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Broch Porcar MJ, Castellanos-Ortega Á. Patient safety, what does clinical simulation and teaching innovation contribute? Med Intensiva 2024:S2173-5727(24)00101-2. [PMID: 38797620 DOI: 10.1016/j.medine.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/24/2024] [Indexed: 05/29/2024]
Abstract
Clinical simulation in Intensive Care Medicine is a crucial tool to strengthen patient safety. It focuses on the complexity of the Intensive Care Unit, where challenging clinical situations require rapid decision making and the use of invasive techniques that can increase the risk of errors and compromise safety. Clinical simulation, by mimicking clinical contexts, is presented as essential for developing technical and non-technical skills and enhancing teamwork in a safe environment, without harm to the patient. in situ simulation is a valuable approach to practice in realistic environments and to address latent security threats. Other simulation methods as virtual reality and tele-simulation are gaining more and more acceptance. Herein, we provide current data on the clinical utility of clinical simulation related to improved safety in the practice of techniques and procedures, as well as improvements of teamwork performance and outcomes. Finally, we propose the needs for future research.
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Renouard F, Renouard E, Rendón A, Pinsky HM. Increasing the margin of patient safety for periodontal and implant treatments: The role of human factors. Periodontol 2000 2023; 92:382-398. [PMID: 37183608 DOI: 10.1111/prd.12488] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/06/2023] [Accepted: 04/02/2023] [Indexed: 05/16/2023]
Abstract
Early complications following periodontal and dental implant surgeries are typically attributed to technique or poor biological response, ignoring the possibility of the human element. Interestingly, significant experience is not correlated with increased success, whereas evidence supports the impact of clinical behavior on patient outcome. This is the result of errors, much like those scrutinized in other high-risk technical fields, such as aviation. What can be surprising is that those who make these errors are very well acquainted with best practices. Given this, how is it possible for the conscientious practitioner to fail to apply protocols that are nonetheless very well known? Recently, the concepts of human and organizational factors have been translated to medicine, though dentistry has been slow to recognize their potential benefit. This review lists specific human factor behaviors, such as use of checklists and crew resource management, which might improve postsurgical outcome.
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Affiliation(s)
| | - Erell Renouard
- Intercampus Affairs, Assistant Dean, Sciences Po, Paris, France
| | - Alexandra Rendón
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Harold M Pinsky
- DDS Private Practice, Airline Transport Pilot, Lead Line Check Pilot Airbus A-330, Michigan, Ann Arbor, USA
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Mindset and Reflection—How to Sustainably Improve Intra- and Interpersonal Competences in Medical Education. Healthcare (Basel) 2023; 11:healthcare11060859. [PMID: 36981516 PMCID: PMC10048539 DOI: 10.3390/healthcare11060859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Intra- and interpersonal competences (IICs) are essential for medical expertise. However, the effects of current medical curricula seem to not be sustainable enough, even though poorly trained IICs have negative effects on medical practice. A defensive attitude towards openly addressing personal–professional challenges seems to hinder a sustainable implementation of IICs training. Therefore, this study asks about the changeability of IICs and target factors of their implementation in medical education. The aim was to detect factors for the sustainable implementation of IICs in medical education from medical and non-medical perspectives. For this purpose, a total of 21 experts were interviewed. The interview material was analysed according to grounded theory principles to generate core categories to answer the research questions. As a first result, analysis revealed that IICs are changeable and developable, not in all, but in many students. It also showed four central prerequisites for successful implementation: the longitudinal integration of reflection and feedback in medical education and practice; a clear framework and individual path of education; the students’ mindset to develop themselves on a personal level; as well as the superiors’ mindset to openly deal with personal challenges in low hierarchies. Contrasting Carol Dweck’s mindset concept with our findings supports our theory that the development of a mindset which allows an open approach to personal deficits and challenges seems to be of central importance for both students and teachers. Two key factors in this process might be teaching about the impact of mindsets on learning and the willingness of superiors to openly address their personal challenges. To improve IICs in medical professionals, it seems helpful to pay more attention to the development of mindsets. Educating teachers and superiors about targeting factors could be a feasible direction for sustainable implementation.
