ObjectivesTo explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous.DesignSystematic literature review of quantitative and qualitative empirical studies.Data sourcesDatabase searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020.Eligibility criteriaOriginal empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care.Data extraction and synthesisOf the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020.ResultsBased on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership.ConclusionsAlthough a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.
Background Strain episodes, defined as phases of higher workload, stress or negative emotions, occur everyday in the operating room (OR). Accurate knowledge of when strain is most intense for the different OR team members is imperative for developing appropriate interventions. The primary goal of the study was to investigate temporal patterns of strain across surgical phases for different professionals working in the OR, for different types of operations. Methods We developed a guided recall method to assess the experience of strain from the perspective of operating room (OR) team members. The guided recall was completed by surgeons, residents, anesthesiologists, circulating nurses and scrub technicians immediately after 113 operations, performed in 5 departments of one hospital in North America. We also conducted interviews with 16 surgeons on strain moments during their specific operation types. Strain experiences were related to surgical phases and compared across different operation types separately for each profession in the OR. Results We analyzed 693 guided recalls. General linear modeling (GLM) showed that strain varied across the phases of the operations (defined as before incision, first third, middle third and last third) [quadratic (F = 47.85, p < 0.001) and cubic (F = 8.94, p = 0.003) effects]. Phases of operations varied across professional groups [linear (F = 4.14, p = 0.001) and quadratic (F = 14.28, p < 0.001) effects] and surgery types [only cubic effects (F = 4.92, p = 0.001)]. Overall strain was similar across surgery types (F = 1.27, p = 0.28). Surgeons reported generally more strain episodes during the first and second third of the operations; except in vascular operations, where no phase was associated with significantly higher strain levels, and emergency/trauma surgery, where strain episodes occurred primarily during the first third of the operation. Other professional groups showed different strain time patterns. Conclusions Members of the OR teams experience strain differently across the phases of an operation. Thus, phases with high concentration requirements may highly vary across OR team members and no single phase of an operation can be defined as a “sterile cockpit” phase for all team members.
This research presents the development of a short scale named "NOTECHS+" to measure the Non-Technical Skills (i.e., NOTECHS: Cooperation, Leadership and Managerial skills, Decision-Making, and Situational Awareness), Resilience and Emotion Regulation, in a sector that comprises the aviation and the emergency personnel: the Helicopter Emergency Medical Service (HEMS). The design process of the scale was carried out starting from a review on the behavioral markers used to detect the NOTECHS. Moreover, 70 interviews with HEMS experts have been conducted with the aim of developing Resilience and Emotion Regulation items by considering the different professional profiles (e.g., pilots, nurses, physicians, etc.) which compose the HEMS. Through a pre-assessment procedure, a Q-Sort test was performed on a sample of students (n = 30) to test the logical principles, but also intelligibility and clarity, of the items developed. Once the instrument was defined, 211 participants from the HEMS sector were surveyed to test the theoretical model behind the NOTECHS+ instrument. First exploratory and then confirmatory analysis yielded results that suggested that the 18 items selected conform to a bi-factor model composed of three skill-dimensions: Social skills (i.e., Cooperation, and Leadership and Managerial skills), Cognitive skills (i.e., Decision-Making and Situational Awareness) and Emotional skills (i.e., Resilience and Emotional Regulation). Finally, the study ends with a discussion on the results obtained, including practical implications on assessment and training based on this novel instrument.
A survey of human factors practitioners working in health care was administered to understand their challenges and successes encountered when responding to the COVID-19 pandemic. Focus areas identified by survey respondents related to workflow, physical environments, communication, and implementation of new technologies. The results from this study can be used by human factors practitioners to demonstrate the common challenges and opportunities for applying human factors to system redesign within their health care organizations. These findings can also be used to encourage investments in human factors by health care organizations and the federal government.
In the framework of positive psychology approach, the present study reports the effect of a mixed human resources (HR) intervention program. We developed an intervention by the integration of the classic resource‐based intervention with the specific strength training program named FAMILY. Then, we examined the extent to which such a combined intervention enhanced commitment, work engagement, job performance, and decreasing exhaustion of the participants. N = 69 sales consultants operating in an Italian pharmaceutical company participated in our study. To monitor the interventions used, participants had to complete a diary with self‐report measures on the dimensions considered for four weeks. Data were analyzed by using growth models to study the variability of the dimensions considered overtime. Afterward, we used multilevel model analyses to test the associations between them. Our results showed that our combined training intervention increased in‐role and extra‐role performance, emotional commitment, and decreased the reported exhaustion level of the employees. Moreover, relationships among such dimensions have been explored in relation to antecedents that affect them (i.e., negative and positive emotions experienced, and job demands, and resources).
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