The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units

BACKGROUND: Executive walk rounds (EWRs) are a widely used but unstudied activity designed to improve safety culture in hospitals. Therefore, we measured the impact of EWRs on one important part of safety culture – provider attitudes about the safety climate in the institution. METHODS: Randomized study of EWRs for 23 clinical units in a tertiary care teaching hospital. All providers except physicians participated. EWRs were conducted at each unit by one of six hospital executives once every four weeks for three visits. Providers were asked about their concerns regarding patient safety and what could be done to improve patient safety. Suggestions were tabulated and when possible, changes were made. Provider attitudes about safety climate measured by the Safety Climate Survey before and after EWRs. We report mean scores, percent positive scores (percentage of providers who responded four or higher on a five point scale (agree slightly or agree strongly), and the odds of EWR participants agreeing with individual survey items when compared to non-participants. RESULTS: Before EWRs the mean safety climate scores for nurses were similar in the control units and EWR units (78.97 and 76.78, P = 0.458) as were percent positive scores (64.6% positive and 61.1% positive). After EWRs the mean safety climate scores were not significantly different for all providers nor for nurses in the control units and EWR units (77.93 and 78.33, P = 0.854) and (56.5% positive and 62.7% positive). However, when analyzed by exposure to EWRs, nurses in the control group who did not participate in EWRs (n = 198) had lower safety climate scores than nurses in the intervention group who did participate in an EWR session (n = 85) (74.88 versus 81.01, P = 0.02; 52.5% positive versus 72.9% positive). Compared to nurses who did not participate, nurses in the experimental group who reported participating in EWRs also responded more favorably to a majority of items on the survey. CONCLUSION: EWRs have a positive effect on the safety climate attitudes of nurses who participate in the walk rounds sessions. EWRs are a promising tool to improve safety climate and the broader construct of safety culture

Correction: The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units [ISRCTN85147255]

Eric J. Thomas is with the Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA -- J. Bryan Sexton is with the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Quality and Safety Research Group, The Johns Hopkins University School of Medicine, Baltimore, USA -- Torsten B. Neilands is with the Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, CA, USA -- Allan Frankel is with the Partners Healthcare System, Prudential Tower, Boston, MA, USA -- Robert L. Helmreich is with the Department of Psychology, The University of Texas at Austin, Austin, TX, USAFollowing publication of this article [1], the study was included in the International Standard Randomised Controlled Trial Number (ISRCTN) Register and assigned the number [email protected]

The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research

BACKGROUND: There is widespread interest in measuring healthcare provider attitudes about issues relevant to patient safety (often called safety climate or safety culture). Here we report the psychometric properties, establish benchmarking data, and discuss emerging areas of research with the University of Texas Safety Attitudes Questionnaire. METHODS: Six cross-sectional surveys of health care providers (n = 10,843) in 203 clinical areas (including critical care units, operating rooms, inpatient settings, and ambulatory clinics) in three countries (USA, UK, New Zealand). Multilevel factor analyses yielded results at the clinical area level and the respondent nested within clinical area level. We report scale reliability, floor/ceiling effects, item factor loadings, inter-factor correlations, and percentage of respondents who agree with each item and scale. RESULTS: A six factor model of provider attitudes fit to the data at both the clinical area and respondent nested within clinical area levels. The factors were: Teamwork Climate, Safety Climate, Perceptions of Management, Job Satisfaction, Working Conditions, and Stress Recognition. Scale reliability was 0.9. Provider attitudes varied greatly both within and among organizations. Results are presented to allow benchmarking among organizations and emerging research is discussed. CONCLUSION: The Safety Attitudes Questionnaire demonstrated good psychometric properties. Healthcare organizations can use the survey to measure caregiver attitudes about six patient safety-related domains, to compare themselves with other organizations, to prompt interventions to improve safety attitudes and to measure the effectiveness of these interventions

Error, stress, and teamwork in medicine and aviation: cross sectional surveys

OBJECTIVES: To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew. DESIGN: Cross sectional surveys. SETTING: Urban teaching and non-teaching hospitals in the United States, Israel, Germany, Switzerland, and Italy. Major airlines around the world. PARTICIPANTS: 1033 doctors, nurses, fellows, and residents working in operating theatres and intensive care units and over 30 000 cockpit crew members (captains, first officers, and second officers). MAIN OUTCOME MEASURES: Perceptions of error, stress, and teamwork. RESULTS: Pilots were least likely to deny the effects of fatigue on performance (26% v 70% of consultant surgeons and 47% of consultant anaesthetists). Most pilots (97%) and intensive care staff (94%) rejected steep hierarchies (in which senior team members are not open to input from junior members), but only 55% of consultant surgeons rejected such hierarchies. High levels of teamwork with consultant surgeons were reported by 73% of surgical residents, 64% of consultant surgeons, 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses, and 10% of anaesthetic residents. Only a third of staff reported that errors are handled appropriately at their hospital. A third of intensive care staff did not acknowledge that they make errors. Over half of intensive care staff reported that they find it difficult to discuss mistakes. CONCLUSIONS: Medical staff reported that error is important but difficult to discuss and not handled well in their hospital. Barriers to discussing error are more important since medical staff seem to deny the effect of stress and fatigue on performance. Further problems include differing perceptions of teamwork among team members and reluctance of senior theatre staff to accept input from junior members

Artificial Intelligence and Metaphors of Mind: Within-Vehicle Reasoning and its Benefits

We define within-vehicle and within-tenor reasoning to be reasoning that is done on-the-fly within the vehicle domain or tenor domain, respectively, of a conceptual metaphor, during the comprehension of utterances that manifest the metaphor. The main claim of this paper is that, at least in Artificial Intelligence systems for understanding metaphorical discourse, within-vehicle reasoning is often beneficial. Indeed, in several important respects it is to be preferred over within-tenor reasoning that would achieve the same overall effect; and in any case for certain types of metaphorical sentence there is useful within-vehicle reasoning that can be done but for which there is no feasible within-tenor parallel. Although some work on metaphor involves within-vehicle reasoning, its benefits do not appear to have been explained and argued. The examples in the present paper focus on metaphors for the particular domain of mental states and processes; also, the examples involve only metaphors ..

Combining Simulative and Metaphor-Based Reasoning about Beliefs

An unprecedented combination of simulative and metaphor-based reasoning about beliefs is achieved in an AI system, ATT-Meta. Much mundane discourse about beliefs uses conceptual metaphors (e.g., MIND AS CONTAINER) productively, and ATTMeta 's metaphor-based reasoning accordingly leads to crucial discourse comprehension decisions. ATT-Meta's non-metaphorical mode of belief reasoning includes simulative reasoning (SR). In ATT-Meta, metaphor-based reasoning can block and otherwise influence the course of SR. Also, ATT-Meta can nest SR and metaphorbased reasoning within themselves and each other. As well as currently allowing ATT-Meta to simulatively reason about beliefs about beliefs ..., the nesting will in the near future allow the system to handle chained metaphors, ascribe its own metaphor-based reasoning to other agents, and apply simulative reasoning to purely metaphorical agents. Introduction Metaphors in discourse affect an understander's task of obtaining a coherent understand..