LILACS, PsycINFO, PubMed and SciVerse Scopus databases in 2013. RESULTS 70 scientific articles answered the guiding question and lead to attributes of disruptive behavior, being: incivility, psychological violence and physical/sexual violence; with their main antecedents (intrapersonal, interpersonal and organizational) being: personality characteristics, stress and work overload; and consequences of: workers' moral/mental distress, compromised patient safety, labor loss, and disruption of communication, collaboration and teamwork. CONCLUSION Analysis of the disruptive behavior concept in healthcare work showed a construct in its theoretical stage that encompasses different disrespectful conduct adopted by health workers in the hospital context, which deserve the attention of leadership for better recognition and proper handling of cases and their consequences.
Collapse
|
|
15
|
Rosenstein AH. Physician disruptive behaviors: Five year progress report. World J Clin Cases 2015; 3:930-4. [PMID: 26601095 PMCID: PMC4644894 DOI: 10.12998/wjcc.v3.i11.930] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/16/2015] [Accepted: 08/13/2015] [Indexed: 02/05/2023] Open
Abstract
Disruptive behaviors in health care can have a significant adverse effect on staff interactions that can negatively impact staff satisfaction, staff performance, and patient outcomes of care. As referenced in a previously published article, the Obstetrics and Gynecology specialty is one of the service areas where these behaviors occur more frequently. Despite growing evidence of the ill effects of these types of behaviors many organizations are still having a difficult time in addressing these issues in an effective manner. Gaining a better understanding of the nature, causes, and impact of these behaviors is crucial to finding the right remedies for solution. Nobody intentionally starts the day planning to be disruptive, it's just that things get in the way. A combination of deep seated factors related to age and gender preferences, culture and ethnicity, life experiences, and other events that help shape values, attitudes and personalities, and more external factors related to training, environmental pressures, stress and burnout, and other personal issues all contribute to the mix. Given the complexities of today's health care environment, each person needs to recognize the importance of being held accountable for appropriate actions and behaviors that affect work relationships and care coordination that impact patient care. Early recognition, early intervention, and taking a pro-active supportive approach to improve individual behaviors will result in better relationships, less disruption, more satisfaction, and better outcomes of care.
Collapse
|
|
16
|
'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital. PLoS One 2015; 10:e0135129. [PMID: 26285108 PMCID: PMC4540429 DOI: 10.1371/journal.pone.0135129] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/18/2015] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place. Additionally promoting communication and interaction among health workers can foster team spirit. Also resolving conflicts using the collaborating response may help to create a conducive work environment that will promote healthy work relations, which can facilitate the delivery of quality maternal and neonatal health care. However, such an approach requires that unequal power relations, which is a root cause of the conflicts is addressed.
Collapse
|
|
17
|
Oliveira RM, Leitao IMTDA, Aguiar LL, Oliveira ACDS, Gazos DM, Silva LMSD, Barros AA, Sampaio RL. Evaluating the intervening factors in patient safety: focusing on hospital nursing staff. Rev Esc Enferm USP 2015; 49:104-13. [DOI: 10.1590/s0080-623420150000100014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/23/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate intervening factors in patient safety, focusing on hospital nursing staff. METHOD The study is descriptive, with qualitative approach, excerpt from a larger study with analytical nature. It was undertaken in a public hospital in Fortaleza, CE, Brazil, between January and June 2013, with semi-structured interviews to 70 nurses, using Thematic Content Analysis. RESULTS The principal intervening factors in patient safety related to hospital nursing staff were staff dimensioning and workload, professional qualification and training, team work, being contracted to the institution, turnover and lack of job security, and bad practice/disruptive behaviors. These aspects severely interfere with the establishment of a safety culture in the hospital analyzed. CONCLUSION It is necessary for managers to invest in nursing staff, so that these workers may be valued as fundamental in the promotion of patient safety, making it possible to develop competences for taking decisions with focus on the improvement of quality care.
Collapse
|
|
18
|
Humanized Childbirth and Cultural Humility: Designing an Online Course for Maternal Health Providers in Limited-Resource Settings. INTERNATIONAL JOURNAL OF CHILDBIRTH 2015. [DOI: 10.1891/2156-5287.5.4.188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews the implications of disrespect and abuse in maternal health services, the growing movement to humanize childbirth and promote cultural humility, and one strategy to build an online course to address this issue among maternal health workers in Mexico. Reports of disrespect and abuse have been widely reported by women seeking health services, including maternity care, across the globe. Evidence indicates offenders are often health care professionals who do not consider their behavior inappropriate and believe they are acting in the interests of both mother and baby. These same providers are often overworked, underpaid, and have few role models who humanize childbirth and demonstrate cultural humility. Strategies which aim to foster competencies in humanized childbirth and cultural humility among health providers are lacking in current health professional training programs. Using the case of Mexico, the authors describe the template and justification for an online course for novice to expert health professionals to build competencies in humanized childbirth and cultural humility. Recommendations for future work are discussed.
