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Cooper WO, Hickson GB, Dmochowski RR, Domenico HJ, Barr FE, Emory CL, Gilbert J, Hartman GE, Lozon MM, Martinez W, Noland J, Webber SA. Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers. JAMA Netw Open 2024; 7:e2415331. [PMID: 38842804 DOI: 10.1001/jamanetworkopen.2024.15331] [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] [Indexed: 06/07/2024] Open
Abstract
Importance Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members. Objective To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers. Design, Setting, and Participants This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022. Exposure Submitted reports concerning communication, professional responsibility, medical care, and professional integrity. Main Outcomes and Measures Physicians' total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report. Results The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, -7.1 percentage points; 95% CI, -7.7 to -6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, -2.4 percentage points, 95% CI, -3.2 to -1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians. Conclusions and Relevance In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.
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Affiliation(s)
- William O Cooper
- Departments of Pediatrics and Health Policy, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald B Hickson
- Department of Pediatrics, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urologic Surgery, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Cynthia L Emory
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jill Gilbert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gary E Hartman
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Marie M Lozon
- Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor
| | - William Martinez
- Department of Medicine, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janesta Noland
- Department of Pediatrics, Stanford University School of Medicine, California and Stanford Medicine Children's Health, Palo Alto, California
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Dambrino RJ, Domenico HJ, Graves JA, Buntin MJB, Martinez W, Rosenbloom ST, Cooper WO. Unsolicited Patient Complaints Following the 21st Century Cures Act Information-Blocking Rule. JAMA HEALTH FORUM 2023; 4:e233244. [PMID: 37773508 PMCID: PMC10543134 DOI: 10.1001/jamahealthforum.2023.3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 10/01/2023] Open
Abstract
Importance The 21st Century Cures Act includes an information-blocking rule (IBR) that requires health systems to provide patients with immediate access to their health information in the electronic medical record upon request. Patients accessing their health information before they receive an explanation from their health care team may experience confusion and may be more likely to share unsolicited patient complaints (UPCs) with their health care organization. Objective To evaluate the quantity of UPCs about physicians before and after IBR implementation and to identify themes in UPCs that may identify patient confusion, fear, or anger related to the release of information. Design, Setting, and Participants This retrospective cohort study was conducted with an interrupted time-series analysis of UPCs spanning January 1, 2020, to June 30, 2022. The data were obtained from a single academic medical center, Vanderbilt University Medical Center, at which the IBR was implemented on January 20, 2021. Data analysis was performed from January 11 to July 15, 2023. Exposure Implementation of the IBR on January 20, 2021. Main Outcomes and Measures The primary outcome was the monthly rate of UPCs before and after IBR implementation. A qualitative analysis was performed for UPCs received after IBR implementation. The Wilcoxon rank-sum test was used to compare monthly complaints between the pre- and post-IBR groups. The Pearson χ2 test was used to compare proportions of complaints by UPC category between time periods. Results The medical center received 8495 UPCs during the study period: 3022 over 12 months before and 5473 over 18 months after institutional IBR implementation. There was no difference in the monthly proportions of UPCs per 1000 patient encounters before (median, 0.81 [IQR, 0.75-0.88]) and after (median, 0.83 [IQR, 0.77-0.89]) IBR implementation (difference in medians, -0.02 [95% CI, -0.12 to 0.07]; P =.86). Segmented regression analysis revealed no difference in monthly UPCs (β [SE], 0.03 [0.09]; P =.72). Conclusions and Relevance In this cohort study, implementation of the Cures Act IBR was not associated with an increase in monthly rates of UPCs. These findings suggest that review of UPCs identified as IBR-specific complaints may allow clinicians and organizations to prepare patients that their test and procedure results may be available before clinicians are able to review them and respond.
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Affiliation(s)
- Robert J. Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry J. Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John A. Graves
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda J. B. Buntin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Carey Business School, Johns Hopkins University, Baltimore, Maryland
| | - William Martinez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William O. Cooper
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. Creating a culture of safety and respect through professional accountability: case study of the Ethos program across eight Australian hospitals. AUST HEALTH REV 2022; 46:319-324. [PMID: 35546252 DOI: 10.1071/ah21308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/10/2022] [Indexed: 11/23/2022]
Abstract
Behaviour that is disrespectful towards others occurs frequently in hospitals, negatively impacts staff, and may undermine patient care. Professional accountability programs may address unprofessional behaviour by staff. This article examines a whole-of-hospital program, Ethos, developed by St Vincent's Health Australia to address unprofessional behaviour, encourage speaking up, and improve organisational culture. Ethos consists of a bundle of tools, training, and resources, including an online system where staff can make submissions regarding their co-workers' exemplary or unprofessional behaviour. Informal feedback is provided to the subject of the submission to recognise or encourage reflection on their behaviour. Following implementation in eight St Vincent's Health Australia hospitals, the Ethos Messaging System has had 2497 submissions, 54% about positive behaviours. Peer messengers who deliver 'Feedback for Reflection' have faced practical challenges in providing feedback. Guidelines for the team who 'triage' Ethos messages have been revised to ensure only feedback that will promote reflection is passed on. Early evidence suggests Ethos has positively impacted staff, although evaluation is ongoing. The COVID-19 pandemic has required some adaptations to the program.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Antoinette Pavithra
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Ryan McMullan
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Stephen Tippett
- People Services, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | - Neil Cunningham
- Emergency Department, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | - Erwin Loh
- St Vincent's Health Australia, East Melbourne, Vic., Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
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Raldow A, Adefres B, Warso M, Shinohara E, Anand S, Domenico HJ, Galloway MB, Pichert JW, Cooper WO. Unsolicited patient complaints among radiation, medical, and surgical oncologists. Cancer 2021; 127:2350-2357. [PMID: 33724453 DOI: 10.1002/cncr.33513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the distributions and types of UPCs associated with oncologists by specialty and assessed oncologist characteristics associated with UPCs. METHODS This retrospective study reviewed UPCs associated with US radiation oncologists (ROs), medical oncologists (MOs), and surgical oncologists (SOs) from 35 health care systems from 2015 to 2018. Average total UPCs were compared by specialty in addition to sex, medical school graduation year, degree, medical school location, residency location, practice setting, and practice region. For continuous variables, linear regression was used to test for an association with total complaints. RESULTS The study included 1576 physicians: 318 ROs, 1020 MOs, and 238 SOs. The average number of UPCs per physician was different and depended on the oncologic specialty: ROs had significantly fewer complaints (1.28; 95% confidence interval [CI], 1.02-1.54) than MOs (3.81; 95% CI, 3.52-4.10) and SOs (6.89; 95% CI, 5.99-7.79; P < .0001). In a multivariable analysis, oncologic specialty, recency of graduation, and academic practice were predictive of higher total UPCs (P < .05). UPCs described concerns with care and treatment (42.8%), communication (26.4%), accessibility (17.5%), concern for patient (10.3%), and billing (2.9%). CONCLUSIONS ROs had significantly fewer complaints than MOs and SOs and may have a lower risk of malpractice claims as a group. In addition to oncologic specialty, a more recent year of medical school graduation and working at an academic center were independent risk factors for UPCs. Further research is needed to clarify the reasons underlying these associations and to identify interventions that decrease UPCs and associated risks. LAY SUMMARY This study of 1576 oncologists found that radiation oncologists had significantly fewer complaints than medical oncologists, who in turn had significantly fewer complaints than surgical oncologists. Other characteristics associated with more patient complaints included recency of medical school graduation and practice in an academic setting. Oncologists' patient complaints provide information that may have practical applications for patient safety and risk management. Understanding and addressing the characteristics that increase the risk for complaints could improve patients' experiences and outcomes.