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Buljac-Samardžić M, Dekker-van Doorn CM, Maynard MT. What Do We Really Know About Crew Resource Management in Healthcare?: An Umbrella Review on Crew Resource Management and Its Effectiveness. J Patient Saf 2021; 17:e929-e958. [PMID: 34852415 PMCID: PMC8612906 DOI: 10.1097/pts.0000000000000816] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this article was to present an overview of the crew resource management (CRM) literature in healthcare. The first aim was to conduct an umbrella review on CRM literature reviews. The second aim was to conduct a new literature review that aims to address the gaps that were identified through the umbrella review. METHODS First, we conducted an umbrella review to identify all reviews that have focused on CRM within the healthcare context. This step resulted in 16 literature reviews. Second, we conducted a comprehensive literature review that resulted in 106 articles. RESULTS The 16 literature reviews showed a high level of heterogeneity, which resulted in discussing 3 ambiguities: definition, outcome, and information ambiguity. As a result of these ambiguities, a new comprehensive review of the CRM literature was conducted. This review showed that CRM seems to have a positive effect on outcomes at Kirkpatrick's level 1, 2, and 3. In contrast, whether CRM has a positive effect on level 4 outcomes and how level 4 should be measured remains undetermined. Recommendations on how to implement and embed CRM training into an organization to achieve the desired effects have not been adequately considered. CONCLUSIONS The extensive nature of this review demonstrates the popularity of CRM in healthcare, but at the same time, it highlights that research tends to be situated within certain settings, focuses on particular outcomes, and has failed to address the full scope of CRM as a team intervention and a management concept.
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Affiliation(s)
| | | | - M. Travis Maynard
- Department of Management, College of Business, Colorado State University, Fort Collins, Colorado
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Davis AS, Kafka AM, González-Morales MG, Feitosa J. Team Belonging: Integrating Teamwork and Diversity Training Through Emotions. SMALL GROUP RESEARCH 2021. [DOI: 10.1177/10464964211044813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the worldwide focus shifting toward important questions of what diversity means to society, organizations are attempting to keep up with employees’ needs to feel recognized and belong. Given that traditionally team and diversity trainings are provided separately, with different theoretical backgrounds and goals, they are often misaligned and ineffective. We review 339 empirical articles depicting a team, diversity, or emotional management training to extract themes and determine which methods are most effective. Although research has demonstrated the importance of belonging for providing positive workplace outcomes, we found that the traditional design of these trainings and lack of emotional management prevent a balance between team and diversity goals, preventing belonging. We propose an integrative training with emotional management to help teams foster optimal belonging, where members can unite together through their differences. Accordingly, our themes inform this training model that can inspire future research into more effective training.
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Misamer M, Flentje M, Stötefalke A, Eismann H. Usage of power by different types of trainers in the education of paramedics - evaluation by means of a validated questionnaire. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc105. [PMID: 34651063 PMCID: PMC8493839 DOI: 10.3205/zma001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/17/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
Objective: Emergency medical services are characterized by a high pressure to act. Dealing with trainees is a challenge. It is known, that the use of power in education subsists: power can be applied in a participative and restrictive way. We investigated the transferability of existing scales to the education system of Emergency medical service trainees. We hypothesized: a restrictive (a) and participative (b) use of power, can be demonstrated in Emergency medical service training, (c) the use of power by educators, who are responsible for theoretical learning, and instructors, who accompany trainees in real-life emergencies, are different and (d) the assessed participatory and restrictive use of power by trainers is negatively correlated. Methods: In a cross-sectional study, 206 trainees of Emergency medical service schools completed a questionnaire. The survey consists of 35 power related items regarding medical educators and practical instructors. Differences in the dimensions of power application were tested. The effect size and the correlation between power dimension were calculated. Results: The reliability of the scales was .92 (practical instructor) and .89 (medical educator) by removing one item. All subscales showed values with higher Cronbach's alpha than .68. Application of participative power differs (p<.00) between practical instructors (mean 64.7; SD 20.3) and medical educators (mean 55.3; SD 17.8). The participatory and the restrictive use of power correlated for medical educators significant negatively (r=-.48; p<.01). Conclusion: In both educator and instructor groups the use of participative power had a greater agreement that the use of restrictive techniques. The practical instructors used participative power slightly more often that did educators due to the dependency on the trainee as a team member. The context of the scales partially overlaps with other descriptions such as leadership and instructor quality.
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Affiliation(s)
- Melanie Misamer
- Hochschule für Angewandte Wissenschaft und Kunst, Göttingen, Germany
| | - Markus Flentje
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | | | - Hendrik Eismann
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
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Casali G, Lock G, Novoa NM. Teaching non-technical skills: the patient centered approach. J Thorac Dis 2021; 13:2044-2053. [PMID: 33841993 PMCID: PMC8024801 DOI: 10.21037/jtd.2019.01.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/14/2019] [Indexed: 12/02/2022]
Abstract
The surgical setting is a highly complex environment where, in ideal conditions, everything should be under control to ensure a positive outcome. However, the existing complexity opens the possibility for multiple failures along the process and many of those failures are related to what is call the non-technical skills of the members of the team. We cannot eradicate human error, but we can try to avoid future mistakes in our daily practice introducing the awareness for providing a high-quality care in which patient safety is crucial. This paper presents an easy approach to concepts and teaching possibilities of those non-technical skills.