Collapse
|
|
19
|
Influence of Surgeon Behavior on Trainee Willingness to Speak Up: A Randomized Controlled Trial. J Am Coll Surg 2014; 219:1001-7. [DOI: 10.1016/j.jamcollsurg.2014.07.933] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/08/2014] [Accepted: 07/18/2014] [Indexed: 11/20/2022]
|
|
20
|
Shapiro J, Whittemore A, Tsen LC. Instituting a culture of professionalism: the establishment of a center for professionalism and peer support. Jt Comm J Qual Patient Saf 2014; 40:168-77. [PMID: 24864525 DOI: 10.1016/s1553-7250(14)40022-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is growing recognition that an environment in which professionalism is not embraced, or where expectations of acceptable behaviors are not clear and enforced, can result in medical errors, adverse events, and unsafe work conditions. METHODS The Center for Professionalism and Peer Support (CPPS) was created in 2008 at Brigham and Women's Hospital (BWH), Boston, to educate the hospital community regarding professionalism and manage unprofessional behavior. CPPS includes the professionalism initiative, a disclosure and apology process, peer and defendant support programs, and wellness programs. Leadership support, establishing behavioral expectations and assessments, emphasizing communication engagement and skills training, and creating a process for intake of professionalism concerns were all critical in developing and implementing an effective professionalism program. The process for assessing and responding to concerns includes management of professionalism concerns, an assessment process, and remediation and monitoring. RESULTS Since 2005, thousands of physicians, scientists, nurse practitioners, and physician assistants have been trained in educational programs to support the identification, prevention, and management of unprofessional behavior. For January 1, 2010, through June 30, 2013, concerns were raised regarding 201 physicians/scientists and 8 health care teams. CONCLUSIONS The results suggest that mandatory education sessions on professional development are successful in engaging physicians and scientists in discussing and participating in an enhanced professionalism culture, and that the processes for responding to professionalism concerns have been able to address, and most often alter, repetitive unprofessional behavior in a substantive and beneficial manner.
Collapse
|
|
21
|
Sakala C, Yang YT, Corry MP. Maternity care and liability: most promising policy strategies for improvement. Womens Health Issues 2013; 23:e25-37. [PMID: 23312711 DOI: 10.1016/j.whi.2012.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/02/2012] [Accepted: 11/07/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND The present liability system is not serving well childbearing women and newborns, maternity care clinicians, or maternity care payers. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are most likely to meet these aims and contribute to needed improvements. A companion paper considers strategies that hold little promise. METHODS We considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable. FINDINGS Ten strategies seem to have potential to improve liability matters in maternity care across multiple aims. The most promising strategy--implementing rigorous maternity care quality improvement (QI) programs--has led to better quality and outcomes of care, and impressive declines in liability claims, payouts, and premium levels. CONCLUSIONS A number of promising strategies warrant demonstration and evaluation at the level of states, health systems, or other appropriate entities. Rigorous QI programs have a growing track record of contributing to diverse aims of a high-functioning liability system and seem to be a win-win-win prevention strategy for childbearing families, maternity care providers, and payers. Effective strategies are also needed to assist families when women and newborns are injured.
Collapse
Affiliation(s)
- Carol Sakala
- Childbirth Connection, New York, New York 10016, USA.
| | | | | |
Collapse
|
|
22
|
The professional responsibility model of physician leadership. Am J Obstet Gynecol 2013; 208:97-101. [PMID: 22483086 DOI: 10.1016/j.ajog.2012.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/29/2012] [Accepted: 03/09/2012] [Indexed: 11/20/2022]
Abstract
The challenges physician leaders confront today call to mind Odysseus' challenge to steer his fragile ship successfully between Scylla and Charybdis. The modern Scylla takes the form of ever-increasing pressures to provide more resources for professional liability, compliance, patient satisfaction, central administration, and a host of other demands. The modern Charybdis takes the form of ever-increasing pressures to procure resources when fewer are available and competition is continuously increasing the need for resources, including managed care, hospital administration, payers, employers, patients who are uninsured or underinsured, research funding, and philanthropy. This publication provides physician leaders with guidance for identifying and managing common leadership challenges on the basis of the professional responsibility model of physician leadership. This model is based on Plato's concept of leadership as a life of service and the professional medical ethics of Drs John Gregory and Thomas Percival. Four professional virtues should guide physician leaders: self-effacement, self-sacrifice, compassion, and integrity. These professional virtues direct physician leaders to treat colleagues as ends in themselves, to provide justice-based resource management, to use power constrained by medical professionalism, and to prevent and respond effectively to organizational dysfunction. The professional responsibility model guides physician leaders by proving an explicit "tool kit" to complement managerial skills.
Collapse
|
|
23
|
Chervenak FA, McCullough LB, Brent RL, Levene MI, Arabin B. Planned home birth: the professional responsibility response. Am J Obstet Gynecol 2013; 208:31-8. [PMID: 23151491 DOI: 10.1016/j.ajog.2012.10.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/11/2012] [Accepted: 10/02/2012] [Indexed: 11/27/2022]
Abstract
This article addresses the recrudescence of and new support for midwife-supervised planned home birth in the United States and the other developed countries in the context of professional responsibility. Advocates of planned home birth have emphasized patient safety, patient satisfaction, cost effectiveness, and respect for women's rights. We provide a critical evaluation of each of these claims and identify professionally appropriate responses of obstetricians and other concerned physicians to planned home birth. We start with patient safety and show that planned home birth has unnecessary, preventable, irremediable increased risk of harm for pregnant, fetal, and neonatal patients. We document that the persistently high rates of emergency transport undermines patient safety and satisfaction, the raison d'etre of planned home birth, and that a comprehensive analysis undermines claims about the cost-effectiveness of planned home birth. We then argue that obstetricians and other concerned physicians should understand, identify, and correct the root causes of the recrudescence of planned home birth; respond to expressions of interest in planned home birth by women with evidence-based recommendations against it; refuse to participate in planned home birth; but still provide excellent and compassionate emergency obstetric care to women transported from planned home birth. We explain why obstetricians should not participate in or refer to randomized clinical trials of planned home vs planned hospital birth. We call on obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital.
Collapse
Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA
| | | | | | | | | |
Collapse
|
|
24
|
|