The Michigan Action Progress System (MAPS): Enhancing a Culture of Professionalism, Accountability, and Psychological Safety

McMichael, Brennan; Kemp, Michael T.; Engler, Tedi A.; Bamdad, Michaela; Perrone, Erin E.; Kwakye, Gifty; Mohr, David C.; Palazzolo, William C.; Sonnenday, C.J.; Sandhu, Gurjit

doi:10.1016/j.jsurg.2022.08.007

Cited by 3 publications

(3 citation statements)

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“…Thus, it should be viewed as one component of a larger program to address and reduce incivility and additional interventions should be explored to complement and extend the findings for longer-term culture change. For example, implementing new systems for staff to report incivility without fear of retribution or judgment can enhance well-being [ 55 , 56 ]. Additional research is needed into mechanisms that address facilitating communication and getting people on the same page about team dynamics.…”

Section: Discussionmentioning

confidence: 99%

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention

Ostroff,

Benincasa,

Rae

et al. 2023

PLoS ONE

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Incivility in surgery is prevalent and negatively impacts effectiveness and staff well-being. The purpose of this study was to a) examine relationships between incivility, team dynamics, and well-being outcomes, and b) explore a low-cost intervention of ‘eye’ signage in operating theater areas to reduce incivility in surgical teams. A mixed methods design was used in an orthopedic hospital. Surveys of incivility, teamwork, and well-being were administered three months apart in a small private hospital. An intervention of signage with eyes was placed in the theater area after administration of the first survey, using a pretest-posttest design. Participants also responded to an open-ended question about suggestions for improvements at the end of the survey which was then thematically analyzed. At the individual level (n = 74), incivility was statistically significantly related to team dynamics which in turn was significantly related to burnout, stress, and job attitudes. At the aggregate level, reported incivility was statistically significantly lower after the ‘eye’ sign intervention. Thematic analysis identified core issues of management behaviors, employee appreciation, communication, and work practices. Incivility in surgical teams has significant detrimental associations with burnout, stress, and job attitudes, which occurs through its impact on decreased team dynamics and communication. A simple intervention that evokes perceptions of being observed, such as signage of eyes in theater areas, has the potential to decrease incivility at least in the short term, demonstrating that incivility is amenable to being modified. Additional research on targeted interventions to address incivility are needed to improve teamwork and staff well-being.

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Section: Discussionmentioning

confidence: 99%

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention

Ostroff,

Benincasa,

Rae

et al. 2023

PLoS ONE

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“…Faculty and trainees should be able to safely report instances of discrimination, harassment, microaggressions, racism, and other concerns without fear of retaliation or humiliation. A psychologically safe space to report concerns is an important contributor to promote accountability and professionalism ( 85 , 95 , 127 ), as well as transparency regarding data and statistics related to reported DEI issues for accountability. Strategies to improve reporting include 1 ) the implementation and encouragement of an institution-wide, multimodal reporting system in which faculty, fellows, residents, students, staff, and patients can report bias-related incidents, discrimination, racism, micro- and macroaggressions, and racial abuse; 2 ) demonstration of ongoing and transparent commitment to address and reconcile critical incidents that have been reported or witnessed; 3 ) the requirement of all managers to be trained in conflict resolution and appropriate handling reports to create a safe space for staff to report these incidents; and 4 ) the inclusion of metrics on reducing incidents of discrimination, racism, and micro- and macroaggressions in annual review cycles and promotions.…”

Section: Subcommittee Recommendations To Improve Diversity In the Ped...mentioning

confidence: 99%

Diversity, Equity, and Inclusion in the Pediatric Pulmonary Workforce: An Official American Thoracic Society Workshop Report

Stephenson,

Forno,

Laguna

et al. 2023

Annals ATS

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Despite growing recognition of the need for increased diversity among students, trainees, and faculty in health care, the medical workforce still lacks adequate representation from groups historically underrepresented in medicine (URiM). The subspecialty field of pediatric pulmonology is no exception. Although there have been efforts to address issues of diversity, equity, and inclusion (DEI) in our own field, gaps persist. To address these gaps, the members of the Diversity, Equity, and Inclusion Advisory Group (DEI-AG) of the American Thoracic Society Pediatrics Assembly created and distributed a Needs Assessment Survey in the United States and Canada to better understand the racial and ethnic demographics of the pediatric pulmonary workforce and to learn more about successes, gaps, and opportunities to enhance how we recruit, train, and retain a diverse workforce. The DEI-AG leadership cochairs convened a workshop to review the findings of the DEI Needs Assessment Survey and to develop strategies to improve the recruitment and retention of URiM fellows and faculty. This Official ATS Workshop Report aims to identify barriers and opportunities for recruitment, training, and career development within the field of pediatric pulmonology. Additionally, we offer useful strategies and resources to improve the recruitment of URiM residents, the mentorship of trainees and junior faculty, and the career development of URiM faculty in academic centers. This Workshop Report is an important first deliverable by the DEI-AG. We hope that this work, originating from within the Pediatrics Assembly, will serve as a model for other Assemblies, disciplines across the ATS, and other fields in Pediatrics.

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“…Such results further reinforce the imperative to implement effective interventions to reduce these behaviours. Despite increased adoption of professional accountability programs [ 17 , 19 – 22 ], evidence of their effectiveness to drive organisational-wide culture change and significantly reduce the overall prevalence of unprofessional behaviours is absent.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals

Westbrook,

Urwin,

McMullan

et al. 2024

BMC Health Serv Res

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Background Unprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program “Ethos” implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for ‘reflection’ or ‘recognition’. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos. Methods A survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5–3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as ‘extreme’ (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics. Results In total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32–41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message. Conclusion The Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers.

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The Michigan Action Progress System (MAPS): Enhancing a Culture of Professionalism, Accountability, and Psychological Safety

Cited by 3 publications

References 9 publications

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention

Diversity, Equity, and Inclusion in the Pediatric Pulmonary Workforce: An Official American Thoracic Society Workshop Report

Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals

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