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Affiliation(s)
- Gianluca Casali
- Thoracic Surgery, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - Gareth Lock
- Human in the System Consulting Limited, Malmesbury, UK
| | - Nuria M. Novoa
- Service of Thoracic Surgery, University Hospital of Salamanca, Salamanca, Spain
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Flentje M, Friedrich L, Eismann H, Koppert W, Ruschulte H. Expectations, training and evaluation of intensive care staff to an interprofessional simulation course in Germany - Development of a relevant training concept. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc9. [PMID: 32270023 PMCID: PMC7105761 DOI: 10.3205/zma001302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/11/2019] [Accepted: 12/16/2019] [Indexed: 06/11/2023]
Abstract
Objective: Increasingly, intensive care units (ICU) are operated by teams of physicians and nurses with specialist training in anaesthesia and intensive care. The aims of our study were to evaluate any prior experience, expectations and the requisites for interprofessional ICU simulation-based training (SBT), and to evaluate a newly designed training course incorporating these findings. Methods: The study was laid out as a cross-sectional study and is projected in three steps. First, questionnaires were sent out to ICU nurses and physicians from 15 different hospitals in a greater metropolitan area (> million citizens). Based upon this survey a one-day ICU simulator course designed for 12 participants (6 nurses and 6 physicians) was developed, with evaluation data from four subsequent courses being analysed. Results: In the survey 40% of nurses and 57% of the physicians had had prior exposure to SBT. Various course formats were explored with respect to duration, day of the week, and group composition. After completing the course, the majority deemed a full working day in interprofessional setting to be most appropriate (p<0.001). The scenarios were considered relevant and had a positive impact on communication, workflow and coping with stress. Conclusion: Currently SBT is not a mainstream tool used by German ICU teams for further education, and this lack of familiarity must be taken into consideration when preparing SBT courses for them. We developed a nontechnical skills training course for ICU teams which was undertaken in the setting of simulated clinical scenarios (pertinent to their work environment). The participants found the course's content to be relevant for their daily work, rated the course's impact on their workplace practices as being good and advocated for longer training sessions.
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Affiliation(s)
- Markus Flentje
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - Lars Friedrich
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - Hendrik Eismann
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - Wolfgang Koppert
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - Heiner Ruschulte
- Sana Klinikum Hameln-Pyrmont, Anaesthesia and Intensive Care Medicine, Hameln, Germany
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Li E, Nash D. The Gift of Fine China: An Appropriate 20th Anniversary Look Back. Am J Med Qual 2019; 34:425-429. [DOI: 10.1177/1062860619865143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erica Li
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - David Nash
- Jefferson College of Population Health, Philadelphia, PA
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Interventions to Reduce Burnout and Improve Resilience: Impact on a Health System’s Outcomes. Clin Obstet Gynecol 2019; 62:432-443. [DOI: 10.1097/grf.0000000000000458] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Team Resource Management Perception Under Managerial Coaching Skills and Organizational Climate: Cross-Level Analysis in Taiwan's Hospitals. Health Care Manag (Frederick) 2019; 38:228-238. [PMID: 31261192 DOI: 10.1097/hcm.0000000000000266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is growing recognition of the importance of teamwork and integration of resources in the health care industry. This article studied the influence of organizational climate and managerial coaching skills on team perception of team resource management (TRM) and coaching techniques in selected hospitals in Taiwan. Structural survey method was used to measure the relationship between organizational climate, managerial coaching skills, and team perception of TRM. The participants of this research were 530 administrative staff from 12 hospitals in Taiwan. Cross-level relationship between organizational climate (group level), managerial coaching skills (individual level), and team perception of TRM (individual level) was examined. The results revealed that organizational climate had a significant influence on team perception of TRM. Second, recognition of managerial coaching skills shaped team perception during TRM implementation. Third, organizational climate had a moderating effect on the relationship between managerial coaching skills and team perception of TRM. The study concluded that positive organizational climate and good managerial coaching skills contribute to effective team management and development. Thus, it is important for health care organizations to understand the importance of coaching and mentoring and create a workplace that makes learning, growth, and adaptation possible across different departments and functional teams.
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Casali G, Cullen W, Lock G. The rise of human factors: optimising performance of individuals and teams to improve patients' outcomes. J Thorac Dis 2019; 11:S998-S1008. [PMID: 31183182 DOI: 10.21037/jtd.2019.03.50] [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] [Indexed: 11/06/2022]
Abstract
The improvement of surgical outcomes has been achieved working under the assumption that they are mainly the result of technical skills. This model, although correct, is not exhaustive and has left out many variables that affect outcomes, of which a number can be grouped under the label of non-technical skills, which is a subset of human factors. Non-technical skills are developed to facilitate a shared mental model between team members, teams and their operational environment. They include situation awareness, decision-making, communication, teamwork, leadership and performance-shaping factors. The importance of these non-technical skills has been highlighted during the investigations of severe accidents in many high-risk industries and healthcare. There is an almost untapped opportunity to improve outcomes focusing on non-technical skills because until recently there has been an under-investment of time and resources in this area compared with technical skills. This theoretical paper supports the adoption of a broader model of human performance as a function of technical and non-technical skills and the cultural and organisational context where these are at play. We also aim to highlight a pathway to increase the investment in non-technical skills following the most updated evidence.
