François Sainfort

Job and organizational determinants of nursing home employee commitment, job satisfaction and intent to turnover

The purpose of this study was to examine whether job characteristics, the work environment, participation in quality improvement activities and facility quality improvement environment predicted employee commitment and job satisfaction in nursing homes, and whether those same predictors and commitment and satisfaction predicted turnover intention. A total of 6584 nursing home employees from 76 nursing homes in a midwestern state participated. A self-administered questionnaire was used to collect the data. The results supported the hypotheses that job and organizational factors predicted commitment and satisfaction while commitment and satisfaction predicted turnover intentions. The implications for retaining nursing home employees are discussed.

Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital.

BACKGROUND Birth trauma is a low-frequency, high-severity event, making obstetrics a major challenge for patient safety. Yet, few strategies have been shown to eliminate preventable perinatal harm. Interdisciplinary team training was prospectively evaluated to assess the relative impact of two different learning modalities to improve nontechnical skills (NTS)--the cognitive and interpersonal skills, such as communication and teamwork, that supplement clinical and technical skills and are necessary to ensure safe patient care. METHODS Between 2005 and 2008, perinatal morbidity and mortality data were prospectively collected using the Weighted Adverse Outcomes Score (WAOS) and a culture of safety survey (Safety Attitudes Questionnaire) at three small-sized community hospitals. In a small cluster randomized clinical trial conducted in the third quarter of 2007, one of the hospitals served as a control group and two served as the treatment intervention sites--one hospital received the TeamSTEPPS didactic training program and one hospital received both the TeamSTEPPS program along with a series of in-situ simulation training exercises. RESULTS A statistically significant and persistent improvement of 37% in perinatal morbidity was observed between the pre- and postintervention for the hospital exposed to the simulation program. There were no statistically significant differences in the didactic-only or the control hospitals. Baseline perceptions of culture of safety were high at all three hospitals, and there were no significant changes. CONCLUSIONS A comprehensive interdisciplinary team training program using in-situ simulation can improve perinatal safety in the hospital setting. This is the first evidence providing a clear association between simulation training and improved patient outcomes. Didactics alone were not effective in improving perinatal outcomes.

Older adults and visual impairment: what do exposure times and accuracy tell us about performance gains associated with multimodal feedback?

This study examines the effects of multimodal feedback on the performance of older adults with different visual abilities. Older adults possessing normal vision (n=29) and those who have been diagnosed with Age-Related Macular Degeneration (n=30) performed a series of drag-and-drop tasks under varying forms of feedback. User performance was assessed with measures of feedback exposure times and accuracy. Results indicated that for some cases, non-visual (e.g. auditory or haptic) and multimodal (bi- and trimodal) feedback forms demonstrated significant performance gains over the visual feedback form, for both AMD and normally sighted users. In addition to visual acuity, effects of manual dexterity and computer experience are considered.

Applying Quality Improvement Principles to Achieve Healthy Work Organizations

BACKGROUND Health care has used total quality management (TQM)/quality improvement (QI) methods to improve quality of care and patient safety. Research on healthy work organizations (HWOs) shows that some of the same work organization factors that affect employee outcomes such as quality of life and safety can also affect organizational outcomes such as profits and performance. An HWO is an organization that has both financial success and a healthy workforce. For a health care organization to have financial success it must provide high-quality care with efficient use of scarce resources. To have a healthy workforce, the workplace must be safe, provide good ergonomic design, and provide working conditions that help to mitigate the stress of health care work. INTEGRATING TQM/QI INTO THE HWO PARADIGM If properly implemented and institutionalized, TQM/QI can serve as the mechanism by which to transform a health care organization into an HWO. To guide future research, a framework is proposed that links research on QI with research on HWOs in the belief that QI methods and interventions might be an effective means by which to create an HWO. Specific areas of research should focus on identifying the work organization, cultural, technological, and environmental factors that affect care processes; affect patient health, safety, and satisfaction; and indirectly affect patient health, safety, and satisfaction through their effects on staff and care process variables. SUMMARY Integrating QI techniques within the paradigm of the HWO paradigm will make it possible to achieve greater improvements in the health of health care organizations and the populations they serve.

Toward achieving universal usability for older adults through multimodal feedback

This experiment examines the effect of combinations of feedback (auditory, haptic, and/or visual) on the performance of older adults completing a drag-and-drop computer task. Participants completed a series of drag-and-drop tasks under each of seven feedback conditions (3 unimodal, 3 bimodal, 1 trimodal). Performance was assessed using measures of efficiency and accuracy. For analyses of results, participants were grouped based on their level of computer experience. All users performed well under auditory-haptic bimodal feedback and experienced users responded well to all multimodal feedback. Based on performance benefits for older adults seen in this experiment, future research should extend investigations to effectively integrate multimodal feedback into GUI interfaces in order to improve usability for this growing and diverse user group.

