Markus Latzke

Development and validation of a patient safety culture questionnaire in acute geriatric units.

Background: Older patients (≧65 years) are exposed to more harm resulting from adverse events in hospitals than younger patients. Theoretical considerations and empirical findings suggest that safety culture is the key to improving the quality of health care. Objective: To describe the development of a German-language instrument for assessing patient safety culture (PSC) and its reliability and validity; to verify criterion validity by means of a cross-sectional analysis of the impact of PSC on clinical quality that compares acute geriatric units with a sample from intensive care, surgery and trauma surgery departments, and to report variations in the PSC profile between these groups. Methodology: Using a review of existing safety culture surveys, multidimensional scaling procedures and expert interviews, we tested the content and convergent validity of a 158-item questionnaire completed by 508 physicians and nurses from 31 acute geriatric units and 7 comparison departments. Criterion validity was verified by various regression models with a self-reported measure of adverse events. Differences in PSC profiles were analyzed using a one-factorial ANOVA and regression models. Results: We identified 7 constructs of PSC and demonstrated substantial convergent and criterion validity. In the acute geriatric units, higher levels of ‘management commitment to patient safety’ and lower levels of ‘error fatalism’ were associated with a reduced incidence of medical errors. In the comparison group, only the variable ‘active learning from mistakes’ was relevant for safety performance. Our results also indicate that acute geriatric units display higher standards than the comparison group in all the aspects of patient safety examined. Conclusion: It is possible to measure salient features of PSC using a valid and reliable survey. Some aspects of PSC are more closely related to safety events than others. In acute geriatric units, patient safety appears to be influenced mainly by management’s determination of how things are done whereas improvement of the system itself in a more incremental manner is required in the other high-risk ward types.

Two sides of the safety coin?: How patient engagement and safety climate jointly affect error occurrence in hospital units.

Background: Safety climate (SC) and more recently patient engagement (PE) have been identified as potential determinants of patient safety, but conceptual and empirical studies combining both are lacking. Purposes: On the basis of extant theories and concepts in safety research, this study investigates the effect of PE in conjunction with SC on perceived error occurrence (pEO) in hospitals, controlling for various staff-, patient-, and hospital-related variables as well as the amount of stress and (lack of) organizational support experienced by staff. Besides the main effects of PE and SC on error occurrence, their interaction is examined, too. Methodology/Approach: In 66 hospital units, 4,345 patients assessed the degree of PE, and 811 staff assessed SC and pEO. PE was measured with a new instrument, capturing its core elements according to a recent literature review: Information Provision (both active and passive) and Activation and Collaboration. SC and pEO were measured with validated German-language questionnaires. Besides standard regression and correlational analyses, partial least squares analysis was employed to model the main and interaction effects of PE and SC on pEO, also controlling for stress and (lack of) support perceived by staff, various staff and patient attributes, and potential single-source bias. Findings: Both PE and SC are associated with lower pEO, to a similar extent. The joint effect of these predictors suggests a substitution rather than mutually reinforcing interaction. Accounting for control variables and/or potential single-source bias slightly attenuates some effects without altering the results. Practice Implications: Ignoring PE potentially amounts to forgoing a potential source of additional safety. On the other hand, despite the abovementioned substitution effect and conjectures of SC being inert, PE should not be considered as a replacement for SC.

Relational career capital: towards a sustainable perspective

Our chapter advocates a relational understanding of career capital and proposes that playing with it may only be considered as sustainable if: (a) the investments are viable; (b) the strategy is long-term; and (c) both are based on a holistic foundation. We discuss a Bourdieuian-inspired concept of career capital that puts more emphasis on the complex relationship between the social structure and individual agency than traditional views of career capital. Taking empirical examples from transitions of business school graduates within and across several career fields, it shows that the value of various forms of capital is contingent on the rules of the respective field. Sustainability in the acquisition, accumulation and conversion of career capital is ensured if: (a) investments fit to a field and enable agency that realizes the inherent potential but does not overstretch individual, organizational or societal resources; (b) the career strategy focuses on a broader time horizon than the present one; and (c) other relevant fields (as, for example, the domestic) are included, which combines perceptual, cognitive and emotional facets.

Wissenskonversion und Behandlungsfehler im Krankenhaus

Rund jeder tausendste Krankenhauspatient stirbt aufgrund vermeidbarer unerwünschter Ereignisse. Empirische Studien zeigen Zusammenhänge zwischen der Sicherheitskultur in Krankenhäusern und der Fehlerhäufigkeit. Die bisherige Forschung weist allerdings Theoriedefizite auf. Unter Heranziehung des Konzeptes der Wissenskonversion nach Nonaka und Takeuchi (1995) wird versucht, einen theoretischen Bezugsrahmen für das Lernen aus Fehlern zu erarbeiten. Auf empirischer Basis wird eine Skala entwickelt, die unterschiedliche Profile der Wissenskonversion im Umgang mit Fehlern misst. Anhand einer 420 Probanden umfassenden Stichprobe aus 11 Abteilungen von sieben Krankenhäusern gelingt der Nachweis, dass eine lernende Sicherheitskultur die Fehlerhäufigkeit zu reduzieren imstande ist. Zudem zeigt sich, dass dem Prozess der Internalisierung der höchste Stellenwert zukommt.