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Affiliation(s)
- Ann Raldow
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Bethel Adefres
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Michael Warso
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Eric Shinohara
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sidharth Anand
- Department of Medical Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | | | - Mitchell B Galloway
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James W Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William O Cooper
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Cooper WO, Spain DA, Guillamondegui O, Kelz RR, Domenico HJ, Hopkins J, Sullivan P, Moore IN, Pichert JW, Catron TF, Webb LE, Dmochowski RR, Hickson GB. Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA Surg 2020; 154:828-834. [PMID: 31215973 DOI: 10.1001/jamasurg.2019.1738] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance For surgical teams, high reliability and optimal performance depend on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may undermine a culture of safety, threaten teamwork, and thereby increase the risk for medical errors and surgical complications. Objective To test the hypothesis that patients of surgeons with higher numbers of reports from coworkers about unprofessional behaviors are at greater risk for postoperative complications than patients whose surgeons generate fewer coworker reports. Design, Setting, and Participants This retrospective cohort study assessed data from 2 geographically diverse academic medical centers that participated in the National Surgical Quality Improvement Program (NSQIP) and recorded and acted on electronic reports of safety events from coworkers describing unprofessional behavior by surgeons. Patients included in the NSQIP database who underwent inpatient or outpatient operations at 1 of the 2 participating sites from January 1, 2012, through December 31, 2016, were eligible. Patients were excluded if they were younger than 18 years on the date of the operation or if the attending surgeon had less than 36 months of monitoring for coworker reports preceding the date of the operation. Data were analyzed from August 8, 2018, through April 9, 2019. Exposures Coworker reports about unprofessional behavior by the surgeon in the 36 months preceding the date of the operation. Main Outcomes and Measures Postoperative surgical or medical complications, as defined by the NSQIP, within 30 days of the operation. Results Among 13 653 patients in the cohort (54.0% [7368 ] female; mean [SD] age, 57 [16] years) who underwent operations performed by 202 surgeons (70.8% [143] male), 1583 (11.6%) experienced a complication, including 825 surgical (6.0%) and 1070 medical (7.8%) complications. Patients whose surgeons had more coworker reports were significantly more likely to experience any complication (0 reports, 954 of 8916 [10.7%]; ≥4 reports, 294 of 2087 [14.1%]; P < .001), any surgical complication (0 reports, 516 of 8916 [5.8%]; ≥4 reports, 159 of 2087 [7.6%]; P < .01), or any medical complication (0 reports, 634 of 8916 [7.1%]; ≥4 reports, 196 of 2087 [9.4%]; P < .001). The adjusted complication rate was 14.3% higher for patients whose surgeons had 1 to 3 reports and 11.9% higher for patients whose surgeons had 4 or more reports compared with patients whose surgeons had no coworker reports (P = .05). Conclusions and Relevance Patients whose surgeons had higher numbers of coworker reports about unprofessional behavior in the 36 months before the patient's operation appeared to be at increased risk of surgical and medical complications. These findings suggest that organizations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behavior toward other medical professionals may increase patients' risk for adverse outcomes.
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Affiliation(s)
- William O Cooper
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, California
| | - Oscar Guillamondegui
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rachel R Kelz
- Center for Surgery and Health Economics, Department of Surgery, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph Hopkins
- Department of Medicine, Stanford University, Stanford, California
| | - Patricia Sullivan
- Department of Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia
| | - Ilene N Moore
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James W Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas F Catron
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynn E Webb
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.,Center for Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.,Center for Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee
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6
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Lee D, Panicker V, Gross C, Zhang J, Landis-Lewis Z. What was visualized? A method for describing content of performance summary displays in feedback interventions. BMC Med Res Methodol 2020; 20:90. [PMID: 32326895 PMCID: PMC7181510 DOI: 10.1186/s12874-020-00951-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visual displays such as charts and tables may significantly moderate the effects of audit and feedback interventions, but the systematic study of these intervention components will likely remain limited without a method for isolating the information content of a visual display from its form elements. The objective of this study is to introduce such a method based on an application of visualization frameworks to enable a systematic approach to answer the question, "What was visualized?" in studies of audit and feedback. METHODS The proposed method uses 3 steps to systematically identify and describe the content of visual displays in feedback interventions: 1) identify displays, 2) classify content, and 3) identify elements. The use of a visualization framework led us to identify information content types as representations of measures (metrics or indicators), ascribees (feedback recipients and comparators), performance levels, and time intervals. We illustrate the proposed method in a series of 3 content analyses, one for each step, to identify visual displays and their information content in published example performance summaries. RESULTS We analyzed a convenience sample of 44 published studies of audit and feedback. Through each step, two coders had good agreement. We identified 42 visual displays of performance, containing 6 unique combinations of content types. What was visualized most commonly in the sample was performance levels across a recipient and comparators (i.e. ascribees) for a single measure and single time interval (n = 16). Content types varied in their inclusion of measures, ascribees, and time intervals. CONCLUSIONS The proposed method appears to be feasible to use as a systematic approach to describing visual displays of performance. The key implication of the method is that it offers more granular and consistent description for empirical, theoretical, and design studies about the information content of feedback interventions.
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Affiliation(s)
- Dahee Lee
- Department of Learning Health Sciences, University of Michigan Medical School, 1161J NIB, 300 N., Ingalls Street, SPC 5403, Ann Arbor, MI, 48109-5403, USA
| | - Veena Panicker
- Department of Learning Health Sciences, University of Michigan Medical School, 1161J NIB, 300 N., Ingalls Street, SPC 5403, Ann Arbor, MI, 48109-5403, USA
| | - Colin Gross
- Department of Learning Health Sciences, University of Michigan Medical School, 1161J NIB, 300 N., Ingalls Street, SPC 5403, Ann Arbor, MI, 48109-5403, USA
| | - Jessica Zhang
- Department of Learning Health Sciences, University of Michigan Medical School, 1161J NIB, 300 N., Ingalls Street, SPC 5403, Ann Arbor, MI, 48109-5403, USA
| | - Zach Landis-Lewis
- Department of Learning Health Sciences, University of Michigan Medical School, 1161J NIB, 300 N., Ingalls Street, SPC 5403, Ann Arbor, MI, 48109-5403, USA.
