Search

Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has long recognized and championed increasing diversity within the surgical workplace. SAGES initiated the Fundamentals of Leadership Development (FLD) Curriculum to address these needs and to provide surgeon leaders with the necessary tools and skills to promote diversity, equity, and inclusion (DEI) in surgical practice. In 2019, the American College of Surgeons issued a request for anti-racism initiatives which lead to the partnering of the two societies. The primary goal of FLD was to create the first surgeon-focused leadership curriculum dedicated to DEI. The rationale/development of this curriculum and its evaluation/feedback methods are detailed in this White Paper. Methods: The FLD curriculum was developed by a multidisciplinary task force that included surgeons, education experts, and diversity consultants. The curriculum development followed the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional design model and utilized a problem-based learning approach. Competencies were identified, and specific learning objectives and assessments were developed. The implementation of the curriculum was designed to be completed in short intervals (virtual and in-person). Post-course surveys used the Kirkpatrick's model to evaluate the curriculum and provide valuable feedback. Results: The curriculum consisted of interactive online modules, an online discussion forum, and small group interactive sessions focused in three key areas: (1) increasing pipeline of underrepresented individuals in surgical leadership, (2) healthcare equity, and (3) conflict negotiation. By focusing on positive action items and utilizing a problem-solving approach, the curriculum aimed to provide a framework for surgical leaders to make meaningful changes in their institutions and organizations. Conclusion: The FLD curriculum is a novel leadership curriculum that provided surgeon leaders with the knowledge and tools to improve diversity in three areas: pipeline improvement, healthcare equity, and conflict negotiation. Future directions include using pilot course feedback to enhance curricular effectiveness and delivery. [ABSTRACT FROM AUTHOR]

Objectives: Using Google online reviews, this study investigated why patients were satisfied or dissatisfied with their public dental clinic in Victoria, Australia. Methods: This mixed methods study gathered Google reviews published by users pre-March, 2021. The reviews were coded and subthemes and major themes were identified. The most common reasons why patients gave reviews were tabulated and stratified according to star rating, remoteness and accessibility index classification, and socio-economic status. Results: Of the 522 reviews included in this study, in 317 (60.7%) satisfaction was expressed. Compliments and complaints were documented. A total of 53 subthemes were identified. Major themes included Treatment, Staff, Communication and Professionalism, Patient Factors and Non-Clinical Reasons. From the reviews, more patients were satisfied with general unspecified treatment (n = 195; 14.7%) and dissatisfied with reception staff (n = 64; 4.8%). More reviews were generated by patients who visited clinics in major cities and lower socio-economic areas. Conclusion: This study found that most patients expressed satisfaction and identified reasons why patients were satisfied or dissatisfied. Consumer feedback, including compliments and complaints, is an integral aspect of monitoring and improving health service quality. It is important to continue seeking feedback and improve accordingly. What is known about the topic? Research has identified common factors for patient satisfaction or dissatisfaction with dental clinics including: facilities and location, waiting list time, cost, gentleness during procedures, communication, and staffing. What does this paper add? This study identified causes of patient satisfaction and dissatisfaction with Victorian public dental clinics. The focus is on the Victorian public dental system because almost half of the eligible population for public dental services are not utilising them. What are the implications for practitioners? Practitioners can use this study to self-reflect and improve the quality of health service delivery. [ABSTRACT FROM AUTHOR]

Abstract In 1965, Glaser and Strauss (1965) offered the concept of "awareness contexts" to explain what patients in hospitals do or don't know about their death trajectories. Awareness ranges from closed (where patients are completely unaware and family and providers protect "the secret") to open (where all parties communicate openly and honestly). While closed awareness was the norm in 1960s, open awareness is now considered standard practice in US, a reflection of mounting evidence that patients, families, and providers benefit from clear and honest communication at end of life (Seale et al., 1997; Wright et al., 2008). Despite the known benefits of open awareness, many terminal patients remain unaware or confused about their prognoses (Chen et al., 2017). This paper asks why, in an era of open awareness, are patients and families uncertain about dying? To answer this question, we focus on an aspect of Glaser and Strauss's theory that remains relatively understudied by researchers, namely the role of institutional and organizational realities in shaping awareness contexts. Based on interviews with 43 family members of deceased patients who died at General Hospital in the Midwestern US, we argue that two related conditions in hospitals—the increased specialization of medical professionals and the fragmentation of patient care—serve as important context for the death awareness of patients and families. Highlights • Specialized and fragmented health care impacts end of life experiences for patients and families. • Patients and families experiencing specialized and fragmented care experience uncertain prognoses. • Uncertain prognoses at end of life can leave families unprepared for death and/or grief stricken. [ABSTRACT FROM AUTHOR]

