Evidence for Batesian mimicry in a polymorphic hoverfly

Palatable Batesian mimics are avoided by predators because they resemble noxious or defended species. The striking resemblance of many hoverflies to noxious Hymenoptera is a “textbook” example of Batesian mimicry, but evidence that selection by predators has shaped the evolution of hoverfly patterns is weak. We looked for geographical and temporal trends in frequencies of morphs of the polymorphic hoverfly Volucella bombylans that would support the hypothesis that these morphs are Batesian mimics of different bumblebee species. The frequency of the black and yellow hoverfly morph was significantly positively related to the frequency of black and yellow bumblebees across 52 sites. Similarly, the frequency of the red-tailed hoverfly morph was positively related to the frequency of red-tailed bumblebees. However, the frequencies of hoverfly morphs were positively spatially autocorrelated, and after controlling for this, only one of the two common hoverfly morphs showed a significant positive relationship with its putative model. We conclude that the distribution of V. bombylans morphs probably reflects geographical variation in selection by predators resulting from differences in the frequencies of noxious bumblebee species

Measuring and improving safety culture in the aviation industry

Europe has approximately 40 air navigation service providers employing over 50,000 staff and coordinating up to 30,000 flights a day. Two mid-air collisions, Milan Linate in 2001 and Überlingen in 2002, revealed serious problems in the safety culture of these service providers. Tom Reader developed a methodology for systematically measuring safety culture in air traffic management, which has contributed to stronger European air safety

Stakeholder safety communication: patient and family reports on safety risks in hospitals

Safety communication relates to the sharing of safety information within organizations in order to mitigate hazards and improve risk management. Although risk researchers have predominantly investigated employee safety communication behaviors (e.g. voice), a growing body of work (e.g. in healthcare, transport) indicates that public stakeholders also communicate safety information to organizations. To investigate the nature of stakeholder safety communication behaviors, and their possible contribution to organizational risk management, accounts from patients and families – recorded in a government public inquiry – about trying to report safety risks in an unsafe hospital were examined. Within the inquiry, 410 narrative accounts of patients and families engaging in safety communication behaviors (voicing concerns, writing complaints, and whistleblowing) were identified and analyzed. Typically, the aim of safety communication was to ensure hospital staff addressed safety risks that were apparent and impactful to patients and families (e.g. medication errors, clinical neglect), yet unnoticed or uncorrected by clinicians and administrators. However, the success of patient and family safety communication in ameliorating risk was variable, and problems in hospital safety culture (e.g. high workloads, downplaying safety problems) meant that information provided by patients and families was frequently not acted upon. Due to their distinct role as independent service-users, public stakeholders can potentially support organizational risk management through communicating on safety risks missed or not addressed by employees and managers. However, for this to happen, there must be capacity and openness within organizations for responding to safety communication from stakeholders

Investigating organisational culture from the ‘outside’, and implications for investing

Dr Alex Gillespie and Dr Tom Reader consider how organizational culture can be researched from ‘outside’ an organization and what dimensions could be of particular interest for potential investment decisions

What can acute medicine learn from qualitative methods?

Purpose of review: The contribution of qualitative methods to evidence-based medicine is growing, with qualitative studies increasingly used to examine patient experience and unsafe organizational cultures. The present review considers qualitative research recently conducted on teamwork and organizational culture in the ICU and also other acute domains. Recent findings: Qualitative studies have highlighted the importance of interpersonal and social aspects of healthcare on managing and responding to patient care needs. Clear/consistent communication, compassion, and trust underpin successful patient-physician interactions, with improved patient experiences linked to patient safety and clinical effectiveness across a wide range of measures and outcomes. Across multidisciplinary teams, good communication facilitates shared understanding, decision-making and coordinated action, reducing patient risk in the process. Summary: Qualitative methods highlight the complex nature of risk management in hospital wards, which is highly contextualized to the demands and resources available, and influenced by multilayered social contexts. In addition to augmenting quantitative research, qualitative investigations enable the investigation of questions on social behaviour that are beyond the scope of quantitative assessment alone. To develop improved patient-centred care, health professionals should therefore consider integrating qualitative procedures into their existing assessments of patient/staff satisfaction

Safety culture in financial trading: an analysis of trading misconduct investigations