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Affiliation(s)
- Gianluca Casali
- Thoracic Surgery, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - William Cullen
- Thoracic Surgery, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - Gareth Lock
- Human in the System Consulting Limited, Malmesbury, UK
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Gross B, Rusin L, Kiesewetter J, Zottmann JM, Fischer MR, Prückner S, Zech A. Crew resource management training in healthcare: a systematic review of intervention design, training conditions and evaluation. BMJ Open 2019; 9:e025247. [PMID: 30826798 PMCID: PMC6410092 DOI: 10.1136/bmjopen-2018-025247] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Crew resource management (CRM) training formats have become a popular method to increase patient safety by consideration of the role that human factors play in healthcare delivery. The purposes of this review were to identify what is subsumed under the label of CRM in a healthcare context and to determine how such training is delivered and evaluated. DESIGN Systematic review of published literature. DATA SOURCES PubMed, PsycINFO and ERIC were searched through 8 October 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Individually constructed interventions for healthcare staff that were labelled as CRM training, or described as based on CRM principles or on aviation-derived human factors training. Only studies reporting both an intervention and results were included. DATA EXTRACTION AND SYNTHESIS The studies were examined and coded for relevant passages. Characteristics regarding intervention design, training conditions and evaluation methods were analysed and summarised both qualitatively and quantitatively. RESULTS Sixty-one interventions were included. 48% did not explain any keyword of their CRM intervention to a reproducible detail. Operating room teams and surgery, emergency medicine, intensive care unit staff and anaesthesiology came in contact most with a majority of the CRM interventions delivered in a 1-day or half-day format. Trainer qualification is reported seldomly. Evaluation methods and levels display strong variation. CONCLUSIONS Critical topics were identified for the CRM training community and include the following: the need to agree on common terms and definitions for CRM in healthcare, standards of good practice for reporting CRM interventions and their effects, as well as the need for more research to establish non-educational criteria for success in the implementation of CRM in healthcare organisations.
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Affiliation(s)
- Benedict Gross
- Institute for Emergency Medicine and Management in Medicine, University Hospital LMU Munich, Munich, Germany
| | - Leonie Rusin
- Institute for Emergency Medicine and Management in Medicine, University Hospital LMU Munich, Munich, Germany
| | - Jan Kiesewetter
- Institute for Medical Education, University Hospital LMU Munich, Munich, Germany
| | - Jan M Zottmann
- Institute for Medical Education, University Hospital LMU Munich, Munich, Germany
| | - Martin R Fischer
- Institute for Medical Education, University Hospital LMU Munich, Munich, Germany
| | - Stephan Prückner
- Institute for Emergency Medicine and Management in Medicine, University Hospital LMU Munich, Munich, Germany
| | - Alexandra Zech
- Institute for Emergency Medicine and Management in Medicine, University Hospital LMU Munich, Munich, Germany
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Emergency response teams in and outside of medicine-structurally crafted to be worlds apart. J Trauma Acute Care Surg 2018; 86:134-140. [PMID: 30247442 DOI: 10.1097/ta.0000000000002073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medical emergency response teams (MERTs) are widespread throughout inpatient hospital care facilities. Besides the rise of the ubiquitous rapid response team, current MERTs span trauma, stroke, myocardial infarction, and sepsis in many hospitals. Given the multiplicity of teams with widely varying membership, leadership, and functionality, the structure of MERTs is appropriate to review to determine opportunities for improvement. Since nonmedical ERTs predate MERT genesis and are similar across multiple disciplines, nonmedical ERTs provide a standard against which to compare and review MERT design and function.Nonmedical ERTs are crafted to leverage team members who are fully trained and dedicated to that domain, whose skills are regularly updated, with leadership tied to unique skill sets rather than based on hierarchical rank; activity is immediately reviewed at the conclusion of each deployment and teams continue to work together between team deployments. Medical emergency response teams, in sharp contradistinction, often incorporate trainees into teams that do not train together, are not focused on the discipline required to be leveraged, are led based on arrival time or hierarchy, and are usually reviewed at a time remote from team action; teams rapidly disperse after each activity and generally do not continue to work together in between team activations. These differences between ERTs and MERTs may impede MERT success with regard to morbidity and mortality mitigation. Readily deployable approaches to bridge identified gaps include dedicated Advanced Practice Provider (APP) team leadership, reductions in trainee MERT leadership while preserving participation, discipline-dedicated rescue teams, and interteam integration training.Emergency response teams in medical and nonmedical domains share parallels yet lack congruency in structure, function, membership, roles, and performance evaluation. Medical emergency response team structural redesign may be warranted to embrace the beneficial elements of nonmedical ERTs to improve patient outcome and reduce variation in rescue practices and team functionality.
