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Sanford N, Lavelle M, Markiewicz O, Reedy G, Rafferty DAM, Darzi LA, Anderson JE. Decoding healthcare teamwork: a typology of hospital teams. J Interprof Care 2024:1-10. [PMID: 38666463 DOI: 10.1080/13561820.2024.2343835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024]
Abstract
The effectiveness of healthcare depends on successful teamwork. Current understanding of teamwork in healthcare is limited due to the complexity of the context, variety of team structures, and unique demands of healthcare work. This qualitative study aimed to identify different types of healthcare teams based on their structure, membership, and function. The study used an ethnographic approach to observe five teams in an English hospital. Data were analyzed using a combined inductive-deductive approach based on the Temporal Observational Analysis of Teamwork framework. A typology was developed, consisting of five team types: structural, hybrid, satellite, responsive, and coordinating. Teams were challenged to varying degrees with staffing, membership instability, equipment shortages, and other elements of the healthcare environment. Teams varied in their ability to respond to these challenges depending on their characteristics, such as their teamworking style, location, and membership. The typology developed in this study can help healthcare organizations to better understand and design effective teams for different healthcare contexts. It can also guide future research on healthcare teams and provide a framework for comparing teams across settings. To improve teamwork, healthcare organizations should consider the unique needs of different team types and design effective training programs accordingly.
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Affiliation(s)
- Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Mary Lavelle
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | - Ola Markiewicz
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Dame Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Lord Ara Darzi
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Janet E Anderson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Markiewicz O, Lorencatto F, D'Lima D, Sanford N, Lavelle M, Acharya A, Anderson J, Darzi A, Judah G. Improving the quality of written communication at patient discharge: triangulation of qualitative analyses and intervention co-design. Lancet 2023; 402 Suppl 1:S67. [PMID: 37997111 DOI: 10.1016/s0140-6736(23)02122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/17/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Poor handovers between hospital and primary care threaten safe discharges, with elderly and frail patients most at risk of harm. Using Behavioural Science we explored influences and identified relevant behaviour change techniques (BCTs) to improve written handovers and safety during discharge. METHODS We conducted two qualitative studies: (1) ethnographic observations (>80 h) collected by five researchers in five purposively sampled clinical areas of a London teaching hospital, investigating routine work and interactions of hospital staff involved in discharges; and (2) 12 semi-structured interviews with hospital staff involved in discharge exploring influences on preparations of written handovers. Written consent was sought from clinical leads for ethnographic observations and from interview participants. Ethnographic fieldnotes and interview transcripts were thematically analysed using inductive and deductive approaches, respectively. Study findings were triangulated to identify key influences, mapped onto the Theoretical Domains Framework (TDF). We identified appropriate BCTs to address observed influences within each TDF domain using the Theory and Techniques Tool. Health-care workers (n=15), patients (n=2) and carers (n=2) selected and designed an intervention to improve written handovers in two workshops. Hospital workshop participants were involved with preparing written discharge handovers. Public participants had either recently been discharged from hospital or cared for someone recently discharged, including patients from groups especially vulnerable during discharge. FINDINGS Triangulation of study findings generated 11 key influences on preparations of written handovers within five TDF domains: knowledge (eg, lack of awareness of guidelines), skills (staff experience), social or professional role and identity (effective communication), environmental context and resources (working patterns), and social influences (lack of feedback). 14 BCTs were identified to address these influences, including behavioural rehearsal or practice, instruction on how to perform a behaviour, and social support (practical). Workshop participants selected and designed a multifaceted educational intervention to improve written handovers. INTERPRETATION The quality of handover documentation prepared by hospital staff for primary care teams is affected by influences from multiple domains, requiring a multifaceted approach to improve handovers. Although only based on findings from one hospital, the designed intervention should be tested in clinical settings with key stakeholders, including primary care staff, to evaluate impact on quality of written handovers and patient safety. FUNDING National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre.
