Behind the wheel: What drives the effects of error handling?

Existing research comparing error management (a strategy focusing on increasing the positive and decreasing the negative consequences of errors) to error prevention (a strategy focusing on working faultlessly), has identified error management as beneficial for multiple outcomes. Yet, due to various methodological limitations, it is unclear whether the effects previously found are due to error prevention, error management, or both. We examine this in an experimental study with a 2 (error prevention: yes vs. no)× 2 (error management: yes vs. no) factorial design. Error prevention had negative effects on cognition and adaptive transfer performance. Error management alleviated worry and boosted one’s perceived self-efficacy. Overall, the results show that error prevention and error management have unique outcomes on negative affect, self-efficacy, cognition, and performance

Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial

<p>Abstract</p> <p>Background</p> <p>Crew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and organizational outcomes, due to weak study designs and the scarce use of direct observations. Therefore, the aim of this study is to determine the effectiveness and cost-effectiveness of CRM training on attitude, behaviour and organization after one year, using a multi-method approach and matched control units. The purpose of the present article is to describe the study protocol and the underlying choices of this evaluation study of CRM in the ICU in detail.</p> <p>Methods/Design</p> <p>Six ICUs participated in a paired controlled trial, with one pre-test and two post test measurements (respectively three months and one year after the training). Three ICUs were trained and compared to matched control ICUs. The 2-day classroom-based training was delivered to multidisciplinary groups. Typical CRM topics on the individual, team and organizational level were discussed, such as situational awareness, leadership and communication. All levels of Kirkpatrick's evaluation framework (reaction, learning, behaviour and organisation) were assessed using questionnaires, direct observations, interviews and routine ICU administration data.</p> <p>Discussion</p> <p>It is expected that the CRM training acts as a generic intervention that stimulates specific interventions. Besides effectiveness and cost-effectiveness, the assessment of the barriers and facilitators will provide insight in the implementation process of CRM.</p> <p>Trial registration</p> <p>Netherlands Trial Register (NTR): <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1976">NTR1976</a></p

Learning from Errors: An Exploratory Study Among Dutch Auditors

Despite the presence of substantial quality control measures present at audit firms, results from regulator inspections suggest that auditors make errors during their work. According to the error management literature, even though errors often lead to negative immediate consequences, they also offer powerful opportunities for individual and organizational learning. However, to fully exploit such opportunities, appropriate error management strategies are necessary. This exploratory study focuses on how auditors and audit firms deal with auditor-committed errors and whether they learn from them. There are two primary, complementary strategies that organizations use to deal with errors. Error prevention is aimed at reducing or eliminating the future occurrence of errors. However, focusing on error prevention has its limits because errors are ubiquitous and it is unrealistic to expect no errors to occur. Also, an exaggerated focus on error prevention may cause organizational members to avoid sharing committed errors, due to for example fear of sanctions, limiting the potential for learning in the long run. Error management strategies on the other hand stimulate open communication about errors, analysis of errors’ root causes, with the ultimate goal of properly handling the consequences of errors and learning from errors. This exploratory study reports the results of 22 semi-structured interviews with Dutch auditors. Our analysis suggests an overall high degree of error prevention in audit practice. Auditors describe a high degree of fear of being blamed for errors, which is a potential barrier to openly discuss errors with others. Overall, we observe that openness as a key element of an effective error management climate is recognized by auditors, but is rarely practiced. While learning through courses and training takes place, the limited openness reduces the opportunities for learning from errors

Walk the talk: leaders' enacted priority of safety, incident reporting, and error management

Purpose – The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by ‘‘walking the safety talk’’ (enacted priority of safety). Design/methodology/approach – Open interviews (N=26) and a crosssectional questionnaire (N=183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherlands. Findings – As hypothesized, leaders’ enacted priority of safety was positively related to incident reporting and error management, and the relation between leaders’ enacted priority of safety and error management was mediated by incident reporting. The interviews yielded rich data on (near) incidents, the leaders’ role in (non)reporting, and error management, grounding quantitative findings in concrete case descriptions. Research implications – We support previous theorizing by providing empirical evidence showing that (1) enacted priority of safety has a stronger relationship with incident reporting than espoused priority of safety and (2) the previously implied positive link between incident reporting and error management indeed exists. Moreover, our findings extend our understanding of behavioral integrity for safety and the mechanisms through which it operates in medical settings. Practical implications – Our findings indicate that for the promotion of incident reporting and error management, active reinforcement of priority of safety by leaders is crucial. Value/originality – Social sciences researchers, health care researchers and health care practitioners can utilize the findings of the current paper in order to help leaders create health care systems characterized by higher incident reporting and more constructive error handling

Walk the talk: Leaders' enacted priority of safety, incident reporting, and error management

Purpose – The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by ‘‘walking the safety talk’’ (enacted priority of safety). Design/methodology/approach – Open interviews (N=26) and a crosssectional questionnaire (N=183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherlands. Findings – As hypothesized, leaders’ enacted priority of safety was positively related to incident reporting and error management, and the relation between leaders’ enacted priority of safety and error management was mediated by incident reporting. The interviews yielded rich data on (near) incidents, the leaders’ role in (non)reporting, and error management, grounding quantitative findings in concrete case descriptions. Research implications – We support previous theorizing by providing empirical evidence showing that (1) enacted priority of safety has a stronger relationship with incident reporting than espoused priority of safety and (2) the previously implied positive link between incident reporting and error management indeed exists. Moreover, our findings extend our understanding of behavioral integrity for safety and the mechanisms through which it operates in medical settings. Practical implications – Our findings indicate that for the promotion of incident reporting and error management, active reinforcement of priority of safety by leaders is crucial. Value/originality – Social sciences researchers, health care researchers and health care practitioners can utilize the findings of the current paper in order to help leaders create health care systems characterized by higher incident reporting and more constructive error handling

Implementation of Crew Resource Management: A Qualitative Study in 3 Intensive Care Units

OBJECTIVES: Classroom-based crew resource management (CRM) training has been increasingly applied in health care to improve safe patient care. Crew resource management aims to increase participants’ understanding of how certain threats can develop as well as provides tools and skills to respond to such threats. Existing literature shows promising but inconclusive results that might be explained by the quality of the implementation. The present research systematically describes the implementation from the perspective of 3 trained intensive care units (ICUs). METHODS: The design of the study was built around 3 stages of implementation: (1) the preparation, (2) the actions after the CRM training, and (3) the plans for the future. To assess all stages in 3 Dutch ICUs, 12 semistructured interviews with implementation leaders were conducted, the End-of-Course Critique questionnaire was administered, and objective measurements consisting of the number and types of plans of action were reported. RESULTS: The results categorize initiatives that all 3 ICUs successfully launched, including the development of checklists, each using a different implementation strategy. All ICUs have taken several steps to sustain their approach for the foreseeable future. Three similarities between the units were seen at the start of the implementation: (1) acknowledgment of a performance gap in communication, (2) structural time allocated for CRM, and (3) a clear vision on how to implement CRM. CONCLUSIONS: This study shows that CRM requires preparation and implementation, both of which require time and dedication. It is promising to note that all 3 ICUs have developed multiple quality improvement initiatives and aim to continue doing so