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Tschannen D, Dorn R, Tedesco C. Improving knowledge and behavior of leadership and followership among the interprofessional team. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:182-188. [PMID: 29965798 PMCID: PMC6129167 DOI: 10.5116/ijme.5b30.9a84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine virtual training on Crew Resource Management (CRM) principles of effective leadership and followership on participants' knowledge, applicability, and intended behaviors. METHODS Graduate students (n=41) from four health disciplines participated in the training, which included a self-learning module (e.g., didactic content and video vignettes) and an optional virtual simulation exercise. Knowledge was examined via a 10-item pre/post knowledge test. Applicability of the training and intended behaviors was measured post-training via an 11-item survey. T-test and Analysis of variance were applied to compare knowledge scores, as well as to determine variation in discipline responses. RESULTS Knowledge improved significantly post-training (t(40)=10.47, p<0.001). Pharmacy students scored significantly lower on the post-knowledge test than medicine and nursing students [F(2,36)=5.99, p=0.006]. On average, participants completing the module reported learning new skills and knowledge (M=4.17, SD=0.54) and intended to use skills/knowledge gained from the training in clinical practice (M=4.29, SD=0.56). No differences were noted among responses from the various disciplines. Those completing the simulation exercise (n=10) found value in the experience, again noting strong application to practice (M=4.9, SD=0.32) and intended use in practice (M=4.9, SD=0.32). CONCLUSIONS The CRM training was valuable and applicable to practice. Use of a virtual platform may provide an avenue for minimizing current barriers to successful interprofessional education by allowing participants to connect in various geographical locations. The module is ready for widespread use in health professional education.
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Raheem S, Ahmed YE, Hussein AA, Johnson A, Cavuoto L, May P, Cole A, Wang D, Ahmad B, Hasasneh A, Guru KA. Variability and interpretation of communication taxonomy during robot-assisted surgery: do we all speak the same language? BJU Int 2018; 122:99-105. [DOI: 10.1111/bju.14150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Sana Raheem
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Youssef E. Ahmed
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Ahmed A. Hussein
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
- Department of Urology; Cairo University; Cairo Egypt
| | - Amanda Johnson
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
- Department of Industrial Engineering; University at Buffalo; Buffalo NY USA
| | - Lora Cavuoto
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
- Department of Industrial Engineering; University at Buffalo; Buffalo NY USA
| | - Paul May
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Adam Cole
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Derek Wang
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Basim Ahmad
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Adam Hasasneh
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Khurshid A. Guru
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
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Moffatt-Bruce S, Clark S, DiMaio M, Fann J. Leadership Oversight for Patient Safety Programs: An Essential Element. Ann Thorac Surg 2018; 105:351-356. [DOI: 10.1016/j.athoracsur.2017.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
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Moffatt-Bruce S, Huerta T, Gaughan A, McAlearney AS. IDEA4PS: The Development of a Research-Oriented Learning Healthcare System. Am J Med Qual 2018; 33:420-425. [PMID: 29310442 DOI: 10.1177/1062860617751044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Leveraging opportunities to learn and then improve the delivery of care using experiences throughout the health care system is essential in efforts to transform health care delivery. The authors present the approach of one academic medical center in becoming a research-oriented Learning Healthcare System (ro-LHS). By reframing the role of research in improving outcomes, the organization was able to move beyond its focus on quality improvement to foster a culture in which feedback informs practice and research drives improvement. The patient safety learning laboratory, the Institute for the Design of Environments Aligned for Patient Safety, funded by the Agency for Healthcare Research and Quality, has provided foundational infrastructure to connect stakeholders across the medical center and university and conduct rigorous research in the context of practice. With this new focus, research now informs operations in a cycle of continuous improvement across the authors' ro-LHS.
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The Role of Checklists and Human Factors for Improved Patient Safety in Plastic Surgery. Plast Reconstr Surg 2017; 140:812e-817e. [PMID: 29176419 DOI: 10.1097/prs.0000000000003892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying the article, participants should be able to: 1. Describe the role of human factors and nontechnical skills for patient safety and recognize the need for customization of surgical checklists. 2. Apply encouragement to speaking up and understand the importance of patient involvement for patient safety. 3. Recognize the potential for improvement regarding patient safety in their own environment and take a leading role in the patient safety process. 4. Assess their own safety status and develop measures to avoid unnecessary distraction in the operating room. SUMMARY Over the past 20 years, there has been increased attention to improving all aspects of patient safety and, in particular, the important role of checklists and human factors. This article gives a condensed overview of selected aspects of patient safety and aims to raise the awareness of the reader and encourage further study of referenced literature, with the goal of increased knowledge and use of proven safety methods. The CME questions should help indicate where there is still potential for improvement in patient safety, namely, in the field of nontechnical skills.