High-profile failures in financial trading have led to interest in how the culture of the industry produces risky and unethical behaviours amongst traders. Yet, there is no established theoretical framework for studying this: we apply safety culture theory to examine ten recent high-profile trading mishaps investigated by the UK financial regulator. The results show that the dimensions of safety culture (e.g. management commitment to safety, systems and procedures) used to understand organisational accidents in domains such as aviation also explain failures in risk management within financial trading organisations. This counters narratives focusing on traders who are unethical ‘rule breakers’, and emphasise the value of a systemic approach, whereby safety culture theory is used to explain why risky behaviours in financial trading occur. Safety culture therefore provides a conceptual basis for further research on risky and unethical behaviours in financial trading, alongside providing insights for possible intervention

Using hospital complaints to improve patient safety

LSE colleagues from the Department of Social Psychology consider the untapped reserve of data that could be used to improve hospital patient safety: hospital complaints. Guest bloggers Dr Tom Reader and Dr Alex Gillespie explain how the analysis of this untapped data could inform future learning

Human factors in financial trading: an analysis of trading incidents

Objective: This study tests the reliability of a system (FINANS) to collect and analyse incident reports in the financial trading domain, and is guided by a human factors taxonomy used to describe error in the trading domain. Background: Research indicates the utility of applying human factors theory to understand error in finance, yet empirical research is lacking. We report on the development of the first system for capturing and analysing human factors-related issues in operational trading incidents. Method: In study 1, 20 incidents are analysed by an expert user group against a referent standard to establish the reliability of FINANS. Study 2 analyses 750 incidents using distribution, mean, pathway and associative analysis to describe the data. Results: Kappa scores indicate that categories within FINANS can be reliably used to identify and extract data on human factors-related problems underlying trading incidents. Approximately 1% of trades (n=750) lead to an incident. Slip/lapse (61%), situation awareness (51%), and teamwork (40%) were found to be the most common problems underlying incidents. For the most serious incidents, problems in situation awareness and teamwork were most common. Conclusion: We show that (i) experts in the trading domain can reliably and accurately code human factors in incidents, (ii) 1% of trades incur error and (iii) poor teamwork skills and situation awareness underpin the most critical incidents. Application: This research provides data crucial for ameliorating risk within financial trading organizations, with implications for regulation and policy

Patient neglect in healthcare institutions: a systematic review and conceptual model

Background Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error. Method The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect. Results Patient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients. Conclusion A social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and health policy to reduce patient neglect

The healthcare complaints analysis tool: development and reliability testing of a method for service monitoring and organisational learning

Background Letters of complaint written by patients and their advocates reporting poor healthcare experiences represent an under-used data source. The lack of a method for extracting reliable data from these heterogeneous letters hinders their use for monitoring and learning. To address this gap, we report on the development and reliability testing of the Healthcare Complaints Analysis Tool (HCAT). Methods HCAT was developed from a taxonomy of healthcare complaints reported in a previously published systematic review. It introduces the novel idea that complaints should be analysed in terms of severity. Recruiting three groups of educated lay participants (n=58, n=58, n=55), we refined the taxonomy through three iterations of discriminant content validity testing. We then supplemented this refined taxonomy with explicit coding procedures for seven problem categories (each with four levels of severity), stage of care and harm. These combined elements were further refined through iterative coding of a UK national sample of healthcare complaints (n= 25, n=80, n=137, n=839). To assess reliability and accuracy for the resultant tool, 14 educated lay participants coded a referent sample of 125 healthcare complaints. Results The seven HCAT problem categories (quality, safety, environment, institutional processes, listening, communication, and respect and patient rights) were found to be conceptually distinct. On average, raters identified 1.94 problems (SD=0.26) per complaint letter. Coders exhibited substantial reliability in identifying problems at four levels of severity; moderate and substantial reliability in identifying stages of care (except for ‘discharge/transfer’ that was only fairly reliable) and substantial reliability in identifying overall harm. Conclusions HCAT is not only the first reliable tool for coding complaints, it is the first tool to measure the severity of complaints. It facilitates service monitoring and organisational learning and it enables future research examining whether healthcare complaints are a leading indicator of poor service outcomes. HCAT is freely available to download and use