The Surgical Hazardous Attitudes Reflection Profile (SHARP) Instrument - A Prototype Study

OBJECTIVE: There is growing recognition that surgeons’ non-technical skills are crucial in guaranteeing optimal quality and safety of patient care. However, insight in relevant attitudes underlying these behavioral skills is lacking. Hazardous attitudes potentially cause risky behavior, which can result in medical errors and adverse events. A questionnaire offering surgeons insight in their attitudinal profile is still missing and would be instrumental in risk reduction. Therefore, the aim of this study is to develop a prototype of a reliable and valid instrument to measure hazardous attitudes among surgeons. DESIGN: To measure hazardous attitudes, a prototype of the Surgical Hazardous Attitudes Reflection Profile (SHARP) tool was designed using a mixed methods approach, consisting of (1) 2 focus group discussions, (2) a modified Delphi analysis, and (3) a survey followed by (4) statistical analysis of the psychometric properties. Statistical analysis included exploratory factor analysis with varimax rotation, calculation of internal consistency reliability coefficients, and interscale correlations. SETTING: Fourteen hospitals across the Netherlands were recruited to guarantee demographic variety and the inclusion of academic, tertiary, and general hospitals. PARTICIPANTS: Nineteen experts participated in the 2 focus groups, and 19 in the modified Delphi study. In total, 302 surgeons (54.1%) completed the SHARP. RESULTS: In total, 302 surgeons (54.1%) completed the SHARP. Exploratory factor analysis resulted in 6 subscales measuring attitude towards (1) authority (α = 0.78), (2) self-performance (α = 0.69), (3) performance feedback (α = 0.61), (4) own fitness to perform (α = 0.54), (5) uncertainty (α = 0.51), and (6) planned procedures (α = 0.48). CONCLUSIONS: This study resulted in a prototype instrument identifying 6 potential hazardous attitudes in surgeons. Attitudes towards “authority” and “self-performance” can now be validly and reliably measured. Further research is required to optimize the prototype version of the instrument and could usefully explore the plausible relations between hazardous attitudes and clinical outcomes

Complex conductivity of soils

The complex conductivity of soils remains poorly known despite the growing importance of this method in hydrogeophysics. In order to fill this gap of knowledge, we investigate the complex conductivity of 71 soils samples (including four peat samples) and one clean sand in the frequency range 0.1 Hz to 45 kHz. The soil samples are saturated with six different NaCl brines with conductivities (0.031, 0.53, 1.15, 5.7, 14.7, and 22 S m21, NaCl, 258C) in order to determine their intrinsic formation factor and surface conductivity. This data set is used to test the predictions of the dynamic Stern polarization model of porous media in terms of relationship between the quadrature conductivity and the surface conductivity. We also investigate the relationship between the normalized chargeability (the difference of in-phase conductivity between two frequencies) and the quadrature conductivity at the geometric mean frequency. This data set confirms the relationships between the surface conductivity, the quadrature conductivity, and the normalized chargeability. The normalized chargeability depends linearly on the cation exchange capacity and specific surface area while the chargeability shows no dependence on these parameters. These new data and the dynamic Stern layer polarization model are observed to be mutually consistent. Traditionally, in hydrogeophysics, surface conductivity is neglected in the analysis of resistivity data. The relationships we have developed can be used in field conditions to avoid neglecting surface conductivity in the interpretation of DC resistivity tomograms. We also investigate the effects of temperature and saturation and, here again, the dynamic Stern layer predictions and the experimental observations are mutually consistent

De zorginstelling als lerende organisatie

De systeembenadering van kwaliteit verschuift naar een lerende benadering waarbij de mens veranderingen kan initiëren. Dat vraagt om kennis van de lerende mens als aanjager van kwaliteitsverbetering. Maar hoe zit de lerende mens in elkaar? Wat doet zijn mindset? En welke mindsets zijn er eigenlijk