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BackgroundQuality improvement efforts are inextricably linked to the readiness of healthcare workers to take them on. The current study aims to clarify the nature and measurement of Improvement Readiness (IR) by 1) examining the psychometric properties of a novel IR scale, 2) assessing relationships between IR and other safety culture domains 3) exploring whether IR differs by healthcare worker demographic factors, and 4) examining linguistic differences in word type use between high and low scoring IR work settings from their free text responses.MethodsOf 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate 81%) completed the 5-item IR scale, demographics, safety culture scales, and two open-ended questions. Psychometric analyses, correlations and ANOVAs tested the properties of IR. Linguistic Inquiry Word Count software assessed comments from open-ended questions.ResultsThe IR scale exhibited strong psychometric properties and a one factor model fit the data well (Cronbach’s alpha = .93; RMSEA = .07; CFI = 99; TLI = .99). IR scores differed significantly by role, shift, shift length, and years in specialty. IR correlated significantly and in expected directions with safety culture scales. Linguistic analyses revealed that people in low versus high IR work settings used significantly more words in their responses, and specifically more past tense verbs (e.g., “ignored”), negative emotion words (e.g., “upset”), and first person singular (“I”). Workers from high IR work settings used significantly more positive emotions words (e.g., “grateful”) and social words (e.g., “team”).ConclusionThe IR scale exhibits strong psychometric properties, is associated with better safety and teamwork climate, lower burnout, and predicts linguistic differences in high versus low IR groups.

Background During the COVID-19 pandemic, there have been an increasing number of emergency department (ED) visits for behavioral health reasons, even as overall ED volumes have decreased. The impact of the pandemic and related public health interventions on specialized psychiatric emergency services has not been described. These services provide high intensity care for severely ill patients who are likely to be homeless and underserved. Objective We describe the change in total volume and psychiatric hospitalization rates among three psychiatric emergency services across the United States. Methods Change in volumes and hospitalization were assessed for statistical significance using a seasonal autoregressive integrated moving average with exogenous factors model from January 2018 to December 2020. Results The pandemic’s impact on volumes and hospitalization varied by site. In Denver (CO), there was a statistically significant 9% decrease in overall volumes, although an 18% increase in hospitalizations was not significant. In New York City (NY), there was a significant 7% decrease in volumes as well as a significant 6% decrease in hospitalizations. In Portland (OR), volumes decreased by 4% and hospitalizations increased by 6% although differences did not reach statistical significance. Conclusion There has been a decrease in volume at these service after the pandemic, but there are substantial variations in the magnitude of change and demand for hospitalization by region. These findings suggest a need to understand where patients in crisis are seeking care and how systems of care must adapt to changing utilization in the pandemic era.

Physicians are among the highest risk groups for suicide, and emerging data suggest this risk begins early in medical training. We describe a screening program at one medical center for identifying and referring physicians and students who may be at risk for suicide, and we explore differences between groups with respect to depressive symptoms, suicidal ideation (SI) and behaviors, and utilization of mental health resources. Over a 5-year period (May 2009–August 2014), we invited 1,134 medical students, 1,380 house staff (residents and fellows), and 1,922 faculty to complete an anonymous web-based “stress” questionnaire including items about depression symptoms, SI and behaviors, emotional distress features, drinking and drug-use behaviors, problematic eating, and utilization of treatments for depression and anxiety. Response rates among each group ranged from 17% (house staff) to 33% (students). Overall, 7% to 10% of respondents met criteria for a current major depressive syndrome, and 9% to 11% of respondents endorsed current SI. Similarities in depression severity and SI between groups far outweighed differences. The following were the four unique predictors of SI: presence of moderately severe or severe depressive symptoms, impairment, hopelessness, and past attempts. Only 17% of those endorsing current SI were taking antidepressant medication, and only 12% were receiving psychotherapy. However, 16% accepted referrals provided through this program. Increased efforts at education and destigmatization, outreach, assessment, and treatment at medical schools are essential. Our educational and screening program is one model others might employ to work toward this goal, though it is likely that additional outreach methods are needed.