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Swiggart WH, Bills JL, Penberthy JK, Dewey CM, Worley LL. A Professional Development Course Improves Unprofessional Physician Behavior. Jt Comm J Qual Patient Saf 2020; 46:64-71. [DOI: 10.1016/j.jcjq.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
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Williams BW, Williams MV. Understanding and Remediating Lapses in Professionalism: Lessons From the Island of Last Resort. Ann Thorac Surg 2020; 109:317-324. [DOI: 10.1016/j.athoracsur.2019.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022]
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Gatto V, Scopetti M, La Russa R, Santurro A, Cipolloni L, Viola RV, Di Sanzo M, Frati P, Fineschi V. Advanced Loss Eventuality Assessment and Technical Estimates: An Integrated Approach for Management of Healthcare-Associated Infections. Curr Pharm Biotechnol 2020; 20:625-634. [PMID: 30961487 DOI: 10.2174/1389201020666190408095050] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/15/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Healthcare Associated Infections (HAIs) represent a crucial issue in health and patient safety management due to the persistent nature, economic impact and possible preventability of the phenomenon. Compensation claims for damages resulting from HAI could provide insights that can improve the understanding of suboptimal steps in the therapeutic process, enable an estimate of costs related to infectious complications, and guide the development of planning tools for implementation of the quality of care. OBJECTIVE This paper analyzes all the HAI claims received at the Umberto I General Hospital of Rome across a five-year period with the aim of outlining a methodological approach to the litigation management and of characterizing the economic impact of infections on health facilities resources. METHODS All claims received during the study period have been classified according to the International Classification for Patient Safety (ICPS) system. Subsequently, claims related to Healthcare Associated Infections were evaluated through an innovative tool for determination of the risk of loss, the Advanced Loss Eventuality Assessment (ALEA) score. RESULTS The results obtained demonstrate the relevance of a correct management of HAI claims in the administration of a health care system. Specifically, the cases examined during the study highlighted the significant impact of infectious diseases of a nosocomial nature in terms of frequency and economic exposure. CONCLUSION The proposed methodological approach allows a productive analysis of the internal processes, providing fundamental data for the refinement of the preventive strategies and for the rationalization of the resources through the expenditure forecasts. Article Highlights Box: Healthcare-Associated Infections represent an essential element to consider in the management of health facilities. • Many studies highlight the economic burden of Healthcare-Associated Infections in health policies. • Litigation management represents a useful resource in the prevention of Healthcare Associated Infections. • Appropriate clinical risk management policies in the field of Healthcare-Associated Infections allow the implementation of preventive measures, the reduction of the incidence of the phenomenon and the quality of care. • The costs of Healthcare-Associated Infections can be limited through a systematic methodological approach based on Advanced Loss Eventuality Assessment and technical estimate of the value of each case. • The application of a standardized system would be desirable in any health facility despite the potential methodological, technical, behavioral and financial issues.
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Affiliation(s)
- Vittorio Gatto
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Rocco V Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Mariantonia Di Sanzo
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
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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: 0.8] [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.
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11
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Kennedy BB, Russell RG, Martinez W, Gigante CI, Penrod CH, Ehrenfeld JM, Vinson KN, Swan R, Schorn MN, Brady DW, Miller B. Development of an interprofessional clinical learning environment report card. J Prof Nurs 2019; 35:314-319. [PMID: 31345512 DOI: 10.1016/j.profnurs.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
Multiple factors in the learning environment can encourage or impede student learning. Unanswered questions regarding the shared learning environment for graduate nursing and medical education and the desire for an ongoing improvement process drove creation of an interprofessional collaborative and development of an Interprofessional Clinical Learning Environment Report Card (I-CLERC) at one U.S. academic medical center. The I-CLERC offers a process and a product for institutionalizing a shared assessment tool to inform improvement efforts, track progress and promote accountability. In addition, it enhances interprofessional collaboration, with students and faculty from both nursing and medicine working together to define excellence, monitor performance, and identify areas for improvement in the shared clinical learning environment. The purpose of this manuscript is to describe development and implementation of an interdisciplinary, institutional collaborative for ongoing evaluation of the shared clinical learning environment.
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Affiliation(s)
- Betsy B Kennedy
- 274 SON, 461 21st Ave South, Vanderbilt University School of Nursing, Nashville, TN, 37240, United States of America.
| | - Regina G Russell
- Learning System Outcomes, Undergraduate Medical Education, VUSM, United States of America
| | - William Martinez
- Assistant Professor, University of Louisville, Department of Pediatrics, Louisville, KY, USA
| | | | - Cody H Penrod
- Assistant Professor, University of Louisville, Department of Pediatrics, Louisville, KY, USA
| | - Jesse M Ehrenfeld
- Assistant Professor, University of Louisville, Department of Pediatrics, Louisville, KY, USA
| | | | - Rebecca Swan
- Graduate Medical Education, VUMC, United States of America
| | | | - Donald W Brady
- Assistant Professor, University of Louisville, Department of Pediatrics, Louisville, KY, USA
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Shapiro DE, Duquette C, Abbott LM, Babineau T, Pearl A, Haidet P. Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize Interventions at the Systems Level. Am J Med 2019; 132:556-563. [PMID: 30553832 DOI: 10.1016/j.amjmed.2018.11.028] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/27/2022]
Abstract
Burnout has been implicated in higher physician turnover, reduced patient satisfaction, and worsened safety, but understanding the degree of burnout in a given physician or team does not direct leaders to solutions. The model proposed integrates a long list of variables that may ameliorate burnout into a prioritized, easy-to-understand hierarchy. Modified from Maslow's hierarchy, the model directs leaders to address physicians' basic physical and mental health needs first; patient and physician physical safety second; and then address higher-order needs, including respect from colleagues, patients, processes, and the electronic health record; appreciation and connection; and finally, time and resources to heal patients and contribute to the greater good. Assessments based on this model will help leaders prioritize interventions and improve physician wellness.