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Affiliation(s)
- Ola Markiewicz
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Danielle D'Lima
- Centre for Behaviour Change, University College London, London, UK
| | - Natalie Sanford
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Mary Lavelle
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Amish Acharya
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Janet Anderson
- Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, Australia
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Gaby Judah
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Adams M, Hartley J, Sanford N, Heazell AE, Iedema R, Bevan C, Booker M, Treadwell M, Sandall J. Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence. BMC Health Serv Res 2023; 23:285. [PMID: 36973796 PMCID: PMC10041808 DOI: 10.1186/s12913-023-09033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Open Disclosure (OD) is open and timely communication about harmful events arising from health care with those affected. It is an entitlement of service-users and an aspect of their recovery, as well as an important dimension of service safety improvement. Recently, OD in maternity care in the English National Health Service has become a pressing public issue, with policymakers promoting multiple interventions to manage the financial and reputational costs of communication failures. There is limited research to understand how OD works and its effects in different contexts. METHODS Realist literature screening, data extraction, and retroductive theorisation involving two advisory stakeholder groups. Data relevant to families, clinicians, and services were mapped to theorise the relationships between contexts, mechanisms, and outcomes. From these maps, key aspects for successful OD were identified. RESULTS After realist quality appraisal, 38 documents were included in the synthesis (22 academic, 2 training guidance, and 14 policy report). 135 explanatory accounts were identified from the included documents (with n = 41 relevant to families; n = 37 relevant to staff; and n = 37 relevant to services). These were theorised as five key mechanism sets: (a) meaningful acknowledgement of harm, (b) opportunity for family involvement in reviews and investigations, (c) possibilities for families and staff to make sense of what happened, (d) specialist skills and psychological safety of clinicians, and (e) families and staff knowing that improvements are happening. Three key contextual factors were identified: (a) the configuration of the incident (how and when identified and classified as more or less severe); (b) national or state drivers, such as polices, regulations, and schemes, designed to promote OD; and (c) the organisational context within which these these drivers are recieived and negotiated. CONCLUSIONS This is the first review to theorise how OD works, for whom, in what circumstances, and why. We identify and examine from the secondary data the five key mechanisms for successful OD and the three contextual factors that influence this. The next study stage will use interview and ethnographic data to test, deepen, or overturn our five hypothesised programme theories to explain what is required to strengthen OD in maternity services.
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Affiliation(s)
- Mary Adams
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Julie Hartley
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, UK
| | | | - Rick Iedema
- School of Life Sciences and Medicine, King's College London, London, UK
| | - Charlotte Bevan
- The Stillbirth and Neonatal Death Charity (SANDS), London, UK
| | | | | | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Sanford N, Lavelle M, Markiewicz O, Reedy G, Rafferty AM, Darzi A, Anderson JE. Understanding complex work using an extension of the resilience CARE model: an ethnographic study. BMC Health Serv Res 2022; 22:1126. [PMID: 36068564 PMCID: PMC9450258 DOI: 10.1186/s12913-022-08482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Resilient Healthcare research centres on understanding and improving quality and safety in healthcare. The Concepts for Applying Resilience Engineering (CARE) model highlights the relationships between demand, capacity, work-as-done, work-as-imagined, and outcomes, all of which are central aspects of Resilient Healthcare theory. However, detailed descriptions of the nature of misalignments and the mechanisms used to adapt to them are still unknown. Objective The objectives were to identify and classify types of misalignments between demand and capacity and types of adaptations that were made in response to misalignments. Methods The study involved 88.5 hours of non-participant ethnographic observations in a large, teaching hospital in central London. The wards included in the study were: two surgical wards, an older adult ward, a critical care unit, and the Acute Assessment Unit (AAU), an extension unit created to expedite patient flow out of the Emergency Department. Data were collected via observations of routine clinical work and ethnographic interviews with healthcare professionals during the observations. Field notes were transcribed and thematically analysed using a combined deductive-inductive approach based on the CARE model. Results A total of 365 instances of demand-capacity misalignment were identified across the five wards included in the study. Of these, 212 had at least one observed corresponding work adaptation. Misalignments identified include equipment, staffing, process, communication, workflow, and space. Adaptations identified include process, resource redistribution, and extra-role performance. For all misalignment types observed across the five in-patient settings, process adaptations were the most frequently used adaptations. The exception to this was for staffing misalignments, which were most frequently responded to with extra-role performance adaptations. Of the three process adaptations, hospital workers most often adapted by changing how the process was done. Conclusions This study contributes a new version of the CARE model that includes types of misalignments and corresponding adaptations, which can be used to better understand work-as-done. This affords insight into the complexity of the system and how it might be improved by reducing misalignments via work system redesign or by enhancing adaptive capacity.
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Affiliation(s)
- Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, James Clerk Maxwell Building 1.32, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Mary Lavelle
- School of Psychology, Queen's University Belfast, Belfast, UK.,NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Ola Markiewicz
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Gabriel Reedy
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, James Clerk Maxwell Building 1.32, 57 Waterloo Road, London, SE1 8WA, UK
| | - Ara Darzi
- NIHR Patient Safety and Translational Research Centre, Imperial College London, London, UK
| | - Janet E Anderson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Sanford N, Lavelle M, Markiewicz O, Reedy G, Rafferty AM, Darzi A, Anderson JE. Capturing challenges and trade-offs in healthcare work using the pressures diagram: An ethnographic study. Appl Ergon 2022; 101:103688. [PMID: 35121407 DOI: 10.1016/j.apergo.2022.103688] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/03/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Healthcare workers must balance competing priorities to deliver high-quality patient care. Rasmussen's Dynamic Safety Model proposed three factors that organisations must balance to maintain acceptable performance, but there has been little empirical exploration of these ideas, and little is known about the risk trade-offs workers make in practice. The aim of this study was to investigate the different pressures that healthcare workers experience, what risk trade-off decisions they make in response to pressures, and to analyse the implications for quality and safety. The study involved 88.5 h of ethnographic observations at a large, teaching hospital in central London. The analysis revealed five distinct categories of hospital pressures faced by healthcare workers: efficiency, organisational, workload, personal, and quality and safety pressures. Workers most often traded-off workload, personal, and quality and safety pressures to accommodate system-level priorities. The Pressures Diagram was developed to visualise risk trade-offs and prioritising decisions and to facilitate communication about these aspects of healthcare work.
