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Li D, Hu Y, Chen H, Zhu X, Wu X, Li J, Zhang Z, Liu S. Identifying the Subtypes and Characteristics of Mental Workload Among Chinese Physicians in Outpatient Practice: A Latent Profile Analysis. Front Public Health 2021; 9:779262. [PMID: 34900919 PMCID: PMC8653799 DOI: 10.3389/fpubh.2021.779262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: The purpose of this study is to investigate the mental workload level of physicians in outpatient practice since the normalization of prevention and control of the COVID-19 pandemic in China and explore the subtypes of physicians regarding their mental workload. Methods: A cross-sectional survey of 1,934 physicians primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China was conducted from November 2020 to February 2021. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of physician mental workload scale developed by our research team. Chi-square tests were performed to explore the differences in demographic characteristics of the subtypes among the subgroups, and multinomial logistic regression analysis was further conducted to identify the determinants of the subtypes of physicians. Results: Overall, the participating physicians reported high levels of task load but with high self-assessed performance (68.01 ± 14.25) while performing communication work tasks characterized by direct patient interaction in outpatient clinics. About 33.8% of the participating physicians were identified as “high workload and high self-assessment” subtype, compared to 49.7% “medium workload and medium self-assessment” subtype and 16.4% “low workload and low self-assessment” subtype. Physicians in “high workload and high self-assessment” subtype had the highest mean mental workload score. Physicians who were female, younger, married, worse health status, those who had lower educational level and an average monthly income of 5,001–10,000 RMB, those who worked in tertiary A hospitals, more hours per week and more than 40 h per week in outpatient clinics, and those who saw more outpatients per day, and spent more time per patient but with higher outpatient satisfaction were more likely to belong to “high workload and high self-assessment” subtype. Conclusion: Our findings can help provide a solid foundation for developing targeted interventions for individual differences across physicians regarding their mental workload. We suggest the hospital managers should pay more attention to those physicians with characteristics of the “high workload and high self-assessment” subtype and strengthen the management of the workload of this subtype of physicians to reduce the risks of their mental health, and to maintain their high work performance in outpatient clinics.
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Affiliation(s)
- Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ximin Zhu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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[Critical Incident Reporting on medication errors regarding units of measurement and calculations]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 158-159:54-61. [PMID: 33243592 DOI: 10.1016/j.zefq.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Medication safety is an important hot spot of patient safety. This fact prompted the Swiss Patient Safety Foundation to conduct its annual CIRRNET (Critical Incident Reporting & Reacting NETwork) reporting month on the topic of "Units of measurement of medicines and calculation errors in prescription/dispensing (mg, g, mmol etc.)". METHODS During the CIRRNET reporting month 2018, the CIRS (Critical Incident Reporting System) managers of the health institutions participating in CIRRNET forwarded all incident reports on the topic to the CIRRNET database. The archive was also searched for usable reports on the same topic. The reports were analysed according to the type of medication involved (type of application and medication class according to ATC codes), the process stage affected (prescription, preparation, administration and documentation) and the error category. RESULTS Of the 110 reports analysed, 27 reports originated directly from the reporting month, 83 reports were additionally extracted from the archive. 67 reports (60 %) concerned intravenously administered medications and analgesics (opioids and non-opioids, such as NSAIDs) were the most frequently affected/involved medication class with 21 reports (18 %). The process step preparation/calculation was the one where most of the errors analysed occurred. With a total of 48 reports (44 %), most of the errors analysed were classified here. Regarding error categories, it becomes apparent that the categories "Derivation of the amount to be administered (volume/number of single doses) from strength or concentration" with 33 (30 %), "Unit of measurement ml - mg" with 20 (18 %) and "Dose/volume per time" with 14 reports (13 %) were reported most frequently. CONCLUSION Errors concerning units of measurement or the calculation of medication have been numerously reported by the CIRRNET institutions. Often, these were cases in which, for example, the volume of a drug to be administered was derived incorrectly. Such calculations are demanding, prone to error and represent a system problem. Therefore, good solution strategies need to be implemented in order to sustainably improve medication safety and thus patient safety.
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Berlanda S, de Cordova F, Fraizzoli M, Pedrazza M. Risk and Protective Factors of Well-Being among Healthcare Staff. A Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6651. [PMID: 32932588 PMCID: PMC7558609 DOI: 10.3390/ijerph17186651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 12/04/2022]
Abstract
The purpose of this study was to identify physical and psychosocial working conditions to improve well-being at work among healthcare staff. This is a potent area of inquiry given the relationship between healthcare staff well-being and service quality and other key organizational characteristics. However, while numerous studies in this area have used a quantitative methodology, very few have applied qualitative methodologies gathering subjective descriptions of the sources of well-being, providing in so doing significant data to explore in depth the factors that influence well-being in healthcare systems. We gathered qualitative data analyzing open-ended questions about risk and protective factors of well-being at work. The sample was made of 795 professionals answering an online questionnaire. Answers were coded and analyzed using the thematic analysis with an inductive approach (data-driven). We identified four themes strongly affecting professional well-being in health-care staff: Interactions, Working Conditions, Emotional Responses to Work, and Competence and Professional Growth. Our findings suggest possible strategies and actions that may be effective in helping to calibrate case-specific support and monitoring interventions to improve health and well-being of healthcare staff. We also discuss the implications of the study and suggest possible avenues for future empirical research.