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Affiliation(s)
- Daniel E Shapiro
- Administrative Affairs, Humanities in Medicine, Penn State College of Medicine, Hershey.
| | | | | | - Timothy Babineau
- Lifespan, Providence, RI; Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI
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13
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DuBois JM, Anderson EE, Chibnall JT, Diakov L, Doukas DJ, Holmboe ES, Koenig HM, Krause JH, McMillan G, Mendelsohn M, Mozersky J, Norcross WA, Whelan AJ. Preventing Egregious Ethical Violations in Medical Practice: Evidence-Informed Recommendations from a Multidisciplinary Working Group. ACTA ACUST UNITED AC 2019; 104:23-31. [PMID: 30984914 DOI: 10.30770/2572-1852-104.4.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article reports the consensus recommendations of a working group that was convened at the end of a 4-year research project funded by the National Institutes of Health that examined 280 cases of egregious ethical violations in medical practice. The group reviewed data from the parent project, as well as other research on sexual abuse of patients, criminal prescribing of controlled substances, and unnecessary invasive procedures that were prosecuted as fraud. The working group embraced the goals of making such violations significantly less frequent and, when they do occur, identifying them sooner and taking necessary steps to ensure they are not repeated. Following review of data and previously published recommendations, the working group developed 10 recommendations that provide a starting point to meet these goals. Recommendations address leadership, oversight, tracking, disciplinary actions, education of patients, partnerships with law enforcement, further research and related matters. The working group recognized the need for further refinement of the recommendations to ensure feasibility and appropriate balance between protection of patients and fairness to physicians. While full implementation of appropriate measures will require time and study, we believe it is urgent to take visible actions to acknowledge and address the problem at hand.
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14
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Gilbert GL, Kerridge I. The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians' perceptions of professional and cultural factors that influence doctors' attitudes and practices in a large Australian hospital. BMC Health Serv Res 2019; 19:212. [PMID: 30940153 PMCID: PMC6444390 DOI: 10.1186/s12913-019-4044-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hospital infection prevention and control (IPC) programs are designed to minimise rates of preventable healthcare-associated infection (HAI) and acquisition of multidrug resistant organisms, which are among the commonest adverse effects of hospitalisation. Failures of hospital IPC in recent years have led to nosocomial and community outbreaks of emerging infections, causing preventable deaths and social disruption. Therefore, effective IPC programs are essential, but can be difficult to sustain in busy clinical environments. Healthcare workers' adherence to routine IPC practices is often suboptimal, but there is evidence that doctors, as a group, are consistently less compliant than nurses. This is significant because doctors' behaviours disproportionately influence those of other staff and their peripatetic practice provides more opportunities for pathogen transmission. A better understanding of what drives doctors' IPC practices will contribute to development of new strategies to improve IPC, overall. METHODS This qualitative case study involved in-depth interviews with senior clinicians and clinician-managers/directors (16 doctors and 10 nurses) from a broad range of specialties, in a large Australian tertiary hospital, to explore their perceptions of professional and cultural factors that influence doctors' IPC practices, using thematic analysis of data. RESULTS Professional/clinical autonomy; leadership and role modelling; uncertainty about the importance of HAIs and doctors' responsibilities for preventing them; and lack of clarity about senior consultants' obligations emerged as major themes. Participants described marked variation in practices between individual doctors, influenced by, inter alia, doctors' own assessment of patients' infection risk and their beliefs about the efficacy of IPC policies. Participants believed that most doctors recognise the significance of HAIs and choose to [mostly] observe organisational IPC policies, but a minority show apparent contempt for accepted rules, disrespect for colleagues who adhere to, or are expected to enforce, them and indifference to patients whose care is compromised. CONCLUSIONS Failure of healthcare and professional organisations to address doctors' poor IPC practices and unprofessional behaviour, more generally, threatens patient safety and staff morale and undermines efforts to minimise the risks of dangerous nosocomial infection.
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Affiliation(s)
- Gwendolyn L Gilbert
- Sydney Health Ethics, University of Sydney, Level 1, Building 1, Medical Foundation Building, 92/94 Parramatta Rd, Camperdown, NSW, 2050, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia.
| | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Level 1, Building 1, Medical Foundation Building, 92/94 Parramatta Rd, Camperdown, NSW, 2050, Australia.,Department of Haematology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia
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15
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Giardina TD, Haskell H, Menon S, Hallisy J, Southwick FS, Sarkar U, Royse KE, Singh H. Learning From Patients' Experiences Related To Diagnostic Errors Is Essential For Progress In Patient Safety. Health Aff (Millwood) 2018; 37:1821-1827. [PMID: 30395513 PMCID: PMC8103734 DOI: 10.1377/hlthaff.2018.0698] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diagnostic error research has largely focused on individual clinicians' decision making and system design, while overlooking information from patients. We analyzed a unique new data source of patient- and family-reported error narratives to explore factors that contribute to diagnostic errors. From reports of adverse medical events submitted in the period January 2010-February 2016, we identified 184 unique patient narratives of diagnostic error. Problems related to patient-physician interactions emerged as major contributors. Our analysis identified 224 instances of behavioral and interpersonal factors that reflected unprofessional clinician behavior, including ignoring patients' knowledge, disrespecting patients, failing to communicate, and manipulation or deception. Patients' perspectives can lead to a more comprehensive understanding of why diagnostic errors occur and help develop strategies for mitigation. Health systems should develop and implement formal programs to collect patients' experiences with the diagnostic process and use these data to promote an organizational culture that strives to reduce harm from diagnostic error.
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Affiliation(s)
- Traber Davis Giardina
- Traber Davis Giardina ( ) is a patient safety researcher in the Center for Innovations in Quality, Effectiveness, and Safety at the Michael E. DeBakey Veterans Affairs (VA) Medical Center and an assistant professor of medicine at Baylor College of Medicine, both in Houston, Texas
| | - Helen Haskell
- Helen Haskell is the founder and president of Mothers Against Medical Error, in Columbia, South Carolina
| | - Shailaja Menon
- Shailaja Menon is an instructor in the Department of Sociology at Houston Community College, in Texas
| | - Julia Hallisy
- Julia Hallisy is the founder of the Empowered Patient Coalition in San Francisco, California
| | - Frederick S Southwick
- Frederick S. Southwick is a professor of medicine at the University of Florida, in Gainesville
| | - Urmimala Sarkar
- Urmimala Sarkar is an associate professor of medicine in the Division of General Internal Medicine, University of California San Francisco, and a primary care physician at Zuckerberg San Francisco General Hospital's Richard H. Fine People's Clinic
| | - Kathryn E Royse
- Kathryn E. Royse is an epidemiologist in the Center for Innovations in Quality, Effectiveness, and Safety at the Michael E. DeBakey VA Medical Center and an instructor in the Department of Medicine at Baylor College of Medicine
| | - Hardeep Singh
- Hardeep Singh is chief of the Health Policy, Quality, and Informatics Program, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, and a professor of medicine at Baylor College of Medicine
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16
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Diraviam SP, Sullivan PG, Sestito JA, Nepps ME, Clapp JT, Fleisher LA. Physician Engagement in Malpractice Risk Reduction: A UPHS Case Study. Jt Comm J Qual Patient Saf 2018; 44:605-612. [DOI: 10.1016/j.jcjq.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/22/2018] [Indexed: 11/26/2022]
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17
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Cooper WO, Martinez W, Domenico HJ, Callahan ST, Kirkby BP, Finlayson AJR, Foster JJ, Johnson TM, Longo FM, Merrill DG, Jacobs ML, Pichert JW, Catron TF, Moore IN, Webb LE, Karrass J, Hickson GB. Unsolicited Patient Complaints Identify Physicians with Evidence of Neurocognitive Disorders. Am J Geriatr Psychiatry 2018; 26:927-936. [PMID: 30146001 DOI: 10.1016/j.jagp.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Determine whether words contained in unsolicited patient complaints differentiate physicians with and without neurocognitive disorders (NCD). METHODS We conducted a nested case-control study using data from 144 healthcare organizations that participate in the Patient Advocacy Reporting System program. Cases (physicians with probable or possible NCD) and two comparison groups of 60 physicians each (matched for age/sex and site/number of unsolicited patient complaints) were identified from 33,814 physicians practicing at study sites. We compared the frequency of words in patient complaints related to an NCD diagnostic domain between cases and our two comparison groups. RESULTS Individual words were all statistically more likely to appear in patient complaints for cases (73% of cases had at least one such word) compared to age/sex matched (8%, p < 0.001 using Pearson's χ2 test, χ2 = 30.21, df = 1) and site/complaint matched comparisons (18%, p < 0.001 using Pearson's χ2 test, χ2 = 17.51, df = 1). Cases were significantly more likely to have at least one complaint with any word describing NCD than the two comparison groups combined (conditional logistic model adjusted odds ratio 20.0 [95% confidence interval 4.9-81.7]). CONCLUSIONS Analysis of words in unsolicited patient complaints found that descriptions of interactions with physicians with NCD were significantly more likely to include words from one of the diagnostic domains for NCD than were two different comparison groups. Further research is needed to understand whether patients might provide information for healthcare organizations interested in identifying professionals with evidence of cognitive impairment.