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Seemann R, Münzberg M, Stange R, Rüsseler M, Egerth M, Kladny B, Hoffmann R, Mutschler M. Verbesserte interpersonelle Kompetenzen erhöhen Patientensicherheit und bewirken Effizienzsteigerung und Kostensenkung. MANUELLE MEDIZIN 2017. [DOI: 10.1007/s00337-017-0325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schwartz ME, Welsh DE, Paull DE, Knowles RS, DeLeeuw LD, Hemphill RR, Essen KE, Sculli GL. The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities. J Healthc Risk Manag 2017; 38:17-37. [PMID: 29120515 DOI: 10.1002/jhrm.21292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Communication failure is a significant source of adverse events in health care and a leading root cause of sentinel events reported to the Joint Commission. The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT) as a comprehensive program to enhance patient safety and to improve communication and teamwork among health care professionals. CTT is based on techniques used in aviation's Crew Resource Management (CRM) training. The aviation industry has reached a significant safety record in large part related to the culture change generated by CRM and sustained by its recurrent implementation. This article focuses on the improvement of communication, teamwork, and patient safety by utilizing a standardized, CRM-based, interprofessional, immersive training in diverse clinical areas. The Teamwork and Safety Climate Questionnaire was used to evaluate safety climate before and after CTT. The scores for all of the 27 questions on the questionnaire showed an increase from baseline to 12 months, and 11 of those increases were statistically significant. A recurrent training is recommended to maintain the positive outcomes. CTT enhances patient safety and reduces risk of patient harm by improving teamwork and facilitating clear, concise, specific and timely communication among health care professionals.
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Affiliation(s)
- Miriam E Schwartz
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI.,Greater Los Angeles Veterans Affairs (VA) Healthcare System, Los Angeles, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Deborah E Welsh
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Douglas E Paull
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI.,University of Michigan, Ann Arbor, MI.,Georgetown University School of Medicine, Washington, D.C
| | - Regina S Knowles
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Lori D DeLeeuw
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Robin R Hemphill
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Keith E Essen
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Gary L Sculli
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
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Tschannen D. Development of a Virtual Crew Resource Management Training Program to Improve Communication. J Contin Educ Nurs 2017; 48:525-532. [PMID: 29083461 DOI: 10.3928/00220124-20171017-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022]
Abstract
Crew Resource Management (CRM), a method focused on the management of human error and risk reduction, has shown promise in reducing communication failure in health care. The purpose of this project was to develop a virtual training program in CRM principles of effective leadership and followership, and evaluate the applicability to nurses working in the hospital setting. The intervention included the development of a virtual CRM training program consisting of a self-learning module and virtual simulation. Beta testing of the module was conducted by six nurses, followed by an evaluation of the training program by nurses (n = 5) in a general medicine department. Nurses reported the overall program to be worthwhile (X̄= 5; SD = 0.5), with great applicability to nursing care (X̄= 4.5, SD = 0.5). Nurses completing the simulation activity reported strong agreement to CRM applicability and training effectiveness. The CRM training module proved to be applicable to nursing care and is ready for widespread use to improve patient care and communication. J Contin Educ Nurs. 2017;48(11):525-532.
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St Pierre M, Gall C, Breuer G, Schüttler J. [Does annual simulation training influence the safety climate of a university hospital? : Prospective 5‑year investigation using dimensions of the safety attitude questionnaire]. Anaesthesist 2017; 66:910-923. [PMID: 28971216 DOI: 10.1007/s00101-017-0371-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simulation-based training with a focus on non-technical skills can have a positive influence on safety relevant attitudes of participants. If an organization succeeds in training sufficient staff, it may experience a positive change in the safety climate. As the effects of a single training are of a transient nature, annual training sessions may lead to an incremental improvement of safety relevant attitudes of employees over time. In spring 2012 the Department of Anesthesia at the University Hospital of Erlangen established an annual simulation-based training for staff members (e.g. consultants, trainee anesthetists and nurse anesthetists). OBJECTIVE The study aimed to test whether an annual simulation-based training would result in an incremental longitudinal improvement in attitudes towards teamwork, safety and stress recognition. METHODS A survey comprising three domains (teamwork climate, safety climate and stress recognition) of the safety attitudes questionnaire (SAQ) and items addressing briefing and speaking up was distributed to all participants in an annual in-house simulation training. Participants filled out the questionnaire in the morning of each training day. The attitudes were measured before the first training series in 2012, 6 months after the first training and then every year (2013-2016). Participants generated a personalized identification code which allowed individuals to be anonymously tracked over time. Results of the 5‑point Likert scale were transformed to a 100-point scale. Results were calculated at the group level and at the individual level. Univariable linear regression was used to calculate mean changes per year. RESULTS Over a period of 5 years (2012-2016) a total of 255 individuals completed the questionnaire. Each year, 14-20% of all nurse anesthetists and 81-90% of all anesthetists participated in the simulation-based training. As a result of annual staff turnover 16-24% of participants were new staff members. A personalized code allowed the before and after comparison of 99 staff members who had participated twice or more. Physicians had a higher mean score for teamwork climate before the first training (+8.7 p < 0.001). Mean teamwork climate and safety climate scores before the first training increased over a period of 5 years (3.11 for teamwork climate, p < 0.001 and 2.73 for safety climate, p < 0.001). Repeat participation led to a bigger mean change of individual attitudes in nurse anesthetists: teamwork climate 5.2 (nurses) vs. 1.4 (physicians) and safety climate 5.3 (nurses) vs. 2.8 (physicians) without reaching significance. Participants acknowledged the importance of briefings but confirmed their existence in less than half of the cases. The frequency of briefings increased over the 5‑year period. There were no changes in attitude towards speaking up. CONCLUSION Over a 5-year period, small positive changes in attitudes towards teamwork and safety occurred. Low participation of nurse anesthetists as well as personnel turnover may have weakened the impact of simulation-based training on the safety climate.