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Affiliation(s)
- Sabrina Berlanda
- Department of Human Sciences, University of Verona, 37129 Verona, Italy; (F.d.C.); (M.F.); (M.P.)
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Tran T, Johnson DF, Balassone J, Tanner F, Chan V, Garrett K. Effect of an integrated clinical pharmacy service with the general medical units on patient flow and medical staff satisfaction: a pre‐ and postintervention study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Tim Tran
- Pharmacy Department Austin Health Melbourne Australia
- Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Douglas Forsyth Johnson
- Department of General Medicine Austin Health Melbourne Australia
- Department of Medicine Austin Health The University of Melbourne Melbourne Australia
| | | | | | - Vincent Chan
- Pharmacy Department Austin Health Melbourne Australia
- Discipline of Pharmacy School of Health and Biomedical Sciences RMIT University Bundoora, Melbourne Australia
| | - Kent Garrett
- Pharmacy Department Austin Health Melbourne Australia
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Teoh K, Hassard J, Cox T. Doctors’ perceived working conditions and the quality of patient care: a systematic review. WORK AND STRESS 2019. [DOI: 10.1080/02678373.2019.1598514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kevin Teoh
- The Department of Organizational Psychology, Birkbeck University of London, London, UK
- The Centre for Sustainable Working Life, Birkbeck University of London, London, UK
| | - Juliet Hassard
- The Centre for Sustainable Working Life, Birkbeck University of London, London, UK
- Centre for Organizational Health and Development, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Cox
- The Centre for Sustainable Working Life, Birkbeck University of London, London, UK
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Dunstan E, Coyer F. Safety culture in two metropolitan Australian tertiary hospital intensive care units: A cross-sectional survey. Aust Crit Care 2019; 33:4-11. [PMID: 30660433 DOI: 10.1016/j.aucc.2018.11.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Safety culture is significant in the complex intensive care environment, where the consequences of human error can be catastrophic. Research within Australian intensive care units has been limited and little is understood about the safety culture of intensive care units in Queensland. AIM The aim was to evaluate and compare safety culture in the intensive care units of two metropolitan tertiary hospitals in Queensland. METHOD A cross-sectional survey, Safety Attitudes Questionnaire, was administered to all medical, nursing and allied health professionals in the research sites (A and B) during January and February 2016. Data were collated into six safety culture domains of teamwork climate, safety climate, job satisfaction, stress recognition, working conditions and perceptions of management. Comparison was made using t-tests and between demographic groups using generalising estimating equations. RESULTS In total, 206 surveys were returned from 522 staff (39.5% response rate). The majority of respondents were nurses (80.6%). Site B scored all domains of the safety attitudes questionnaire significantly higher than Site A (p < 0.001). The scores for both site A and B were significantly higher in all domains (p < 0.001) than a previous Australian study conducted in 2013. Both sites returned low scores in the stress recognition domain. Medical staff perceived the teamwork climate as more positive than nursing staff (mean difference 16.6 [Wald χ2 = 10383.8, p < 0.001]). Allied health professionals reported poorer perceptions of working conditions than medical staff (mean difference 7.8 [Wald χ2 = 775.4, p < 0.001]). CONCLUSION Despite similar governance and external structures, differences were found in safety culture between the two research sites. This finding emphasises the importance of local, unit-level assessment of safety culture and planning of improvement strategies. This study adds to the evidence and implications for critical care clinical practice that these interventions need to be unit focused, supported by management and multidisciplinary in approach.
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Affiliation(s)
- Elspeth Dunstan
- Clinical Nurse, Intensive Care Unit, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD, Australia.
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Metro North Health Service District, Queensland, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom.
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Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, Chew-Graham C, Peters D, Hodkinson A, Riley R, Esmail A. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:1317-1331. [PMID: 30193239 PMCID: PMC6233757 DOI: 10.1001/jamainternmed.2018.3713] [Citation(s) in RCA: 572] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified. OBJECTIVE To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction. DATA SOURCES MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched. STUDY SELECTION Quantitative observational studies. DATA EXTRACTION AND SYNTHESIS Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed. MAIN OUTCOMES AND MEASURES The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs. RESULTS Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007). CONCLUSIONS AND RELEVANCE This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.
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Affiliation(s)
- Maria Panagioti
- National Institute for Health Research (NIHR) School for Primary Care Research, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Keith Geraghty
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Judith Johnson
- Bradford Institute for Health Research, University of Leeds, Leeds, United Kingdom
| | - Anli Zhou
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom
| | - David Peters
- Westminster Centre for Resilience, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - Alexander Hodkinson
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Ruth Riley
- Institute of Applied Health Research College of Medical and Dental Sciences, Murray Learning Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Aneez Esmail
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Chaos in the Clinic: Characteristics and Consequences of Practices Perceived as Chaotic. J Healthc Qual 2017; 39:43-53. [DOI: 10.1097/jhq.0000000000000016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLoS One 2016; 11:e0159015. [PMID: 27391946 PMCID: PMC4938539 DOI: 10.1371/journal.pone.0159015] [Citation(s) in RCA: 796] [Impact Index Per Article: 99.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/24/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety. DESIGN Systematic research review. DATA SOURCES PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. RESULTS Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. CONCLUSIONS Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. IMPLICATIONS This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42015023340.
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Abstract
Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.
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Affiliation(s)
- Karen H. Frith
- Karen H. Frith is Professor, College of Nursing, University of Alabama in Huntsville, 301 Sparkman Dr, Huntsville, AL 35899
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