Voice in healthcare is crucial because of its ability to improve organizational performance and prevent medical errors. This paper contends that a comparative analysis of voice promotion in the American and German healthcare industries can strengthen a culture of safety in both countries. It provides a brief introduction to the concept of voice in healthcare, including its impact on safety culture, barriers to voice, and the dual influences of confidentiality and transparency on voice promotion policies. It then examines the theoretical basis, practical workings, and legal aspects of voluntary error reporting and error disclosure as avenues for exercising voice in the U.S. and Germany. Finally, it identifies transferable practices that can remedy shortcomings in each country's voice promotion policy. [ABSTRACT FROM AUTHOR]

Suboptimal maternal nutrition and excessive gestational weight gain (GWG) establish in mothers and their offspring a weight gain trajectory towards overweight and obesity. Therefore, pregnancy may be the best opportunity to disrupt the generational cycle of obesity. More than half of women in the UK now enter pregnancy overweight or obese, highlighting that if interventions are not targeted towards women in higher weight categories before conception they are likely to 'miss the mark'. To address issues of suboptimal maternal nutrition and excessive GWG in antenatal care, health professionals need to consider how women's requirements and expectations may have changed in recent years and the impact of weight stigma on the care of women who are obese. This paper aims to drive changes in clinical practice guidelines, medical curricula, the language used by health professionals, and ultimately promote maternal nutrition and weight management in pregnancy as key priorities during antenatal care. Evidence indicates that women want non-judgemental, simple and encouraging guidance in these areas. Small changes to health professionals' practice can improve how advice regarding nutrition and weight management in pregnancy is delivered, and has the potential to reduce overweight and obesity prevalence in women and their children in the years to come. Surely that goal is worth pursuing. [ABSTRACT FROM AUTHOR]

This paper outlines the current ethical guidelines for electronic therapy services, and the sufficiency and implications of these guidelines in a culturally diverse population as found in the United States. The paper limits the discussion of ethical deliberations to: what is considered adequate competency to practice mental health therapy electronically; the disclosure and identity verification requirements; confidentiality issues when different social norms exist; the social responsibility of public institutions or individuals; and issues that relate to miscommunication due to different cultural or educational backgrounds. It concludes that since E-Therapy helps to reach underserved populations and significantly reduces costs associated with mental health services, compliance with ethical guidelines must be enforced to benefit from the latest communication technologies. This paper is relevant for various professions related to psychology and psychotherapy, including pastors and pastoral counselors, because various forms of E-therapy are emerging in the 21st century and can serve as resources for 'E-pastoral counseling.' [ABSTRACT FROM AUTHOR]

The U.S. Department of Health and Human Services implemented the Healthy People initiative to set national health objectives for four different decades since 1979. This national effort has promoted a shared vision for improving the health of all Americans in a very fragmented health care delivery system. The current Healthy People 2020 initiative being implemented by the Department's Office of Disease Prevention and Health Promotion differs from previous efforts in several important ways. This paper explores one of these changes: implementation of a new communication strategy based in modern information technology. This strategy conceptualized a Healthy People 2020 online space that would be a user-focused, 'one-stop shop' for public health and health care professionals, policymakers, and community members to learn about the objectives, plan interventions, and implement strategies to reach the 2020 objectives. The communication strategy incorporated new digital media, including building a following on LinkedIn and Twitter. At present, membership in the Healthy People LinkedIn group is more than 7700 people, and the Healthy People Twitter account (@gohealthypeople) has nearly 50 000 followers. In addition to the growth in number of users, the success of the communication strategy is also confirmed by the consistently high customer satisfaction rankings the site receives from the American Customer Satisfaction Index E-government Satisfaction Index. New developments in digital communication technology have the potential to advance three principal functions originally conceptualized for Healthy People 2020 online: benchmarking, advocacy, and connecting with others. Several exciting digital tools can be used to implement each of these key Healthy People 2020 functions, including mobile Web site optimization, smartphone/tablet apps, social media, and cloud computing. Ultimately, HHS can conduct research with Healthy People target audiences and stakeholders to inform the types of digital tools that will be most helpful to Healthy People 2020 users. [ABSTRACT FROM AUTHOR]

