Cathy van Dyck

Organizational error management culture and its impact on performance: a two-study replication

The authors argue that a high-organizational error management culture, conceptualized to include norms and common practices in organizations (e.g., communicating about errors, detecting, analyzing, and correcting errors quickly), is pivotal to the reduction of negative and the promotion of positive error consequences. Organizational error management culture was positively related to firm performance across 2 studies conducted in 2 different European countries. On the basis of quantitative and qualitative cross-sectional data from 65 Dutch organizations, Study 1 revealed that organizational error management culture was significantly correlated with both organizational goal achievement and an objective indicator of economic performance. This finding was confirmed in Study 2, using change-of-profitability data from 47 German organizations. The results suggest that organizations may want to introduce organizational error management as a way to boost firm performance.

Exploration strategies, performance, and error consequences when learning a complex computer task

When trying to learn a complex task, people can use different strategies. They can use systematic exploration in which they take on an active approach to discover the computer functions and make use of problem solving steps such as planning, evaluation of feedback, and control of emotion and motivation. Alternatively, they can use non-systematic strategies like trial-and-error, rigid exploration, and encapsulation in information seeking. This study examined whether the exploration strategies were related to error consequences and performance when people learned a new computer program. Strategies were assessed by means of coding. Analysis showed strong correlations between strategies, error consequences, and task performance. These results can have implications for training design and human reliability in dealing with complex devices.

Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial.

BackgroundCrew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and organizational outcomes, due to weak study designs and the scarce use of direct observations. Therefore, the aim of this study is to determine the effectiveness and cost-effectiveness of CRM training on attitude, behaviour and organization after one year, using a multi-method approach and matched control units. The purpose of the present article is to describe the study protocol and the underlying choices of this evaluation study of CRM in the ICU in detail.Methods/DesignSix ICUs participated in a paired controlled trial, with one pre-test and two post test measurements (respectively three months and one year after the training). Three ICUs were trained and compared to matched control ICUs. The 2-day classroom-based training was delivered to multidisciplinary groups. Typical CRM topics on the individual, team and organizational level were discussed, such as situational awareness, leadership and communication. All levels of Kirkpatricks evaluation framework (reaction, learning, behaviour and organisation) were assessed using questionnaires, direct observations, interviews and routine ICU administration data.DiscussionIt is expected that the CRM training acts as a generic intervention that stimulates specific interventions. Besides effectiveness and cost-effectiveness, the assessment of the barriers and facilitators will provide insight in the implementation process of CRM.Trial registrationNetherlands Trial Register (NTR): NTR1976

The tragic 1996 Everest expedition: a tale of error culture

Error occurrence cannot be fully eliminated. A strict differentiation between errors and their consequences is used to (a) discuss error prevention and error management, and (b) to show how organisations can promote an error mastery culture that combines the best of both. This article uses two 1996 Everest expeditions as an illustration of what can go wrong in complex high-risk systems. The point of this article, however, is not restricted to high-risk industries. A mastery error culture aims at control of negative error consequences − most relevant in high-risk industries − but also fosters positive error consequences needed for adaptation and innovation. The article discusses both general and recent empirical literature on safety, quality and error handling. (Netherlands Journal of Psychology, 65, 22-34.)

Development and reliability of the explicit professional oral communication observation tool to quantify the use of non-technical skills in healthcare

Background A lack of non-technical skills is increasingly recognised as an important underlying cause of adverse events in healthcare. The nature and number of things professionals communicate to each other can be perceived as a product of their use of non-technical skills. This paper describes the development and reliability of an instrument to measure and quantify the use of non-technical skills by direct observations of explicit professional oral communication (EPOC) in the clinical situation. Methods In an iterative process we translated, tested and refined an existing checklist from the aviation industry, called self, human interaction, aircraft, procedures and environment, in the context of healthcare, notably emergency departments (ED) and intensive care units (ICU). The EPOC comprises six dimensions: assertiveness, working with others; task-oriented leadership; people-oriented leadership; situational awareness; planning and anticipation. Each dimension is specified into several concrete items reflecting verbal behaviours. The EPOC was evaluated in four ED and six ICU. Results In the ED and ICU, respectively, 378 and 1144 individual and 51 and 68 contemporaneous observations of individual staff members were conducted. All EPOC dimensions occur frequently, apart from assertiveness, which was hardly observed. Intraclass correlations for the overall EPOC score ranged between 0.85 and 0.91 and for underlying EPOC dimensions between 0.53 and 0.95. Conclusions The EPOC is a new instrument for evaluating the use of non-technical skills in healthcare, which is reliable in two highly different settings. By quantifying professional behaviour the instrument facilitates measurement of behavioural change over time. The results suggest that EPOC can also be translated to other settings.

