Nursing opinion leadership: a preliminary model derived from philosophic theories of rational belief

Opinion leaders are informal leaders who have the ability to influence others' decisions about adopting new products, practices or ideas. In the healthcare setting, the importance of translating new research evidence into practice has led to interest in understanding how opinion leaders could be used to speed this process. Despite continued interest, gaps in understanding opinion leadership remain. Agent‐based models are computer models that have proven to be useful for representing dynamic and contextual phenomena such as opinion leadership. The purpose of this paper is to describe the work conducted in preparation for the development of an agent‐based model of nursing opinion leadership. The aim of this phase of the model development project was to clarify basic assumptions about opinions, the individual attributes of opinion leaders and characteristics of the context in which they are effective. The process used to clarify these assumptions was the construction of a preliminary nursing opinion leader model, derived from philosophical theories about belief formation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/100132/1/nup12008.pd

Measuring a Safety Culture: Critical Pathway or Academic Activity?

he Institute of Medicine (IOM) identified six core needs in a health care system, the first of which was safety. 1 Furthermore, several IOM committees and others have identified the creation of a “culture of safety ” as the key institutional requirement to achieve safe medical care. 1–3 In this issue of the journal, Modak et al. 4 present an instrument that may help measure the extent to which a patient safety culture exists in an ambulatory setting. While these authors and others have done considerable work on defining and measuring a culture of safety in the hospital setting, 5,6 few have tackled the difficult task of measuring a safety culture in the ambulatory arena within the US health care system. Even in the hospital setting, where there has been more effort, the development of a culture of safety within all US hospitals has been spotty and, for some safety advocates, too slow. 7 There are many potential reasons for the poor progress in developing a culture of safety: confusion about the difference between safety and quality, concerns that increasing safety will further erode profits, or perhaps simply a lack of attention by institutional leaders. Whatever the reasons for the slow pace of transformation across the nation’s 5,000-plus hospitals, it is likely that this transformation will be even more difficult to achieve in the much larger and more diverse ambulatory setting. Thus, it is important to define and measure an ambulatory culture of safety. It is also difficult, perhaps impossible, to change beliefs, attitudes, knowledge, or actions (all components of a “culture”) without some form of feedback. Therefore, a necessary step in creating a culture of safety is to develop tools to measure the components of that culture. For those individuals and institutions that wish to truly improve the safety of the care they deliver, the creation and testing of tools such as the Safety Attitudes Questionnaire-Ambulatory (SAQ-A) version is critical. Beliefs, attitudes, and knowledge do not always lend themselves to clear-cut end points. Thus, we can expect to see more than one safety culture measuremen

Defining and Measuring Successful Emergency Care Networks: A Research Agenda

The demands on emergency services have grown relentlessly, and the Institute of Medicine (IOM) has asserted the need for “regionalized, coordinated, and accountable emergency care systems throughout the country.” There are large gaps in the evidence base needed to fix the problem of how emergency care is organized and delivered, and science is urgently needed to define and measure success in the emerging network of emergency care. In 2010, Academic Emergency Medicine convened a consensus conference entitled “Beyond Regionalization: Integrated Networks of Emergency Care.” This article is a product of the conference breakout session on “Defining and Measuring Successful Networks”; it explores the concept of integrated emergency care delivery and prioritizes a research agenda for how to best define and measure successful networks of emergency care. The authors discuss five key areas: 1) the fundamental metrics that are needed to measure networks across time-sensitive and non–time-sensitive conditions; 2) how networks can be scalable and nimble and can be creative in terms of best practices; 3) the potential unintended consequences of networks of emergency care; 4) the development of large-scale, yet feasible, network data systems; and 5) the linkage of data systems across the disease course. These knowledge gaps must be filled to improve the quality and efficiency of emergency care and to fulfill the IOM’s vision of regionalized, coordinated, and accountable emergency care systems.ACADEMIC EMERGENCY MEDICINE 2010; 17:1297–1305 © 2010 by the Society for Academic Emergency MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79228/1/j.1553-2712.2010.00930.x.pd

The Patient‐Centered Medical Home and Patient Experience

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94450/1/hesr1429-sup-0001-Authormatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/94450/2/hesr1429.pd

Bedside Interactions from the Other Side of the Bedrail

To assess the importance to patients of various aspects of bedside interactions with physician teams. Design : Cross-sectional survey. Setting : VA hospital. Patients : Ninety-seven medical inpatients. Intervention : Survey of 44 questions including short answer, multiple choice, and Likert-type questions. Measurements and Main Results : Data analysis included descriptive statistics. The sample was predominantly male, with a mean age of 62. Overall satisfaction with the hospital experience and with the team of doctors were both high (95% and 96% reported being very or mostly satisfied, respectively). Patients reported learning about several issues during their interactions with the teams; the 3 most highly rated areas were new problems, tests that will be done, and treatments that will be done. Most patients (76%) felt that their teams cared about them very much. Patients were made comfortable when the team showed that they cared, listened, and appeared relaxed (reported by 63%, 57%, and 54%, respectively). Patients were made uncomfortable by the team using language they did not understand (22%) and when several people examined them at once (13%). Many (58%) patients felt personally involved in teaching. The majority of patients liked having medical students and residents involved in their care (69% and 64%, respectively). Conclusions : Patients have much to teach about what is important about interacting with physician teams. Although patients' reactions to team interactions are generally positive, patients are different with respect to what makes them comfortable and uncomfortable. Taking their preferences into account could improve the experience of being in a teaching hospital.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75456/1/j.1525-1497.2005.40192.x.pd

Disclosure, Apology, and Offer Programs: Stakeholders’ Views of Barriers to and Strategies for Broad Implementation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94445/1/j.1468-0009.2012.00679.x.pd