Purpose: The aims for this paper are to summarize the current state of disparities in clinical research participation, discuss regulatory and interpersonal causes for these disparities, and to suggest an approach to address this problem by standardized training for consent administrators. Organizing Construct: A program based on the Precede-Proceed model for training consent administrators is proposed and described. Conclusions: The current process for informed consent for research is unstandardized and inadequate, and may contribute to racial and ethnic disparities. Researchers are urged to consider a formal training program for members of their research teams who will be obtaining participants' consent. Clinical Relevance: An educational program for consent administrators may help to reduce disparities in research participation by improving communication between research staff and potential participants. [ABSTRACT FROM AUTHOR]

Background National governments across the globe have set goals to improve healthcare delivery. Understanding patient–provider communication is essential for the development of policies that measure how well a healthcare system delivers care. Objectives This study was designed to determine which, if any, demographic factors were independently associated with how US patients perceive various aspects of communication with their healthcare providers. Design and methods The study was a secondary, cross-sectional analysis of nationally representative data from the 2002 Medical Expenditure Panel Survey (MEPS). Among US adults with a healthcare visit in the past year ( n = approximately 16 700), we assessed the association between several covariate demographic and socioeconomic factors and four dependent measures of patient perceptions of communication with their healthcare providers. Results Across all four measures of communication, older patients were more likely to report positively. Having health insurance and a usual source of care were consistent predictors of positive perceptions of communication. Hispanic patients also reported better perceptions of communication across all four measures. The most economically disadvantaged patients were less likely to report that providers always explained things so that they understood. Male patients were more likely to report that providers always spent enough time with them. Conclusions This study suggests that patient perceptions of communication in healthcare settings vary widely by demographics and other individual patient characteristics. In this paper, we discuss the relevance of these communication disparities to design policies to improve healthcare systems, both at the individual practice level and the national level. [ABSTRACT FROM AUTHOR]

This paper considers the role of statistical discrimination as a potential explanation for racial and ethnic disparities in health care. The underlying problem is that a physician may have a harder time understanding a symptom report from minority patients. If so, even if there are no objective differences between Whites and minorities, and even if the physician has no discriminatory motives, minority patients will benefit less from treatment, and may rationally demand less care. After comparing these and other predictions to the published literature, we conclude that statistical discrimination is a potential source of racial/ethnic disparities, and worthy of research. [ABSTRACT FROM AUTHOR]

‘Scraps’: hidden nursing information and its influence on the delivery of care What nurses commonly describe as ‘scraps’ are defined as the personalized recordings of information that is routinely made on any available piece of paper (hence scraps) or in small notebooks. The use of scraps is common in practice and has been noted in research from across the globe. Drawing on an empirical study it is argued that scraps are a unique combination of personal and professional knowledge that informs the delivery of care. The overall aim of the study was to discover how nurses define and communicate information about patients and the delivery of care to each other on an elderly care unit. The processes by which information was constructed and the organizational structure and interactions that influenced this were also identified. The research design was an ethnographic one that involved: observations of formal nursing end of shift reports (23 handovers) and informal interactions between nurses (146 hours); interviews (n + 34) with registered nurses, student nurses and nursing auxiliaries; and analysis of written records. Data were collected from five acute elderly care wards at a district general hospital in the south of England. A grounded theory analysis was undertaken which revealed that scraps may have a significant role in the communication of information and the delivery of care. Therefore a categorization of scraps within three main themes was undertaken. First, the analysis revealed the processes involved in the construction of scraps. Second, the content and role of scraps in influencing the delivery of care was exposed. Finally, the potentially confidential nature of scraps and consequent problems of storage and disposal was recognized. The findings are discussed in relation to a suggested model of the interrelationship between paperwork, scraps, handovers and the delivery of nursing care. It is concluded that scraps are significant... [ABSTRACT FROM AUTHOR]

