PubMed Health⌕ Search

Biomedical subjects

G Ross Baker

Publications and source records attributed to G Ross Baker.

At least 19 recordsLinked to original sources
PubMed2006

Error or "act of God"? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure.

BACKGROUND: Calls abound for a culture change in health care to improve patient safety. However, effective change cannot proceed without a clear understanding of perceptions and beliefs about error. In this study, we describe and compare operative team members' and patients' perceptions of error, reporting of error, and disclosure of error. METHODS: Thirty-nine interviews of team members (9 surgeons, 9 nurses, 10 anesthesiologists) and patients (11) were conducted at 2 teaching hospitals using 4 scenarios as prompts. Transcribed responses to open questions were analyzed by 2 researchers for recurrent themes using the grounded-theory method. Yes/no answers were compared across groups using chi-square analyses. RESULTS: Team members and patients agreed on what constitutes an error. Deviation from standards and negative outcome were emphasized as definitive features. Patients and nurse professionals differed significantly in their perception of whether errors should be reported. Nurses were willing to report only events within their disciplinary scope of practice. Although most patients strongly advocated full disclosure of errors (what happened and how), team members preferred to disclose only what happened. When patients did support partial disclosure, their rationales varied from that of team members. CONCLUSIONS: Both operative teams and patients define error in terms of breaking the rules and the concept of "no harm no foul." These concepts pose challenges for treating errors as system failures. A strong culture of individualism pervades nurses' perception of error reporting, suggesting that interventions are needed to foster collective responsibility and a constructive approach to error identification.

Adult↗
PubMed2006

Towards safer interprofessional communication: constructing a model of "utility" from preoperative team briefings.

"Improved team communication" is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative "utility", defined as the visible impact of communication on team awareness and behavior. "Informational utility" occurred when team awareness or knowledge was improved by provision of new information, explicit confirmation, reminders, or education. "Functional utility" represented direct communication - work connections: many briefings identified problems, prompting decision-making and follow-up actions. The crux of the model is an elaboration of the causal pathway between a specific communication practice (the team briefing), intermediary processes such as enhanced knowledge and purposeful action, and the quality and safety of collaborative care processes. Modeling this pathway is a critical step in promoting change, as it renders visible both the latent dangers present in current team communication systems and the specific ways in which altered communication patterns can impact team awareness and behaviors.

Communication↗
PubMed2005

Progressive independence in clinical training: a tradition worth defending?

BACKGROUND: Progressive independence is a traditional premise of clinical training. Recently, issues such as managed care, work hours limitation, and patient safety have begun to impact the degree of autonomy afforded to clinical trainees. This article reviews empirical evidence and theory pertaining to the role of progressive autonomy in clinical learning. METHOD: A computerized literature search was performed using Medline, PsycINFO, Social Sciences Citation Index, and Educational Resources Information Center. This article presents a synthetic review of relevant empirical and theoretical concepts from the domains of medicine, psychology, education, kinesiology, and sociology. RESULTS: The clinical psychology and medical education literatures provide evidence that clinical trainees act more independently as their training progresses, but have not yet evaluated the educational efficacy of providing progressive independence, or the consequences of failing to do so. The expertise and motor learning literatures provide some theoretical evidence (as yet untested in complex clinical environments) that the provision of too much guidance or feedback to trainees could be educationally detrimental in the long term. The sociology literature provides insight into the cultural values underlying the behavior of clinical teachers and trainees relating to issues of supervision and independence. CONCLUSIONS: There is limited empirical support for the current model of progressive independence in clinical learning; however, diverse theoretical perspectives raise concern about the potential educational consequences of eroding progressive independence. These perspectives could inform future research programs that would create a creative and effective response to the social and economic forces impacting clinical education.

Counseling↗
PubMed2005

Acute care hospital strategic priorities: perceptions of challenges, control, competition and collaboration in Ontario's evolving healthcare system.

