Psychological safety is associated with better work environment and lower levels of clinician burnout.

Burnout is attributed to negative work environments and threatens patient and clinician safety. Psychological safety is the perception that the work environment is safe for interpersonal risk-taking and may offer insight into the relationship between the work environment and burnout. In this cross-sectional analysis of survey data from 621 nurse practitioners in California, we found that one-third (34%) experienced high burnout. Four factors in the work environment were negatively associated with burnout and positively associated with psychological safety. Significant mediation effects of psychological safety were observed on the relationships between each work environment factor and both emotional exhaustion and depersonalization. The largest mediation effects were observed on the total effects of Nurse Practitioner-Physician Relations and Practice Visibility on Emotional Exhaustion (37% and 32%, respectively) and Independent Practice and Support and NP-Administration Relations on Depersonalization (32% and 29%, respectively). We found, overall, that psychological safety decreased the strength of the negative relationship between work environment and burnout. We argue that research, practice, and policy efforts to mitigate burnout and improve the work environment should consider psychological safety as a metric for system-level well-being

The effect of provider- and workflow-focused strategies for guideline implementation on provider acceptance

<p>Abstract</p> <p>Background</p> <p>The effective implementation of clinical practice guidelines (CPGs) depends critically on the extent to which the strategies that are deployed for implementing the guidelines promote provider acceptance of CPGs. Such implementation strategies can be classified into two types based on whether they primarily target providers (<it>e.g.</it>, academic detailing, grand rounds presentations) or the work context (<it>e.g.</it>, computer reminders, modifications to forms). This study investigated the independent and joint effects of these two types of implementation strategies on provider acceptance of CPGs.</p> <p>Methods</p> <p>Surveys were mailed to a national sample of providers (primary care physicians, physician assistants, nurses, and nurse practitioners) and quality managers selected from Veterans Affairs Medical Centers (VAMCs). A total of 2,438 providers and 242 quality managers from 123 VAMCs participated. Survey items measured implementation strategies and provider acceptance (<it>e.g.</it>, guideline-related knowledge, attitudes, and adherence) for three sets of CPGs--chronic obstructive pulmonary disease, chronic heart failure, and major depressive disorder. The relationships between implementation strategy types and provider acceptance were tested using multi-level analytic models.</p> <p>Results</p> <p>For all three CPGs, provider acceptance increased with the number of implementation strategies of either type. Moreover, the number of workflow-focused strategies compensated (contributing more strongly to provider acceptance) when few provider-focused strategies were used.</p> <p>Conclusion</p> <p>Provider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies.</p

Voluntary Reporting of Medical Errors and Organizational Change: A Simulation Study

In this study we describe a computer simulation model that can be used to explore organizational changes that are required to improve patient safety based on a medication error reporting system

Influences on Nurse Perception of Hospital Unit Safety Climate:an HLM Approach

Patient safety is a critical issue in healthcare. The Institute of Medicine[1] estimates up to 98,000 hopitalized patients die annually as a result if medical error. Nurses serve as a hospital unit\u27s twenty-four hour surveillance team[2]. Assesment of patient condition, evaluation of physician orders, administration of medications, and supervision of patient activity are all safety functions which fall within the nurse\u27s scope of practice. Health care organizations have introduced a variety of technological upgrades and structural changes in an effort to encourage a system, or root cause, approach to error reduction. However, these changes have failed to provide an adequate reduction in error. Because nurses play an integral role in patient safety, the solution may lie within the work of the nurses

The Link between Organizational Errors and Adverse Consequences: The Role of Error-Correcting and Error-Amplifying Feedback Processes

We examine when and how organizations experience major adverse outcomes as a result of latent errors in their operations—i.e., unintended deviations from pre-specified rules and standard operating procedures that can potentially generate adverse outcomes of organizational significance. To address these questions, we develop a conceptual framework around organizational feedback processes for error correction and error amplification and their organizational antecedents. We illustrate the framework using two contrasting cases. In one case set in an investment bank, several recognizable precursors of errors were present over an extended period of time and eventually contributed to losses in excess of $1 billion. In the other case set in a hospital that adopted several recommended practices for effective error management, errors nevertheless caused the preventable deaths of three infants. We discuss the challenges and opportunities for future research about the role of organizational feedback processes in linking latent errors and adverse consequences.</p

The Relationship Between Change Across Multiple Organizational Domains and the Incidence of Latent Errors

The authors examined the relationship between types of organizational change (i.e., changes across multiple domains, e.g., employees, structure, and technology) and the incidence of latent errors (i.e., potentially consequential deviations from rules and procedures), using data from internal audit reports and interviews with managers in 80 business units in a large financial institution. Consistent with their premise that latent errors result from the increased demands on organizational attention associated with organizational change, the authors found that changes in multiple organizational domains was positively related to the frequency of latent errors. Moreover, this relationship was only observed for changes that had an adverse impact on managerial time, expertise, and/or work coordination. Implications for research on organizational change and latent errors, as well as for managers, are discussed.</p