The delivery of comprehensive breast care seems to be undergoing a paradigm shift driven by advances in technology, interprofessional collaboration and patient dissatisfaction with interruptions in care. This paradigm shift includes the emergence of new models of care that optimize the use of embedded radiology services and encourage greater interprofessional collaboration. This paper briefly reviews the three drivers (advances in technology, expectations regarding interprofessional collaboration and patient dissatisfaction with interrupted care) underlying the paradigm shift in comprehensive breast care as well as introduces the environment of care model, which describes the proximity of radiology services and interprofessional collaboration between the Women's Wellness Clinic (WWC) and Radiology at the Karmanos Cancer Institute (KCI) - both based in the United States. In addition, this model is proposed as a way to facilitate improved patient satisfaction and early appropriate referral. Finally, plans for evaluating the effectiveness of this model are presented. [ABSTRACT FROM AUTHOR]

Background: When doctors have honest conversations with patients about their illness and involve them in decisions about their care, patients express greater satisfaction with care and lowered anxiety and depression. The Serious Illness Care Programme (the Programme), originally developed in the United States (U.S), promotes meaningful, realistic and focused conversations about patient's wishes, fears and worries for the future with their illness. The Serious Illness Conversation Guide (the guide) provides a framework to structure these conversations. The aim of this paper is to present findings from a study to examine the 'face validity', acceptability and relevance of the Guide for use within the United Kingdom (UK) health care setting.Methods: A multi-stage approach was undertaken, using three separate techniques: 1. Nominal Group Technique with clinician 'expert groups' to review the Serious Illness Conversation Guide: 14 'experts' in Oncology, Palliative Care and Communication Skills; 2. Cognitive Interviews with 6 patient and public representatives, using the 'think aloud technique'; to explore the cognitive processes involved in answering the questions in the guide, including appropriateness of language, question wording and format 3. Final stakeholder review and consensus.Results: Nominal Group Technique Unanimous agreement the conversation guide could provide a useful support to clinicians. Amendments are required but should be informed directly from the cognitive interviews. Training highlighted as key to underpin the use of the guide. Cognitive interviews The 'holistic' attention to the person as a whole was valued rather than a narrow focus on their disease. Some concern was raised regarding the 'formality' of some wording however and suggestions for amendments were made. Final stakeholder review Stakeholders agreed amendments to 5/13 prompts and unanimously agreed the UK guide should be implemented as a part of the pilot implementation of the Serious Illness Care Programme UK.Conclusion: Use of the guide has the potential to benefit patients, facilitating a 'person-centred' approach to these important conversations, and providing a framework to promote shared decision making and care planning. Further research is ongoing, to understand the impact of these conversations on patients, families and clinicians and on concordance of care delivery with expressed patient wishes. [ABSTRACT FROM AUTHOR]

The aim of this paper is discussion of a new middle‐range theory of patient safety goal priming via safety culture communication. Bedside nurses are key to safe care, but there is little theory about how organizations can influence nursing behavior through safety culture to improve patient safety outcomes. We theorize patient safety goal priming via safety culture communication may support organizations in this endeavor. According to this theory, hospital safety culture communication activates a previously held patient safety goal and increases the perceived value of actions nurses can take to achieve that goal. Nurses subsequently prioritize and are motivated to perform tasks and risk assessment related to achieving patient safety. These efforts continue until nurses mitigate or ameliorate identified risks and hazards during the patient care encounter. Critically, this process requires nurses to have a previously held safety goal associated with a repertoire of appropriate actions. This theory suggests undergraduate educators should foster an outcomes focus emphasizing the connections between nursing interventions and safety outcomes, hospitals should strategically structure patient safety primes into communicative activities, and organizations should support professional development including new skills and the latest evidence supporting nursing practice for patient safety. [ABSTRACT FROM AUTHOR]