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Affiliation(s)
- William O Cooper
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
| | - William Martinez
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - S Todd Callahan
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Brian P Kirkby
- Department of Surgery, Launceston General Hospital, Australia
| | | | - Jody J Foster
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Theodore M Johnson
- Birmingham/Atlanta VA GRECC and the Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Frank M Longo
- Department of Neurology, Stanford University, Stanford, CA
| | | | - Monica L Jacobs
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN
| | - James W Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas F Catron
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Ilene N Moore
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Lynn E Webb
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
| | - Jan Karrass
- Department of Psychology, University of Maryland University College Europe, Kaiserslautern, Germany
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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18
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de Vos MS, Hamming JF, Marang-van de Mheen PJ. The problem with using patient complaints for improvement. BMJ Qual Saf 2018; 27:758-762. [PMID: 29298910 DOI: 10.1136/bmjqs-2017-007463] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 11/04/2022]
Abstract
'The Problem with…' series covers controversial topics related to efforts to improve healthcare quality, including widely recommended, but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution.
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Affiliation(s)
- Marit S de Vos
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Fathy CA, Pichert JW, Domenico H, Kohanim S, Sternberg P, Cooper WO. Association Between Ophthalmologist Age and Unsolicited Patient Complaints. JAMA Ophthalmol 2018; 136:61-67. [PMID: 29192303 PMCID: PMC5833603 DOI: 10.1001/jamaophthalmol.2017.5154] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/28/2017] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Understanding the distribution of patient complaints by physician age may provide insight into common patient concerns characteristic of early, middle, and late stages of careers in ophthalmology. Most previous studies of patient dissatisfaction have not addressed the association with physician age or controlled for other characteristics (eg, practice setting, subspecialty) that may contribute to the likelihood of patient complaints, unsafe care, and lawsuits. OBJECTIVE To assess the association between ophthalmologist age and the likelihood of generating unsolicited patient complaints (UPCs) among a cohort of ophthalmologists. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study with variable duration of follow-up. The study assessed time to first complaint between 2002 and 2015 in 1342 attending ophthalmologists or neuro-ophthalmologists who had graduated from medical school before 2010 and were affiliated with an organization that participates in Vanderbilt University Medical Center's Patient Advocacy Reporting System. Participants were stratified into 5 age bands and were followed up from the time of their employment to receipt of their first complaint. Trained coders categorized UPCs into 34 specific types under 6 major categories. MAIN OUTCOMES AND MEASURES Time to first recorded complaint. Multivariable Cox proportional hazards model was used to measure the association between time to first complaint and ophthalmologist age after adjustment for predetermined covariates. RESULTS The median physician age was 47 years, with 9% who were 71 years or older. The cohort was 74% male, 90% held MD degrees, and 73% practiced in academic medical centers. The mean follow-up period was 9.8 years. Ophthalmologists older than 70 years had the lowest complaint rate (0.71 per 1000 follow-up days vs 1.41, 1.84, 2.02, and 1.88 in descending order of age band). By 2000 days of follow-up (or within 5.5 years), the youngest group had an estimated UPC risk of 0.523. By 4000 days (>10 years), participants in the older than 70 years age band had an estimated risk of UPC of only 0.364. The 2 youngest age bands were associated with a statistically significant shorter time to first complaint. Compared with those aged 71 years or older, the risk of incurring a UPC for those aged 41 to 50 years was 1.73-fold higher (hazard ratio [HR], 1.73; 95% CI, 1.21-2.46; P = .002). Similarly, participants aged 31 to 40 years had a 2.36 times higher risk of incurring a UPC (HR, 2.36; 95% CI, 1.64-3.40; P < .001). CONCLUSIONS AND RELEVANCE This study suggests that older ophthalmologists are less likely to receive UPCs than younger ones. Although limitations in the study design could affect the interpretation of these conclusions, the findings may have practical implications for patient safety, clinical education, and clinical practice management.
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Affiliation(s)
- Cherie A. Fathy
- Medical student at Vanderbilt University School of Medicine, Nashville, Tennessee
| | - James W. Pichert
- Center for Patient and Professional Advocacy, Nashville, Tennessee
| | - Henry Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sahar Kohanim
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul Sternberg
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
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20
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Mirzoev T, Kane S. Key strategies to improve systems for managing patient complaints within health facilities - what can we learn from the existing literature? Glob Health Action 2018; 11:1458938. [PMID: 29658393 PMCID: PMC5912438 DOI: 10.1080/16549716.2018.1458938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Information from patient complaints - a widely accepted measure of patient satisfaction with services - can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. OBJECTIVES The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. METHODS We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. RESULTS Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients' awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. CONCLUSIONS Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.