Comparing Bayesian and Frequentist Approaches for Multiple Outcome Mixed Treatment Comparisons

Objectives. Bayesian statistical methods are increasingly popular as a tool for meta-analysis of clinical trial data involving both direct and indirect treatment comparisons. However, appropriate selection of prior distributions for unknown model parameters and checking of consistency assumptions required for modeling remain particularly challenging. We compared Bayesian and traditional frequentist statistical methods for mixed treatment comparisons with multiple binary outcomes. Data. We searched major electronic bibliographic databases, Food and Drug Administration reviews, trial registries, and research grant databases up to December 2011 to find randomized studies published in English that examined drugs for female urgency urinary incontinence (UI) on continence, improvement in UI, and treatment discontinuation due to harm. Methods. We describe and fit fixed and random effects models in both Bayesian and frequentist statistical frameworks. In a hierarchical model of 8 treatments, we separately analyze 1 safety and 2 efficacy outcomes. We produce Bayesian and frequentist treatment ranks and odds ratios across all drug v placebo comparisons, as well as Bayesian probabilities that each drug is best overall through a weighted scoring rule that trades off efficacy and safety. Results. In our study, Bayesian and frequentist random effects models generally suggest the same drugs as most attractive, although neither suggests any significant differences between drugs. However, the Bayesian methods more consistently identify one drug (propiverine) as best overall, produce interval estimates that are generally better at capturing all sources of uncertainty in the data, and also permit attractive “rankograms” that visually capture the probability that each drug assumes each possible rank. Conclusions. Bayesian methods are more flexible and their results more clinically interpretable, but they require more careful development and specialized software.

Introduction and validation of the American Urological Association Basic Laparoscopic Urologic Surgery skills curriculum.

BACKGROUND AND PURPOSE The Fundamentals of Laparoscopic Surgery (FLS(™)) skills curriculum has validity evidence supporting use for assessing laparoscopic skills for general surgeons. As charged by the American Urological Association (AUA) Laparoscopy, Robotic, and New Surgical Technology Committee, we sought to develop and validate a urology-specific FLS, referred to as the Basic Laparoscopic Urologic Surgery (BLUS(©)) skills curriculum. The psychomotor component consists of three existing FLS tasks and one new clip-applying task. MATERIALS AND METHODS An animate renal artery model was designed for a clip-applying skills task. We assessed the acceptability and construct validity of using BLUS for basic laparoscopic skills assessment for urologists. A cohort of practicing urologists, fellows, residents, and medical students completed the tasks at the AUA Annual Meetings in 2010 and 2011. RESULTS All exercises were acceptable and demonstrated excellent face and content validity (>4.5/5 on a five-point Likert scale). Practicing clinical urologists (N=81) outperformed residents and medical students (N=35) in time to completion of circle cut (P<0.01) and in keeping scissor tips toward the center of the circle (P<0.01). Practicing urologists who reported >3 laparoscopic procedures per week were faster at the peg-transfer exercise (P<0.05) and the cutting exercise (P<0.01) than those reporting one to two procedures. More errors were committed for clip-applying among practicing urologists who perform one to two laparoscopic procedures (1.24) vs. those who perform >3 procedures (0.57) per week (P<0.01). CONCLUSIONS All exercises including the novel clip-applying model demonstrated good acceptability and evidence of construct validity (face, content, concurrent and convergent validity) for assessment of basic laparoscopic skill for urologic surgeons.

Quality of Work Life of Independent vs Employed Family Physicians in Wisconsin: A WReN Study

PURPOSE Family physicians in Wisconsin who are mainly employed by large health care organizations have voiced concerns regarding the quality of their work lives. We explored the quality of work life and its relationship to employment by health care organizations. METHODS We conducted a cross-sectional survey of the 1,482 active members of the Wisconsin Academy of Family Physicians in 2000. RESULTS A 47% overall response rate was obtained, and 584 respondents could be identified as independent or employed by a health care organization. There were no differences in age or sex between the 2 groups. The independent physicians worked longer hours, were in smaller work groups, and had been in practice longer and in their current practice longer than the employed physicians. Independent physicians reported better working relationships, more satisfaction with family time, more influence over management decisions, better satisfaction with being a physician, better perceived quality of the care they provided, greater ability to achieve professional goals, and lesser intention to leave the practice. CONCLUSIONS Independent physicians have significantly more positive ratings of several aspects of the quality of their work life compared with physicians employed by health care organizations. Health care organizations need to address these issues if they are to have a satisfied and stable workforce.

The effects of multimodal feedback on older adults' task performance given varying levels of computer experience

This experiment examines the effect that computer experience and various combinations of feedback (auditory, haptic, and/or visual) have on the performance of older adults completing a drag-and-drop task on a computer. Participants were divided into three computer experience groups, based on their frequency of use and breadth of computer knowledge. Each participant completed a series of drag-and-drop tasks under each of seven feedback conditions (three unimodal, three bimodal, one trimodal). Performance was assessed using measures of efficiency and accuracy. Experienced users responded well to all multimodal feedback while users without experience responded well to auditory-haptic bimodal, but poorly to haptic-visual bimodal feedback. Based on performance benefits for older adults seen in this experiment, future research should extend investigations to effectively integrate multimodal feedback into GUI interfaces in order to improve usability for this growing and diverse user group.

Isolating the effects of visual impairment: exploring the effect of AMD on the utility of multimodal feedback

This study examines the effects of multimodal feedback on the performance of older adults with an ocular disease, Age-Related Macular Degeneration (AMD), when completing a simple computer-based task. Visually healthy older users (n = 6) and older users with AMD (n = 6) performed a series of drag-and-drop tasks that incorporated a variety of different feedback modalities. The user groups were equivalent with respect to traditional visual function metrics and measured subject cofactors, aside from the presence or absence of AMD. Results indicate that users with AMD exhibited decreased performance, with respect to required feedback exposure time. Some non-visual and multimodal feedback forms show potential as solutions to enhance performance, for those with AMD as well as for visually healthy older adults.