To explore the current and pending strategic agenda of Ontario hospitals (the largest consumers of the provincial healthcare budget), a survey of Ontario acute care hospital CEOs was conducted in January 2004. The survey, with an 82% response rate, identifies 29 strategic priorities under seven key strategic themes consistent across different hospital types. These themes include (1) human resources cultivation, (2) service integration and partnerships, (3) consumer engagement, (4) corporate governance and management, (5) organizational efficiency and redesign, (6) improved information use for decision-making, (7) patient care management. The extent to which an individual hospital's control over strategic resolutions is perceived may affect multilevel strategic priority-setting and action-planning. In addition to supporting ongoing development of meaningful performance measures and information critical to strategic decision-making, this study's findings may facilitate a better understanding of hospitals' key resource commitments, the extent of competition and collaboration for key resources, the perceived degree of individual control over strategic issue resolution and where systemic resolutions may be required.

Attitude of Health Personnel↗
PubMed2004

The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.

BACKGROUND: Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals. METHODS: We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify AEs and determine their preventability. RESULTS: At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7- 9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%-41.8%) and death in 20.8% (95% CI 7.8%-33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016). INTERPRETATION: The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.

Canada↗
PubMed2004

Competing values of emergency department performance: balancing multiple stakeholder perspectives.

OBJECTIVE: To describe the performance interests of multiple stakeholders associated with the management and delivery of emergency department (ED) care, and to develop a performance framework and set of indicators that reflect these interests. STUDY SETTING: Stakeholders (1,100 physicians, nurses, managers, home care providers, and prehospital care personnel) with responsibility for ED patients in hospitals in the Canadian province of Ontario. STUDY DESIGN: Sixty-two percent of stakeholders responded to a mail survey regarding the importance of 104 potential ED performance indicators. Descriptive and inferential statistics are used to explore the interests of each stakeholder group and to compare interests across the five groups. PRINCIPAL FINDINGS: Emergency department stakeholders are primarily interested in indicators that focus on their role and capacity to provide care. Key differences exist between hospital and nonhospital stakeholders. Physicians mean ratings of the importance on ED performance measures were lower than mean ratings in the other stakeholder groups. CONCLUSIONS: Emergency department performance interests are not homogeneous across stakeholder groups, and evaluating performance from the perspective of any one stakeholder group will result in unbalanced assessments. Community-based stakeholders, a group frequently excluded from commenting on ED performance, provide important insights into ED performance related to the external environment and the broader continuum of care.

Adult↗
PubMed2004

Next steps for patient safety in Canadian healthcare.

Morgan outlines some important elements necessary for improving patient safety in Canadian healthcare. But these steps are likely to require considerable time and resources and may be difficult to implement. In the light of the evidence of adverse events in Canadian hospitals, all Canadian healthcare organizations need to begin to measure the numbers and types of adverse events experienced by their patients and clients. Staff need to learn new skills for investigating and improving care. A variety of tools and resources are available for these tasks. Leadership both in senior management and on the front lines must learn to shift the focus from blaming individuals to improving systems of care. Leaders must also acknowledge that most healthcare organizations have failed to gather the necessary information on adverse events, and they must invest in building knowledge and implementing practices that reduce the current levels of injury.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Current strategies to improve patient safety in Canada: an overview of federal and provincial initiatives.

Several major news stories in the past year have highlighted adverse events in Canadian healthcare and prompted questions about whether healthcare in Canada is safe and what is being done to improve it. While individual hospitals and regions are mounting patient safety efforts, these problems are systemic and require policy and organizational responses from governments and health regions, not just individual organizations.

Canada↗
PubMed2004

Competency identification and modeling in healthcare leadership.

In line with the current interest in leadership development across many industries today, a number of competency-based educational programming initiatives have been launched in professional education. As well, the National Summit on the Future of Education and Practice in Health Management and Policy in 2001 called for the documentation of learning outcomes for continual educational improvement in health management and policy. The National Center for Healthcare Leadership (NCHL) subsequently launched a comprehensive, multi-stage process for identifying the competencies salient to distinguishing outstanding leadership performance in health management. This article describes the plan and the processes associated with NCHL's specification of a preliminary model of core competencies for leadership in health management, as well as the continued methods for refinement and validation of the model with both educators and practitioners in the field. The initial version of the NCHL Competency Model has facilitated field-wide dialogue regarding outcomes-based learning and assessment for both educational and professional development program planning. Subsequent development of the model will continue to stimulate open exchanges regarding pedagogical practice, as well as facilitate the design of leadership assessments for individuals, programs, organizations, and the field at large.