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Affiliation(s)
- Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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21
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DuBois JM, Chibnall JT, Anderson EE, Walsh HA, Eggers M, Baldwin K, Dineen KK. Exploring unnecessary invasive procedures in the United States: a retrospective mixed-methods analysis of cases from 2008-2016. Patient Saf Surg 2017; 11:30. [PMID: 29270224 PMCID: PMC5735893 DOI: 10.1186/s13037-017-0144-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Unnecessary invasive procedures risk harming patients physically, emotionally, and financially. Very little is known about the factors that provide the motive, means, and opportunity (MMO) for unnecessary procedures. METHODS This project used a mixed-methods design that involved five key steps: (1) systematically searching the literature to identify cases of unnecessary procedures reported from 2008 to 2016; (2) identifying all medical board, court, and news records on relevant cases; (3) coding all relevant records using a structured codebook of case characteristics; (4) analyzing each case using a MMO framework to develop a causal theory of the case; and (5) identifying typologies of cases through a two-step cluster analysis using variables hypothesized to be causally related to unnecessary procedures. RESULTS Seventy-nine cases met inclusion criteria. The mean number of documents or sources examined for each case was 36.4. Unnecessary procedures were performed for at least five years in most cases (53.2%); 56.3% of the cases involved 30 or more patients, and 37.5% involved 100 or more patients. In nearly all cases the physician was male (96.2%) and working in private practice (92.4%); 57.0% of the physicians had an accomplice, 48.1% were 50 years of age or older, and 40.5% trained outside the U.S. The most common motives were financial gain (92.4%) and suspected antisocial personality (48.1%), followed by poor problem-solving or clinical skills (11.4%) and ambition (3.8%). The most common environmental factors that provided opportunity for unnecessary procedures included a lack of oversight (40.5%) or oversight failures (39.2%), a corrupt moral climate (26.6%), vulnerable patients (20.3%), and financial conflicts of interest (13.9%). CONCLUSIONS Unnecessary procedures usually appear motivated by financial gain and occur in settings that have oversight problems. Preventive efforts should focus on early detection by peers and institutions, and decisive action by medical boards and federal prosecutors.
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Affiliation(s)
- James M. DuBois
- Division of General Medical Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8005, St Louis, MO 63110 USA
| | - John T. Chibnall
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, 1438 S. Grand Blvd, St. Louis, MO 63104 USA
| | - Emily E. Anderson
- Neiswanger Institute for Bioethics & Health Policy, Loyola University Chicago Stritch School of Medicine, 2160 S. First Avenue, Maywood, IL 60153 USA
| | - Heidi A. Walsh
- Division of General Medical Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8005, St Louis, MO 63110 USA
| | - Michelle Eggers
- Division of General Medical Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8005, St Louis, MO 63110 USA
| | - Kari Baldwin
- Division of General Medical Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8005, St Louis, MO 63110 USA
| | - Kelly K. Dineen
- Creighton University, School of Law, 2500 California Plaza, Omaha, NE 68178 USA
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Stimson C, Karrass J, Dmochowski RR, Pichert JW. Academic Urological Surgeons have Greater Exposure to Risk Management Activity than Community Urological Surgeons: An Empirical Analysis of Patient Complaint Data. UROLOGY PRACTICE 2017. [DOI: 10.1016/j.urpr.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C.J. Stimson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jan Karrass
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James W. Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
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Fisher KA, Mazor KM. Patient and Family Complaints in Cancer Care: What Can We Learn From the Tip of the Iceberg? Jt Comm J Qual Patient Saf 2017; 43:495-497. [DOI: 10.1016/j.jcjq.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Evaluation of Patient and Family Outpatient Complaints as a Strategy to Prioritize Efforts to Improve Cancer Care Delivery. Jt Comm J Qual Patient Saf 2017; 43:498-507. [DOI: 10.1016/j.jcjq.2017.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/14/2017] [Accepted: 04/19/2017] [Indexed: 11/21/2022]
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Cooper WO, Guillamondegui O, Hines OJ, Hultman CS, Kelz RR, Shen P, Spain DA, Sweeney JF, Moore IN, Hopkins J, Horowitz IR, Howerton RM, Meredith JW, Spell NO, Sullivan P, Domenico HJ, Pichert JW, Catron TF, Webb LE, Dmochowski RR, Karrass J, Hickson GB. Use of Unsolicited Patient Observations to Identify Surgeons With Increased Risk for Postoperative Complications. JAMA Surg 2017; 152:522-529. [PMID: 28199477 DOI: 10.1001/jamasurg.2016.5703] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Unsolicited patient observations are associated with risk of medical malpractice claims. Because lawsuits may be triggered by an unexpected adverse outcome superimposed on a strained patient-physician relationship, a question remains as to whether behaviors that generate patient dissatisfaction might also contribute to the genesis of adverse outcomes themselves. Objective To examine whether patients of surgeons with a history of higher numbers of unsolicited patient observations are at greater risk for postoperative complications than patients whose surgeons generate fewer such unsolicited patient observations. Design, Setting, and Participants This retrospective cohort study used data from 7 academic medical centers participating in the National Surgical Quality Improvement Program and the Vanderbilt Patient Advocacy Reporting System from January 1, 2011, to December 31, 2013. Patients older than 18 years included in the National Surgical Quality Improvement Program who underwent inpatient or outpatient operations at 1 of the participating sites during the study period were included. Patients were excluded if the attending surgeon had less than 24 months of data in the Vanderbilt Patient Advocacy Reporting System preceding the date of the operation. Data analysis was conducted from June 1, 2015, to October 20, 2016. Exposures Unsolicited patient observations for the patient's surgeon in the 24 months preceding the date of the operation. Main Outcomes and Measures Postoperative surgical or medical complications as defined by the National Surgical Quality Improvement Program within 30 days of the operation of interest. Results Among the 32 125 patients in the cohort (13 230 men, 18 895 women; mean [SD] age, 55.8 [15.8] years), 3501 (10.9%) experienced a complication, including 1754 (5.5%) surgical and 2422 (7.5%) medical complications. Prior unsolicited patient observations for a surgeon were significantly associated with the risk of a patient having any complication (odds ratio, 1.0063; 95% CI, 1.0004-1.0123; P = .03), any surgical complication (odds ratio, 1.0104; 95% CI, 1.0022-1.0186; P = .01), any medical complication (odds ratio, 1.0079; 95% CI, 1.0009-1.0148; P = .03), and being readmitted (odds ratio, 1.0088, 95% CI, 1.0024-1.0151; P = .007). The adjusted rate of complications was 13.9% higher for patients whose surgeon was in the highest quartile of unsolicited patient observations compared with patients whose surgeon was in the lowest quartile. Conclusions and Relevance Patients whose surgeons have large numbers of unsolicited patient observations in the 24 months prior to the patient's operation are at increased risk of surgical and medical complications. Efforts to promote patient safety and address risk of malpractice claims should continue to focus on surgeons' ability to communicate respectfully and effectively with patients and other medical professionals.
