The results suggest that residents who have a high EC level are better able to manage negative affect, so that they are better able to put their medical knowledge to work and explore alternative diagnoses. Emotional-management training for residents who, as new MDs, have limited experience may be beneficial to complement simulation exercises. Additional studies should be considered to better define the links between the affect experienced by MDs and their thought processes during establishment of a diagnosis.
Background: Numerous studies have been conducted over the past 15 years to assess safety culture within healthcare facilities; in general, these studies have shown the pivotal role that managers play in its development. However, little is known about what healthcare managers actually do to support this development, and how caregivers and managers represent managers'role. Thus the objectives of this study were to explore: i) caregivers and managers' perceptions and representations of safety, ii) the role of managers in the development of safety culture as perceived by themselves and by caregivers, iii) managers' activities related to the development of safety culture. Methods: An exploratory, multicentre, qualitative study was conducted from May 2014 to March 2015 in seven healthcare facilities in France. Semi-structured interviews were conducted with managers (frontline, middle and top level) and caregivers (doctors, nurses and nurse assistants) and on-site observations of two managers were carried out in all facilities. A thematic analysis of semi-structured interviews was performed. Observed activities were categorised using Luthans' typology of managerial activities. Results: Participants in semi-structured interviews (44 managers and 21 caregivers) expressed positive perceptions of the level of safety in their facility. Support from frontline management was particularly appreciated, while support from top managers was identified as an area for improvement. Six main categories of safety-related activities were both observed among managers and regularly expressed by participants. However, caregivers' expectations of their managers and managerial perceptions of these expectations only partially overlapped. Conclusions: The present study highlights current categories of managerial activities that foster safety culture, and points out an important gap between caregivers' expectations of their managers, and managerial perceptions of these expectations. The findings underline the need to allow more time for managers and caregivers to talk about safety issues. The results could be used to develop training programs to help healthcare managers to understand their role in the development of safety culture.
The aim of the study was to assess the effectiveness of a new methodological tool for the identification of corrective and preventive actions (CAPAs) after root cause analysis of health care-related adverse events.Methods: From January to June 2010, we conducted a randomized controlled trial involving risk managers from 111 health care facilities of the Aquitaine Regional Center for Quality and Safety in Health Care (France). Fifty-six risk managers, randomly assigned to two groups (intervention and control), identified CAPAs in response to two sequentially presented adverse event scenarios. For the baseline measure, both groups used their usual adverse event management tools to identify CAPAs in each scenario. For the experimental measure, the control group continued using their usual tools, whereas the intervention group used a new tool involving a systemic approach for CAPA identification. The main outcome measure was the number of CAPAs the participants identified that matched a criterion standard established by eight experts.Results: Baseline mean number of identified CAPAs did not differ between the two groups (P = 0.83). For the experimental measure, significantly more CAPAs (P = 0.001) were identified by the intervention group (mean [SD] = 4.6 [1.7]) than by the control group (mean [SD] = 2.8 [1.2]). Conclusions:For the two scenarios tested, more relevant CAPAs were identified with the new tool than with usual tools. Further research is needed to assess the effectiveness of the new tool for other types of adverse events and its impact on patient safety.
Context: Methods and tools which enabled healthcare organization for learning from adverse events focus mainly on reporting and analysis phases. However, formulating appropriate action plan is also a difficult phase that current methods do not help us with. Objective: To assess the effectiveness of a tool for structuring action plan for hospital risk managers. Method: A randomization procedure has been used to assign 56 voluntary hospital risk managers in two groups differing only by the use of the tool. Each group had to identify causes and formulate an action plan for two scenarios of adverse drug events successively. The first measure was realized without tool. In the second measure, only the intervention group used the tool. Results: The mean difference in the number of relevant actions proposed by participants between the two measures was statistically significant between the reference group (M = -0.6, SD = 2.2) and the intervention group (M = 1.3, SD = 2.2), t(53) = 2.96, p = < .01). In a linear mixed effects model for longitudinal data, the number of proposed actions was statistically higher in the intervention group with a difference of 2.4 actions, 95% CI [1.43, 3.40], p < .001 and 1.1 actions, 95% CI [0.02, 2.00], p < .05) for scenario 1 and scenario 2 respectively. Discussion: Our study confirms the effectiveness of the tool in two scenarios. Further studies could assess its effectiveness in other adverse events, its feasibility and acceptability by hospital risk managers before proposing its broad use.
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