Competency-Based Education↗
PubMed2003

Nurse staffing models as predictors of patient outcomes.

BACKGROUND: Little research has been conducted that examined the intended effects of nursing care on clinical outcomes. OBJECTIVE: The objective of this study was to evaluate the impact of different nurse staffing models on the patient outcomes of functional status, pain control, and patient satisfaction with nursing care. RESEARCH DESIGN: A repeated-measures study was conducted in all 19 teaching hospitals in Ontario, Canada. SUBJECTS: The sample comprised hospitals and adult medical-surgical and obstetric inpatients within those hospitals. MEASURES: The patient's functional health outcomes were assessed with the Functional Independence Measure (FIM) and the Medical Outcome Study SF-36. Pain was assessed with the Brief Pain Inventory and patient perceptions of nursing care were measured with the nursing care quality subscale of the Patient Judgment of Hospital Quality Questionnaire. RESULTS: The proportion of regulated nursing staff on the unit was associated with better FIM scores and better social function scores at hospital discharge. In addition, a mix of staff that included RNs and unregulated workers was associated with better pain outcomes at discharge than a mix that involved RNs/RPNs and unregulated workers. Finally, patients were more satisfied with their obstetric nursing care on units where there was a higher proportion of regulated staff. CONCLUSIONS: The results of this study suggest that a higher proportion of RNs/RPNs on inpatient units in Ontario teaching hospitals is associated with better clinical outcomes at the time of hospital discharge.

Adult↗
PubMed2003

Identifying and assessing competencies: a strategy to improve healthcare leadership.

There appears to be a growing consensus that better leadership is needed in healthcare, although there is much less agreement on the specific knowledge and skills required to improve performance. This commentary suggests that the articulation of healthcare leadership and management competencies provides a framework and a language for identifying the leadership knowledge and skills required for high-quality healthcare in the 21st century.

Administrative Personnel↗
PubMed2003

Using organizational assessment surveys for improvement in neonatal intensive care.

BACKGROUND: Problems with organizational culture, lack of or poor team communications, and conflict are often seen as barriers to improvement efforts. METHODS: A survey measuring aspects of organizational culture was administered twice to staff in neonatal intensive care units participating in the Neonatal Intensive Care Unit Quality Improvement Collaborative Year 2000 collaborative. The surveys provided comparative data on coordination, teamwork and leadership, conflict management, unit leadership and unit culture. These data were summarized and fed back to NICU teams with guidance on their use. Interviews on the use of the survey were held with 12 medical directors and patient care leaders in 9 different NICUs. RESULTS: The findings indicated that all the units contacted saw themselves as committed to undertaking the organizational survey and using the results. Some units shared the data widely and initiated changes. Other units limited the distribution of data to the unit leadership. There was no apparent relationship between scores on the survey and activities undertaken. Several respondents credited the survey with helping to promote discussions about organizational and team issues. CONCLUSIONS: Future use of the survey should include additional materials to assist in disseminating the results to staff.

Data Collection↗
PubMed2002

Achieving clinical improvement: an interdisciplinary intervention.

This study evaluates whether training health care teams in continuous quality improvement methods results in improvements in the care of and outcomes for patients. Nine of the 25 teams who participated in the study were successful in improving the care/outcomes for patients. Successful teams were more effective at problem solving, engaged in more functional group interactions, and were more likely to have physician participation.

Clinical Competence↗
PubMed2002

Nurse staffing and work status in medical, surgical and obstetrical units in Ontario teaching hospitals.

This article reports on the staff mix and work status of nurses in the adult medical, surgical and obstetrical units in Ontario's teaching hospitals. While staff nurses have extensive career experience, most have been on their unit a much shorter period of time. More than one-third of the nursing staff in the study were employed on a part-time or casual basis, with few indicating an interest in moving into full-time positions. The need for enhanced retention strategies on these units is identified, as well as the development of a better understanding of motivating factors for nurses' regarding full-time, part-time or casual work options.

Adult↗