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Affiliation(s)
- William O Cooper
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Oscar Guillamondegui
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - O Joe Hines
- Division of General Surgery, University of California, Los Angeles Medical Center
| | - C Scott Hultman
- Department of Surgery, University of North Carolina, Chapel Hill
| | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, California
| | - John F Sweeney
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ilene N Moore
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph Hopkins
- Department of Medicine, Stanford University, Stanford, California
| | - Ira R Horowitz
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Russell M Howerton
- Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - J Wayne Meredith
- Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Nathan O Spell
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Patricia Sullivan
- Department of Quality and Patient Safety, University of Pennsylvania Health System, Philadelphia
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James W Pichert
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas F Catron
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynn E Webb
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee2Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jan Karrass
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee12Center for Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee
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Elmessiry A, Cooper WO, Catron TF, Karrass J, Zhang Z, Singh MP. Triaging Patient Complaints: Monte Carlo Cross-Validation of Six Machine Learning Classifiers. JMIR Med Inform 2017; 5:e19. [PMID: 28760726 PMCID: PMC5556254 DOI: 10.2196/medinform.7140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/15/2017] [Accepted: 05/30/2017] [Indexed: 12/02/2022] Open
Abstract
Background Unsolicited patient complaints can be a useful service recovery tool for health care organizations. Some patient complaints contain information that may necessitate further action on the part of the health care organization and/or the health care professional. Current approaches depend on the manual processing of patient complaints, which can be costly, slow, and challenging in terms of scalability. Objective The aim of this study was to evaluate automatic patient triage, which can potentially improve response time and provide much-needed scale, thereby enhancing opportunities to encourage physicians to self-regulate. Methods We implemented a comparison of several well-known machine learning classifiers to detect whether a complaint was associated with a physician or his/her medical practice. We compared these classifiers using a real-life dataset containing 14,335 patient complaints associated with 768 physicians that was extracted from patient complaints collected by the Patient Advocacy Reporting System developed at Vanderbilt University and associated institutions. We conducted a 10-splits Monte Carlo cross-validation to validate our results. Results We achieved an accuracy of 82% and F-score of 81% in correctly classifying patient complaints with sensitivity and specificity of 0.76 and 0.87, respectively. Conclusions We demonstrate that natural language processing methods based on modeling patient complaint text can be effective in identifying those patient complaints requiring physician action.
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Affiliation(s)
- Adel Elmessiry
- North Carolina State University, Department of Computer Science, Raleigh, NC, United States
| | - William O Cooper
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Thomas F Catron
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jan Karrass
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Zhe Zhang
- IBM, Research Triangle Park, NC, United States
| | - Munindar P Singh
- North Carolina State University, Department of Computer Science, Raleigh, NC, United States
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The Behavioral and Social Sciences: Contributions and Opportunities in Academic Medicine. J Clin Psychol Med Settings 2017; 24:100-109. [PMID: 28501928 DOI: 10.1007/s10880-017-9493-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Association of American Medical Colleges plays a leading role in supporting the expansion and evolution of academic medicine and medical science in North America, which are undergoing high-velocity change. Behavioral and social science concepts have great practical value when applied to the leadership practices and administrative structures that guide and support the rapid evolution of academic medicine and medical sciences. The authors are two behavioral and social science professionals who serve as academic administrators in academic medical centers. They outline their career development and describe the many ways activities have been shaped by their work with the Association of American Medical Colleges. Behavioral and social science professionals are encouraged to become change agents in the ongoing transformation of academic medicine.
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Raper SE, Joseph J, Seymour WG, Sullivan PG. Tipping the scales: educating surgeons about medical malpractice. J Surg Res 2016; 206:206-213. [DOI: 10.1016/j.jss.2016.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/25/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022]
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Catron TF, Guillamondegui OD, Karrass J, Cooper WO, Martin BJ, Dmochowski RR, Pichert JW, Hickson GB. Patient Complaints and Adverse Surgical Outcomes. Am J Med Qual 2016; 31:415-22. [DOI: 10.1177/1062860615584158] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Jan Karrass
- Vanderbilt University Medical Center, Nashville, TN
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Webb LE, Dmochowski RR, Moore IN, Pichert JW, Catron TF, Troyer M, Martinez W, Cooper WO, Hickson GB. Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals. Jt Comm J Qual Patient Saf 2016; 42:149-64. [PMID: 27025575 DOI: 10.1016/s1553-7250(16)42019-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health care team members are well positioned to observe disrespectful and unsafe conduct-behaviors known to undermine team function. Based on experience in sharing patient complaints with physicians who subsequently achieved decreased complaints and malpractice risk, Vanderbilt University Medical Center developed and assessed the feasibility of the Co-Worker Observation Reporting System(SM) (CORS (SM)) for addressing coworkers' reported concerns. METHODS VUMC leaders used a "Project Bundle" readiness assessment, which entailed identification and development of key people, organizational supports, and systems. Methods involved gaining leadership buy-in, recruiting and training key individuals, aligning the project with organizational values and policies, promoting reporting, monitoring reports, and employing a tiered intervention process to address reported coworker concerns. RESULTS Peer messengers shared coworker reports with the physicians and advanced practice professionals associated with at least one report 84% of the time. Since CORS inception, 3% of the medical staff was associated with a pattern of CORS reports, and 71% of recipients of pattern-related interventions were not named in any subsequent reports in a one-year follow-up period. CONCLUSIONS Systematic monitoring of documented co-worker observations about unprofessional conduct and sharing that information with involved professionals are feasible. Feasibility requires organizationwide implementation; co-workers willing and able to share respectful, nonjudgmental, timely feedback designed initially to encourage self-reflection; and leadership committed to be more directive if needed. Follow-up surveillance indicates that the majority of professionals "self-regulate" after receiving CORS data.
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Affiliation(s)
- Lynn E Webb
- Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA
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Breaking Through Dangerous Silence to Tap an Organization’s Richest Source of Information: Its Own Staff. Jt Comm J Qual Patient Saf 2016; 42:147-8. [DOI: 10.1016/s1553-7250(16)42018-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Grimmer K, Morris J, Kim S, Milanese S, Fletcher W. Physiotherapy Practice: Opportunities for International Collaboration on Workforce Reforms, Policy and Research. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [DOI: 10.1002/pri.1661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/23/2015] [Accepted: 11/24/2015] [Indexed: 11/08/2022]
Affiliation(s)
- K Grimmer
- International Centre for Allied Health Evidence; University of South Australia; Adelaide Australia
| | - J Morris
- University of Canberra; Canberra Australia
| | - S Kim
- Department of Health Sciences; California Baptist University; Riverside CA USA
| | - S Milanese
- International Centre for Allied Health Evidence; University of South Australia; Adelaide Australia
| | - W Fletcher
- Department of Health Sciences; California Baptist University; Riverside CA USA
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Kohanim S, Sternberg P, Karrass J, Cooper WO, Pichert JW. Unsolicited Patient Complaints in Ophthalmology. Ophthalmology 2016; 123:234-241. [DOI: 10.1016/j.ophtha.2015.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022] Open
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Abstract
OBJECTIVE To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. DATA SOURCES/STUDY SETTING Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. STUDY DESIGN/DATA COLLECTION We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. PRINCIPAL FINDINGS First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the public and private sectors in financing PRI and orchestrating an appropriate balance among its four forms. CONCLUSIONS Unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value. Certain policy parameters are already clear, but additional research is required to clarify how best to collect patient narratives in varied settings, how to report narratives to consumers in conjunction with quantified metrics, and how to promote a "culture of learning" at the practice level that incorporates patient feedback.