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Affiliation(s)
- M St Pierre
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
| | - C Gall
- Lehrstuhl für Medizininformatik, Biometrie & Epidemiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - G Breuer
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Schüttler
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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McAlearney AS, Hefner JL, Sieck CJ, Walker DM, Aldrich AM, Sova LN, Gaughan AA, Slevin CM, Hebert C, Hade E, Buck J, Grove M, Huerta TR. Searching for management approaches to reduce HAI transmission (SMART): a study protocol. Implement Sci 2017; 12:82. [PMID: 28659159 PMCID: PMC5490089 DOI: 10.1186/s13012-017-0610-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/14/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. METHODS Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an implementation program for toolkit use, and disseminate that Toolkit nationwide. DISCUSSION Providing hospitals with the tools they need to successfully measure management structures that support clinical care provides a powerful approach that can be leveraged to reduce the incidence of HAIs experienced by patients. This study is critical to providing the information necessary to successfully "make health care safer" by providing guidance on how contextual factors within a healthcare setting can improve patient safety across hospitals.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43201 USA
| | - Jennifer L. Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Cynthia J. Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Daniel M. Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Alison M. Aldrich
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Lindsey N. Sova
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Alice A. Gaughan
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Caitlin M. Slevin
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Courtney Hebert
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43201 USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 310-E Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH USA
| | - Erinn Hade
- Center for Biostatistics, College of Medicine, The Ohio State University, 320G Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
| | - Jacalyn Buck
- The Ohio State University Wexner Medical Center, 134 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- Administrator of Health System Nursing Quality, Research, Education and Evidence- Based Practice, The Ohio State University Wexner Medical Center, Office 2021, 600 Ackerman Road, Columbus, OH 43202 USA
| | - Michele Grove
- The Ohio State University Wexner Medical Center, 134 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Timothy R. Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 310-E Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH USA
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Doepfer AK, Seemann R, Merschin D, Stange R, Egerth M, Münzberg M, Mutschler M, Bouillon B, Hoffmann R. [Safety culture in orthopedics and trauma surgery : Course concept: interpersonal competence by the German Society for Orthopaedics and Trauma (DGOU) and Lufthansa Aviation Training]. Ophthalmologe 2017. [PMID: 28643113 DOI: 10.1007/s00347-017-0522-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient safety has become a central and measurable key factor in the routine daily medical practice. The human factor plays a decisive role in safety culture and has moved into focus regarding the reduction of treatment errors and undesired critical incidents. Nonetheless, the systematic training in communication and interpersonal competences has so far only played a minor role. The German Society of Orthopaedics and Trauma (DGOU) in cooperation with the Lufthansa Aviation Training initiated a course system for interpersonal competence. Several studies confirmed the reduction of critical incidents and costs after implementation of a regular and targeted human factor training. The interpersonal competence should be an essential component of specialist training within the framework of a 3‑column model.
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Affiliation(s)
- A-K Doepfer
- AKK Altonaer Kinderkrankenhaus gGmbH, Bleickenallee 38, 22763, Hamburg, Deutschland.