More explicit communication after classroom-based crew resource management training: results of a pragmatic trial

RATIONALE, AIMS AND OBJECTIVES Aviation-based crew resource management trainings to optimize non-technical skills among professionals are often suggested for health care as a way to increase patient safety. Our aim was to evaluate the effect of a 2-day classroom-based crew resource management (CRM) training at emergency departments (EDs) on explicit professional oral communication (EPOC; non-technical skills). METHOD A pragmatic controlled before-after trial was conducted. Four EDs of general teaching hospitals were recruited (two intervention and two control departments). ED nurses and ED doctors were observed on their non-technical skills by means of a validated observation tool (EPOC). Our main outcome measure was the amount of EPOC observed per interaction in 30 minutes direct observations. Three outcome measures from EPOC were analysed: human interaction, anticipation on environment and an overall EPOC score. Linear and logistic mixed model analyses were performed. Models were corrected for the outcome measurement at baseline, days between training and observation, patient safety culture and error management culture at baseline. RESULTS A statistically significant increase after the training was found on human interaction (β=0.27, 95% CI 0.08-0.49) and the overall EPOC score (β=0.25, 95% CI 0.06-0.43), but not for anticipation on environment (OR=1.19, 95% CI .45-3.15). This means that approximately 25% more explicit communication was shown after CRM training. CONCLUSIONS We found an increase in the use of CRM skills after classroom-based crew resource management training. This study adds to the body of evidence that CRM trainings have the potential to increase patient safety by reducing communication flaws, which play an important role in health care-related adverse events.

Behind the wheel: What drives the effects of error handling?

ABSTRACT Existing research comparing error management (a strategy focusing on increasing the positive and decreasing the negative consequences of errors) to error prevention (a strategy focusing on working faultlessly), has identified error management as beneficial for multiple outcomes. Yet, due to various methodological limitations, it is unclear whether the effects previously found are due to error prevention, error management, or both. We examine this in an experimental study with a 2 (error prevention: yes vs. no) × 2 (error management: yes vs. no) factorial design. Error prevention had negative effects on cognition and adaptive transfer performance. Error management alleviated worry and boosted one’s perceived self-efficacy. Overall, the results show that error prevention and error management have unique outcomes on negative affect, self-efficacy, cognition, and performance.

Does classroom-based Crew Resource Management training improve patient safety culture? A systematic review

Aim: To evaluate the evidence of the effectiveness of classroom-based Crew Resource Management training on safety culture by a systematic review of literature. Methods: Studies were identified in PubMed, Cochrane Library, PsycINFO, and Educational Resources Information Center up to 19 December 2012. The Methods Guide for Comparative Effectiveness Reviews was used to assess the risk of bias in the individual studies. Results: In total, 22 manuscripts were included for review. Training settings, study designs, and evaluation methods varied widely. Most studies reporting only a selection of culture dimensions found mainly positive results, whereas studies reporting all safety culture dimensions of the particular survey found mixed results. On average, studies were at moderate risk of bias. Conclusion: Evidence of the effectiveness of Crew Resource Management training in health care on safety culture is scarce and the validity of most studies is limited. The results underline the necessity of more valid study designs, preferably using triangulation methods.

Error prevention, error management, or both?

All people make errors, but how people think and perform after errors is theorized to be affected by the way errors are framed. The literature differentiates between two error-handling strategies: error prevention, which focuses on removing all errors, and error management, which focuses on catching errors, learning from them, and minimizing their negative consequences. In the present study we develop and test a theoretical model in order to establish whether it is the presence or absence of error management or error prevention instructions, or their combination that influence peoples cognitions and performance. Our findings show that error prevention has negative effects on cognition (fewer on-task thoughts; more negative self-related off-task thoughts) and adaptive transfer performance (trend), while error management dampens peoples appraisal of errors as threats. Thus, error prevention has more negative effects, whereas error management reduces negative effects rather than strengthening positive effects. The results indicate that the way error prevention and error management act and interact is more complex than previously thought and work that incorporates full-factorial designs is necessary in order to establish what drives the effects we find