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Affiliation(s)
- Mark Schlesinger
- Department of Health Policy and ManagementYale University School of Public HealthRoom 304 LEPH 60 College StNew HavenCT 06520
| | - Rachel Grob
- Center for Patient PartnershipsUW Law SchoolUniversity of Wisconsin‐MadisonMadisonWI
- Department of Family MedicineUW Medical SchoolUniversity of Wisconsin‐MadisonMadisonWI
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Posner KL, Severson J, Domino KB. The role of informed consent in patient complaints: Reducing hidden health system costs and improving patient engagement through shared decision making. J Healthc Risk Manag 2015; 35:38-45. [PMID: 26418139 DOI: 10.1002/jhrm.21200] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Patient complaints about physicians are strongly associated with malpractice risk. Physicians at high risk for lawsuits tend to have poor communication skills and are more commonly the subject of patient complaints about communication issues. If a malpractice action does not arise, patient complaints nonetheless represent significant prelitigation transaction costs for the healthcare system that have not been previously quantified. Informed consent complaints represent a unique constellation of clinical communication skills clearly tied to malpractice risk. The goal of this study was to measure institutional resource consumption allocated to informed consent (IC) complaints, which are both costly and preventable. METHODS We compared IC complaints to other complaints about medical care in a single medical center in the United States, estimating the absolute and relative burden of IC deficiencies within this healthcare system. RESULTS Resource consumption for the resolution of IC complaints far exceeded their proportional representation of complaints, representing half of all complaints, while disproportionately absorbing two-thirds of staff time devoted to complaint resolution. CONCLUSIONS Complaint resolution represents an unrecognized remediable cost and an underappreciated opportunity for reducing waste in healthcare. We suggest that healthcare systems can reduce costs and elevate their patient-centered care practices by improving patient-provider communication during medical decision making via engagement strategies such as shared decision making.
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Le Grand Rogers R, Narvaez Y, Venkatesh AK, Fleischman W, Hall MK, Taylor RA, Hersey D, Sette L, Melnick ER. Improving emergency physician performance using audit and feedback: a systematic review. Am J Emerg Med 2015; 33:1505-14. [PMID: 26296903 DOI: 10.1016/j.ajem.2015.07.039] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Audit and feedback can decrease variation and improve the quality of care in a variety of health care settings. There is a growing literature on audit and feedback in the emergency department (ED) setting. Because most studies have been small and not focused on a single clinical process, systematic assessment could determine the effectiveness of audit and feedback interventions in the ED and which specific characteristics improve the quality of emergency care. OBJECTIVE The objective of the study is to assess the effect of audit and feedback on emergency physician performance and identify features critical to success. METHODS We adhered to the PRISMA statement to conduct a systematic review of the literature from January 1994 to January 2014 related to audit and feedback of physicians in the ED. We searched Medline, EMBASE, PsycINFO, and PubMed databases. We included studies that were conducted in the ED and reported quantitative outcomes with interventions using both audit and feedback. For included studies, 2 reviewers independently assessed methodological quality using the validated Downs and Black checklist for nonrandomized studies. Treatment effect and heterogeneity were to be reported via meta-analysis and the I2 inconsistency index. RESULTS The search yielded 4332 articles, all of which underwent title review; 780 abstracts and 131 full-text articles were reviewed. Of these, 24 studies met inclusion criteria with an average Downs and Black score of 15.6 of 30 (range, 6-22). Improved performance was reported in 23 of the 24 studies. Six studies reported sufficient outcome data to conduct summary analysis. Pooled data from studies that included 41,124 patients yielded an average treatment effect among physicians of 36% (SD, 16%) with high heterogeneity (I2=83%). CONCLUSION The literature on audit and feedback in the ED reports positive results for interventions across numerous clinical conditions but without standardized reporting sufficient for meta-analysis. Characteristics of audit and feedback interventions that were used in a majority of studies were feedback that targeted errors of omission and that was explicit with measurable instruction and a plan for change delivered in the clinical setting greater than 1 week after the audited performance using a combination of media and types at both the individual and group levels. Future work should use standardized reporting to identify the specific aspects of audit or feedback that drive effectiveness in the ED.
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Affiliation(s)
- R Le Grand Rogers
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Yizza Narvaez
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT
| | - William Fleischman
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Robert Wood Johnson Clinical Scholar Program, Yale School of Medicine, New Haven, CT
| | - M Kennedy Hall
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Denise Hersey
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT
| | - Lynn Sette
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT
| | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
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Levin CM, Hopkins J. Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient-Centered Representation. Jt Comm J Qual Patient Saf 2014; 40:484-12. [PMID: 26111366 DOI: 10.1016/s1553-7250(14)40063-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A growing body of evidence suggests that patient (including family) feedback can provide compelling opportunities for developing risk management and quality improvement strategies, as well as improving customer satisfaction. The Patient Representative Department (PRD) at Stanford Health Care (SHC) (Stanford, California) created a streamlined patient complaint capture and resolution process to improve the capture of patient complaints and grievances from multiple parts of the organization and manage them in a centralized database. METHODS In March 2008 the PRD rolled out a data management system for tracking patient complaints and generating reports to SHC leadership, and SHC needed to modify and address its data input procedures. A reevaluation of the overall work flow showed it to be complex, with over-lapping and redundant steps, and to lack standard processes and actions. Best-practice changes were implemented: (1) leadership engagement, (2) increased capture of complaints, (3) centralized data and reporting, (4) improved average response times to patient grievances and complaints, and (5) improved service recovery. Standard work flows were created for each category of complaint linked to specific actions. RESULTS Complaints captured increased from 20 to 270 per month. Links to a specific physician rose from 16%-36% to more than 80%. In addition, 68% of high-complaint physicians improved. With improved work flows, responses to patients expressing concerns met a requirement of less than seven days. CONCLUSIONS Standardized work flows for managing complaints and grievances, centralized data management and clear leadership accountability can improve responsiveness to patients, capture incidents more consistently, and meet regulatory and accreditation requirements.
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Affiliation(s)
- Cynthia Mahood Levin
- Executive Programs & Service Quality, Guest Services, Stanford Health Care, Stanford, California, USA
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Martinez W, Pichert JW, Hickson GB, Cooper WO. Editorial: Programs for Promoting Professionalism: Questions to Guide Next Steps. Jt Comm J Qual Patient Saf 2014; 40:159-60. [DOI: 10.1016/s1553-7250(14)40020-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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