Karriereforschung: Konzeptioneller Rahmen, zentrale Diskurse und neue Forschungsfelder

Auf Basis eines konzeptionellen Rahmens – dem „Social Chronology Framework (SCF)“ (Gunz und Mayrhofer 2015) – bietet der vorliegende Beitrag einen Uberblick zur Karriereforschung. Nach ausfuhrlicher Herleitung des Begriffs werden Hauptstrange der Karriereforschung vorgestellt und anhand eines Beispiels illustriert, typische blinde Flecken herausgearbeitet und neue Ansatze und Methoden vorgestellt, die diese adressieren.

Prospective sensemaking, frames and planned change interventions: A comparison of change trajectories in two hospital units:

Changing organizations is difficult. In this article, we analyze how sensemaking that follows the initiation of change projects relies on the interplay of prospective and retrospective aspects, and we elucidate how organization members’ frames develop over time based on this interplay. Our data, 38 in-depth interviews with nursing and medical staff held at four different points in time, reveal how expectations impact the dynamics of meaning construction in change processes. Our findings demonstrate that the frames through which actors make sense of change initiatives develop continuously, although the expectations embedded in them are ‘sticky’ to some extent. The degree of ‘stickiness’ depends on expectations that are formed through initial prospective sensemaking, as these expectations influence actors’ tolerance regarding dissonant cues. Change initiatives fail when this tolerance becomes exhausted. Our study contributes to theory on sensemaking and change by elaborating on the undertheorized role of prospective sensemaking during change processes.

Der Einfluss eines anonymen Fehlermeldesystems auf das organisationale Lernen und die Häufigkeit von Behandlungsfehlern

Errors in hospitals entail high mortality rates and economic costs. While the positive effect of a good safety culture on error occurrence has been repeatedly demonstrated, there is a lack of longitudinal studies that reveal if and how safety culture can be improved. Based on the theory of knowledge conversion a concept for describing and measuring learning safety culture is developed. Applying a distinction between explicit and implicit learning, the effect of an anonymous error reporting system (CIRS) on a change in the learning safety culture and the occurrence of errors is investigated. Data has been collected with a quasi-experimental design in four hospital units with a total sample of 276 doctors and nurses and was examined via correlational and path analysis. Results show that CIRS reduces errors and leads to an improvement in explicit but not implicit learning. Implicit learning in turn has a stronger effect on the reduction of errors than explicit learning.ZusammenfassungBehandlungsfehler in Krankenhausern ziehen hohe Mortalitatsraten und Folgekosten nach sich. Während die fehlerreduzierende Wirkung einer positiven Sicherheitskultur empirisch gut belegt ist, fehlen bis dato Längsschnittstudien zur Frage, ob und wie diese verbessert werden kann. Basierend auf dem organisationstheoretischen Modell der Wissenskonversion wird ein Konzept zur Beschreibung und Messung der lernenden Sicherheitskultur entwickelt. Anhand der Unterscheidung zwischen explizitem und implizitem Lernen wird der Einfluss eines anonymen Fehlermeldesystems (CIRS) auf die Veränderung der Sicherheitskultur und weiters die Fehlerhäufigkeit untersucht. Die Daten wurden an vier Krankenhausabteilungen mit insgesamt 276 MedizinerInnen und Pflegekräften in einem quasi-experimentellen Design erhoben und mittels Korrelationen und eines Pfadmodells analysiert. CIRS reduziert demnach direkt und indirekt die Fehlerhäufigkeit und verbessert das explizite, aber nicht das implizite Lernen. Letzteres wirkt sich wiederum stärker auf die Fehlerhäufigkeit aus als explizites Lernen.

Contents Vol. 57, 2011

Behavioural Science Section K.J. Anstey, Canberra L. Clare, Bangor D. Gerstorf, Berlin J.D. Henry, Sydney T. Hess, Raleigh, N.C. S.M. Hofer, Victoria I. Kryspin Exner, Wien D.C. Park, Dallas, Tex. K. Ritchie, Montpellier J. Smith, Ann Arbor, Mich. Experimental Section C. Bertoni-Freddari, Ancona R. Faragher, Brighton C. Franceschi, Bologna T. Fülöp, Sherbrooke L. Gavrilov, Chicago, Ill. L. Haynes, Saranac Lake, N.Y. K. Hirokawa, Tokyo G.J. Lithgow, Novato, Calif. M. Rose, Irvine, Calif. A. Viidik, Wien J. Vijg, Bronx, N.Y.