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Affiliation(s)
- Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care King's College London, UK.
| | - Mary Lavelle
- School of Psychology, Queen's University Belfast, UK; NIHR Patient Safety and Translational Research Centre, Imperial College London, UK
| | - Ola Markiewicz
- NIHR Patient Safety and Translational Research Centre, Imperial College London, UK
| | - Gabriel Reedy
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care King's College London, UK
| | - Ara Darzi
- NIHR Patient Safety and Translational Research Centre, Imperial College London, UK
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Affiliation(s)
- R. Wolcott
- Southwest Regional Wound Care Center, Lubbock, Texas
| | - N. Sanford
- Southwest Regional Wound Care Center, Lubbock, Texas
| | - R. Gabrilska
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - J.L. Oates
- Research and Testing Laboratory, Lubbock, Texas
| | | | - K.P. Rumbaugh
- Texas Tech University Health Sciences Center, Lubbock, Texas
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Abstract
BACKGROUND It has been previously demonstrated that a cognitive bias against disconfirmatory evidence (BADE) is associated with delusions. However, small samples of delusional patients, reliance on difference scores and choice of comparison groups may have hampered the reliability of these results. In the present study we aimed to improve on this methodology with a recent version of the BADE task, and compare larger groups of schizophrenia patients with/without delusions to obsessive-compulsive disorder (OCD) patients, a population with persistent and possibly bizarre beliefs without psychosis. METHOD A component analysis was used to identify cognitive operations underlying the BADE task, and how they differ across four groups of participants: (1) high-delusional schizophrenia, (2) low-delusional schizophrenia, (3) OCD patients and (4) non-psychiatric controls. RESULTS As in past studies, two components emerged and were labelled 'evidence integration' (the degree to which disambiguating information has been integrated) and 'conservatism' (reduced willingness to provide high plausibility ratings when justified), and only evidence integration differed between severely delusional patients and the other groups, reflecting delusional subjects giving higher ratings for disconfirmed interpretations and lower ratings for confirmed interpretations. CONCLUSIONS These data support the finding that a reduced willingness to adjust beliefs when confronted with disconfirming evidence may be a cognitive underpinning of delusions specifically, rather than obsessive beliefs or other aspects of psychosis such as hallucinations, and illustrates a cognitive process that may underlie maintenance of delusions in the face of counter-evidence. This supports the possibility of the BADE operation being a useful target in cognitive-based therapies for delusions.
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Affiliation(s)
- N Sanford
- Department of Psychiatry,University of British Columbia,Vancouver, BC,Canada
| | - R Veckenstedt
- Department of Psychiatry and Psychotherapy, Clinical Neuropsychology,University Medical Centre Hamburg-Eppendorf,Germany
| | - S Moritz
- Department of Psychiatry and Psychotherapy, Clinical Neuropsychology,University Medical Centre Hamburg-Eppendorf,Germany
| | - R P Balzan
- School of Psychology,Flinders University,Australia
| | - T S Woodward
- Department of Psychiatry,University of British Columbia,Vancouver, BC,Canada
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Blieszner R, Sanford N. Looking Back and Looking Ahead as Journal of Gerontology: Psychological Sciences Turns 65. J Gerontol B Psychol Sci Soc Sci 2009; 65B:3-4. [DOI: 10.1093/geronb/gbp097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Grant R, Sanford N. The way it will be: psychiatric nursing in the United States. Int Nurs Rev 1973; 20:47-8. [PMID: 4487985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sanford N, Deloughery GL. Teaching nurses to care for the dying patient. J Psychiatr Nurs Ment Health Serv 1973; 11:24-6. [PMID: 4347348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sanford N. The decline of individualism. Public Health Rep (1896) 1970; 85:213-9. [PMID: 4984879 PMCID: PMC2031658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Sanford N. Students and studies. Am J Nurs 1968; 68:805-6. [PMID: 5183734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Sanford N. The development of social responsibility. Am J Orthopsychiatry 1967; 37:22-29. [PMID: 6030206 DOI: 10.1111/j.1939-0025.1967.tb01063.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Sanford N. The prevention of mental illness. Bull Menninger Clin 1966; 30:1-22. [PMID: 5321691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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