Transferring Aviation Practices into Clinical Medicine for the Promotion of High Reliability

Powell-Dunford, Nicole; McPherson, Mark; Pina, Joseph S; Gaydos, Steven

doi:10.3357/amhp.4736.2017

Cited by 14 publications

(7 citation statements)

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“…Indeed, high-reliability organizations have recognized that to succeed in creating a psychologically safe practice environment, certain high-risk communications should be structured with critical language that effectively allows for all team members to grasp the meaning. 50 The Agency for Healthcare Research and Quality advocates for empowering all members of the care team, including patients, with escalating assertive statements, easily recalled by the acronym CUS (I am Concerned, I am Uncomfortable, this is a Safety issue). 51 The clinician's response to that engagement is of paramount importance.…”

Section: Fostering Trust and Communicationmentioning

confidence: 99%

When Patients and Their Families Feel Like Hostages to Health Care

Berry

Danaher

Beckham

et al. 2017

Mayo Clinic Proceedings

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Patients are often reluctant to assert their interests in the presence of clinicians, whom they see as experts. The higher the stakes of a health decision, the more entrenched the socially sanctioned roles of patient and clinician can become. As a result, many patients are susceptible to "hostage bargaining syndrome" (HBS), whereby they behave as if negotiating for their health from a position of fear and confusion. It may manifest as understating a concern, asking for less than what is desired or needed, or even remaining silent against one's better judgment. When HBS persists and escalates, a patient may succumb to learned helplessness, making his or her authentic involvement in shared decision making almost impossible. To subvert HBS and prevent learned helplessness, clinicians must aim to be sensitive to the power imbalance inherent in the clinician-patient relationship. They should then actively and mindfully pursue shared decision making by helping patients trust that it is safe to communicate their concerns and priorities, ask questions about the available clinical options, and contribute knowledge of self to clinical decisions about their care. Hostage bargaining syndrome is an insidious psychosocial dynamic that can compromise quality of care, but clinicians often have the power to arrest it and reverse it by appreciating, paradoxically, how patients' perceptions of their power as experts play a central role in the care they provide.

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Section: Fostering Trust and Communicationmentioning

confidence: 99%

When Patients and Their Families Feel Like Hostages to Health Care

Berry

Danaher

Beckham

et al. 2017

Mayo Clinic Proceedings

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show abstract

“…The CCTT should check all the equipment, medication, supplies before they leave the referring hospital. A complete and practical checklist is necessary for HST transport, which can improve CCTT-oriented workflow through both routine and unexpected situations for good outcomes 8 . During air medical transport, checklists can improve team performance through the prevention of errors and complications 9 .…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of high-speed train transport for critical children: a retrospective propensity score matching cohort study

Zhao

Liu

Yang

et al. 2021

Sci Rep

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It is widely acknowledged that efficiency of pediatric critical care transport plays a vital role in treatment of critically-ill children. In developing countries, most critically-ill children were transported by ambulance, and a few by air, such as a helicopter or fixed airplane. High-speed train (HST) transport may be a potential choice for critically-ill children to a tertiary medical center for further therapy. This is a single-center, retrospective cohort study from June 01, 2016 to June 30, 2019. All the patients transported to the Pediatric Intensive Care Unit (PICU) of PLA general hospital were divided into two groups, HST group and ambulance group. The propensity score matching method was performed for the comparison between the two groups. Finally, a 2:1 patient matching was performed using the nearest-neighbor matching method without replacement. The primary outcome was hospital mortality. Secondary outcomes included duration of transport, transport cost, hospital stay, and hospitalization cost. A total of 509 critically-ill children were transported and admitted. Of them, 40 patients were transported by HST, and 469 by ambulance. The hospital mortality showed no difference between the two groups (p > 0.05). The transport distance in the HST group was longer than that in the ambulance group (1894.5 ± 907.09 vs. 902.66 ± 735.74, p < 0.001). However, compared to the HST group, the duration of transport time by ambulance was significantly longer (p < 0.001). No difference in vital signs, blood gas analysis, and critical illness score between groups at admission was noted (p > 0.05). There was no death during the transport. There was no difference between groups regarding the transport cost, hospital stays, and hospitalization cost (p > 0.05). High-quality tertiary medical centers are usually located in megacities. HST transport network for critically-ill children could be established to cover most regions of the country. Without increasing financial burden, HST medical transport can be a potentially promising option to improve the outcomes of critically-ill children in developing countries with developed HST network.Clinical Trial Registration: This study was registered at http://www.chictr.org.cn/index.aspx (chiCTR.gov; Identifier: ChiCTR2000032306).

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“…A aviação é um exemplo clássico de Organizações de Alta Confiabilidade (HROs), as quais são definidas como aquelas que operam em ambientes com alta exposição a condições de risco, porém acabam por adaptar-se a mudanças não esperadas de cenários, conduzindo sua entrega final próxima à margem zero de erro e sem eventos catastróficos (POWELL-DUNFORD et al, 2017). Para tal, sempre estão em busca de duas abordagens essenciais: -Prevenção (antecipação): envolve identificar riscos que podem levar a eventos não planejados, criando processos para evitá-los.…”

Section: A Avaliação Da Simulação Interprofissionalunclassified

“…A história por trás da alta confiabilidade está na pesquisa conduzida na Universidade de Berkeley, Califórnia, por Laporte, Rochlin e Roberts, que examinaram semelhanças entre controle do tráfego aéreo, companhias comerciais de aviação e plantas nucleares. Os autores destacaram que a utilização adequada das habilidades não técnicas (soft skills) e a implementação de processos que apoiam o profissional em tarefas complexas, o que pode ser facilitado pela utilização de tecnologias ((POWELL-DUNFORD et al, 2017).…”

Section: A Avaliação Da Simulação Interprofissionalunclassified

Simulação em saúde para ensino e avaliação: conceitos e práticas

Médica¹

2021

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Educação na Saúde (SGTES) do Ministério da Saúde do Brasil formalizou um intercâmbio de políticas e práticas sobre demografia médica, avaliação de competências dos profissionais da saúde e centros de simulação realística com a Conselheria de Igualdade, Saúde e Políticas Sociais da Junta de Andaluzia, Espanha. Após as mudanças decorrentes da publicação da Lei 12.871/2013 (Programa Mais Médicos para o Brasil), colocou-se em pauta a ordenação da formação de profissionais de saúde pelo SUS, postulando-se nessa parceria, entre outras ações, a transferência de tecnologia para construção de centros de simulação realística em saúde no Brasil. A partir deste primeiro acordo e de oficinas de formação e desenvolvimento, a Ebserh foi incorporada à proposta e realizou-se com os professores de Andaluzia uma oficina na Universidade Federal de São Carlos, UFSCar, na perspectiva de mobilizar centros de formação em simulação realística no SUS, voltados para educação permanente de profissionais de saúde e também para formação de estudantes e residentes. Este foi o primeiro movimento que, após anos, resultou na presente carta-acordo que possibilitou à ABEM, em parceria com a OPAS, SGTES, Ebserh, realizar o Projeto "Desenvolvimento da Rede de centros de Simulação Clínica: elaboração de curso para capacitação de multiplicadores".

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Transferring Aviation Practices into Clinical Medicine for the Promotion of High Reliability

Cited by 14 publications

References 0 publications

When Patients and Their Families Feel Like Hostages to Health Care

When Patients and Their Families Feel Like Hostages to Health Care

The safety and efficacy of high-speed train transport for critical children: a retrospective propensity score matching cohort study

Simulação em saúde para ensino e avaliação: conceitos e práticas

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