Taking medication requires developing plans to accomplish the activity. This planning challenges older adults because of age-related cognitive limits and inadequate collaboration with health providers. The authors investigated whether an external aid (medtable) supports collaborative planning in the context of a simulated patient/provider task in which pairs of older adults worked together to create medication schedules. Experiment 1 compared pairs who used the medtable, blank paper (unstructured aid), or no aid to create schedules varying in complexity of medication constraints (number of medications and medication co-occurrence restrictions) and patient constraints (available times during the day to take medication). Both aids increased problem-solving accuracy and efficiency (time per unit accuracy) compared to the no-aid condition, primarily for more complex schedules. However, benefits were similar for the two aids. In Experiment 2, a redesigned medtable increased problem-solving accuracy and efficiency compared to blank paper. Both aids presumably supported problem solving by providing a jointly visible workspace for developing schedules. The medtable may be more effective because it externalizes constraints (relationships between medication and patient information), so that participants can more easily organize information.
Recently, leading healthcare providers have adopted the principles of just culture to guide their organizations in learning from mistakes to ultimately improve patient safety. To do this, they have adopted an approach to foster active learning wherein members of an organization are encouraged to openly discuss errors without the fear of reprisals. This paper reports results from a just culture survey that was developed at the University of Illinois as part of a patient safety fellowship project. As part of a team, participating hospitals agreed to take part in the study and creation of a "just" culture of shared accountability. Overall results from the survey indicate a slightly positive perception of just culture, but detailed analysis revealed significant differences in the perception of a just culture across professions and departments.
While much is known about differences in decision making outcomes related to pilot expertise, less is known about the processes that underlie these differences. We explored expertise differences in decision making processes by simultaneously measuring expert and novice pilots' attention, using eye-tracking, and their decision outcomes in a realistic context. We also investigated how expertise differences in pilots' attentional strategies were influenced by cue properties of diagnosticity and correlation. Fourteen expert and 14 novice pilots flew brief simulated flights. Half the flights contained failures that required diagnosis and an action (i.e., a decision). The environmental cues that signaled these failures varied in diagnosticity and/or correlation. We found that experts made better decisions than novices in terms of speed and accuracy. Both groups made faster correct decisions when cues were higher in diagnosticity. Only experts made faster correct decisions when cues were correlated. Experts attended more to cues relevant to the failure when a failure was present. Findings suggest that expertise differences in decision outcomes partly reflect attentional strategies relevant to problem diagnosis.
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