| | - R Seemann
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - D Merschin
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - R Stange
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - M Egerth
- Lufthansa Aviation Training, Frankfurt am Main, Deutschland
| | - M Münzberg
- Klinik für Orthopädie und Unfallchirurgie, BG-Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - M Mutschler
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken Köln, Köln, Deutschland
| | - B Bouillon
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken Köln, Köln, Deutschland
| | - R Hoffmann
- BG Unfallklinik, Frankfurt am Main, Deutschland
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Bjurling-Sjöberg P, Wadensten B, Pöder U, Jansson I, Nordgren L. Balancing intertwined responsibilities: A grounded theory study of teamwork in everyday intensive care unit practice. J Interprof Care 2017; 31:233-244. [DOI: 10.1080/13561820.2016.1255184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Petronella Bjurling-Sjöberg
- Department of Public Health and Caring Sciences, Caring Science, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Barbro Wadensten
- Department of Public Health and Caring Sciences, Caring Science, Uppsala University, Uppsala, Sweden
| | - Ulrika Pöder
- Department of Public Health and Caring Sciences, Caring Science, Uppsala University, Uppsala, Sweden
| | - Inger Jansson
- Institute of Health and Caring Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Caring Science, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
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Kuy S, Romero RAL. Eliminating Critical Incident Tracking Network Patient Safety Events at a Veterans Affairs Institution Through Crew Resource Management Training. Am J Med Qual 2016; 32:480-484. [PMID: 28862030 DOI: 10.1177/1062860616673904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to determine whether rates of Critical Incident Tracking Network (CITN) patient safety adverse events change after implementation of crew resource management (CRM) training at a Veterans Affairs (VA) hospital. CRM training was conducted for all surgical staff at a VA hospital. Compliance with briefing and debriefing checklists was assessed for all operating room procedures. Tracking of adverse patient safety events utilizing the VA CITN events was performed. There was 100% adherence to performance of briefings and debriefings after initiation of CRM training. There were 3 CITN events in the year prior to implementation of CRM training; following CRM training, there have been zero CITN events. Following CRM training, CITN events were eliminated, and this has been sustained for 2.5 years. This is the first study to demonstrate the impact of CRM training on CITN events, specifically, in a VA medical center.
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Affiliation(s)
- SreyRam Kuy
- 1 Overton Brooks Veterans Affairs Medical Center, Shreveport, LA.,2 Louisiana State University School of Medicine-Shreveport, LA
| | - Ramon A L Romero
- 1 Overton Brooks Veterans Affairs Medical Center, Shreveport, LA.,2 Louisiana State University School of Medicine-Shreveport, LA
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Seemann R, Münzberg M, Stange R, Rüsseler M, Egerth M, Bouillon B, Hoffmann R, Mutschler M. [Interpersonal competence in orthopedics and traumatology : Why technical and procedural skills alone are not sufficient]. Unfallchirurg 2016; 119:881-4. [PMID: 27566507 DOI: 10.1007/s00113-016-0229-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patient safety has increasingly gained significance as criterion which clinics and doctors will be measured against in terms of ethics and finances. The "human factor" moved into focus regarding the question of how to reduce treatment errors in clinical daily routine. Nevertheless, systematic mediation of interpersonal competences only plays a minor role in the catalogue of requirements for medical specialization and professional training. This is the case not only in orthopedics and traumatology, but in other medical fields as well. At the insistence of DGOU and in cooperation with Lufthansa Flight Training, a training model was initiated, comparable to training models used in aviation. In aviation, apart from the training of procedural and technical abilities, regular soft skills training has become standard in the training of all Lufthansa staff. Several studies confirm that by improving communication, interaction, and teamwork skills not only a reduction of intolerable incidents is observed, but also a positive economic effect. Interpersonal competences should be firmly anchored in orthopedics and traumatology and thus be implemented as third post in specialist training.
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Affiliation(s)
- R Seemann
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - M Münzberg
- Klinik für Orthopädie und Unfallchirurgie, BG-Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - R Stange
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - M Rüsseler
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - M Egerth
- Lufthansa Flight Training, Frankfurt am Main, Deutschland
| | - B Bouillon
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken Köln, Köln, Deutschland
| | - R Hoffmann
- BG Unfallklinik, Frankfurt am Main, Deutschland
| | - M Mutschler
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken Köln, Köln, Deutschland
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Hefner JL, Hilligoss B, Knupp A, Bournique J, Sullivan J, Adkins E, Moffatt-Bruce SD. Cultural Transformation After Implementation of Crew Resource Management: Is It Really Possible? Am J Med Qual 2016; 32:384-390. [PMID: 27422314 DOI: 10.1177/1062860616655424] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Crew resource management (CRM) has the potential to improve safety culture and reduce patient safety errors across different hospitals and inherent cultures, but hospital-wide implementations have not been studied. The authors examined the impact of a systematic CRM implementation across 8 departments spanning 3 hospitals and 2 campuses. The Hospital Survey on Patient Safety Culture (HSOPS) was administered electronically to all employees before CRM implementation and about 2 years after; changes in percent positive composite scores were compared in pre-post analyses. Across all respondents, there was a statistically significant increase in composite score for 10 of the 12 HSOPS dimensions ( P < .05). These significant results persisted across the 8 departments studied and among both practitioners and staff. Consideration of score changes across dimensions reveals that the teamwork and communication dimensions of patient safety culture may be more highly influenced by CRM training than supervisor and management dimensions.
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Affiliation(s)
| | | | - Amy Knupp
- 1 The Ohio State University, Columbus, OH, USA
| | | | | | - Eric Adkins
- 1 The Ohio State University, Columbus, OH, USA
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Nguyen M, Moffatt-Bruce S. What's New in Academic Medicine? Retained surgical items: Is “zero incidence” achievable? INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2016. [DOI: 10.4103/2455-5568.183330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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