Silvia Gilardi

Interprofessional team dynamics and information flow management in emergency departments.

AIM In Emergency Departments, fragmentation and breakdown in information exchange can be important factors leading to adverse events. This article aims to consider the critical aspects of collaborative teamwork in Emergency Departments that may have an impact on the information flow. BACKGROUND On the basis of Distributed Cognition Theory, we have assumed that cognitive outcomes in critical-care settings are not confined to the thoughts of isolated individuals; rather, they are better understood as properties of a distributed cognitive system across the minds of the clinical team members and across the technological artefacts. DESIGN We report on an exploratory ethnographic study of two Emergency Departments. METHODS Data were collected over a period of four months in 2008 via observation and interviews. RESULTS The results highlight a specific distribution of cognitive work between physicians and nurses. The nurses roles as information highlighter, memory keeper and process organizer helped to ensure the information flow and to overcome some of the problems identified with the computer-assisted communication process. Such distribution of cognitive work improved care quality, but it crossed established professional boundaries. CONCLUSION As cross-boundary distribution of cognitive work in Emergency Departments can be perceived as role substitution, building an interprofessional working system is needed to avoid information breakdown in fast-moving contexts. To realize an interprofessional working system, practice-based training is required, aimed at developing a deep understanding of team cognition.

Health care services and the coproduction puzzle : filling in the blanks

This qualitative study analyzes an Italian hospital’s endeavor to introduce a coproduction practice and the critical factors that affect its efficacy and efficiency. The empirical evidence shows that the meaningful engagement of the patient can be achieved only by factoring in the socioorganizational conditions of all stakeholders; that no divide exists between organizational production and client coproduction, rather, it is a relationship of interdependence that in turn raises critical issues; and that formalized and effective “practices-in-use” cannot work unless there is strong managerial commitment and enforcement of the new coproduction initiative.

La relazione con i pazienti in sanità: quali risorse lavorative per attenuare l’impatto degli stressor sociali?

Ricerche nazionali e internazionali hanno mostrato che gli operatori sanitari si trovano ad affrontare episodi di violenza verbale e fisica con sempre maggior frequenza. Evidenze empiriche supportano l’ipotesi che comportamenti aggressivi dei pazienti possono generare processi di burnout. Scarsi sono pero gli studi sulle risorse lavorative che consentono di attenuare l’impatto di tale stressor sociale sul benessere degli operatori nei contesti ospedalieri. Nel nostro contributo abbiamo analizzato se e in quali circostanze differenti tipi di risorse, emotive (supporto dei colleghi, supporto dei superiori) e cognitive (autonomia decisionale, significato del lavoro), moderino l’effetto negativo dell’aggressivita verbale su burnout e benessere affettivo. Lo studio, di tipo trasversale, ha coinvolto il personale sanitario di un dipartimento chirurgico (133 operatori con un tasso di partecipazione del 67%). Lo strumento di rilevazione e stato un questionario self-report. Le analisi, effettuate attraverso una regressione gerarchica moderata, hanno evidenziato l’effetto diretto dei comportamenti aggressivi come importanti predittori del burnout e del benessere affettivo. Il supporto dei colleghi e dei superiori e, in misura minore, l’attribuzione di significato al lavoro moderano l’impatto negativo sull’esaurimento emotivo. Il benessere affettivo risulta essere moderato dal supporto dei colleghi e dalla percezione di autonomia lavorativa. Inoltre si e riscontrato che l’attribuzione di significato al proprio lavoro influenza positivamente il benessere nel caso di alta aggressivita dei pazienti. Lo studio contribuisce a evidenziare gli aspetti socioorganizzativi che svolgono un’azione protettiva rispetto agli stressor sociali legati alla relazione con i pazienti nei contesti sanitari.

Verbal Aggression from Care Recipients as a Risk Factor among Nursing Staff: A Study on Burnout in the JD-R Model Perspective

Among nursing staff, the risk of experiencing violence, especially verbal aggression, is particularly relevant. The present study, developed in the theoretical framework of the Job Demands-Resources model (JD-R), has two main aims: (a) to examine the association between verbal aggression and job burnout in both nurses and nurses aides and (b) to assess whether job content, social resources, and organizational resources lessen the negative impact of verbal aggression on burnout in the two professional groups. The cross-sectional study uses a dataset that consists of 630 workers (522 nurses and 108 nurses aides) employed in emergency and medical units. High associations were found between verbal aggression and job burnout in both professional groups. Moderated hierarchical regressions showed that, among nurses, only the job content level resources moderated the effects of the verbal aggression on job burnout. Among nurses aides, the opposite was found. Some resources on the social and organizational levels but none of the job content level resources buffered the effects of verbal aggression on workers burnout. The study highlights the crucial role of different types of resources in protecting nursing staff from the detrimental effects of verbal aggression on job burnout.

Fertilizing a patient engagement ecosystem to innovate healthcare: Toward the first Italian Consensus conference on patient engagement

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide “system” inertia—really difficult to be overcome—and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of “fertilizing a patient engagement ecosystem”: an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient “disengagement” is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.

Co-production in Healthcare: Moving Patient Engagement Towards a Managerial Approach

The pressure toward co-produced health services is increasing as an answer to quality improvement and system sustainability. However, the reflection and the empirical knowledge on the nature of co-production and on how healthcare practices change in order to manage effective partnerships between clients and professionals remain scant. The chapter addresses this gap by analysing how the concept of co-production is used and investigated in the healthcare literature. Specifically, it focuses on two key perspectives that vary significantly on the issues of who the co-producing health authors are; what the domains of co-production are; and how to stimulate and support patients in their role of co-producers. The first perspective frames co-production as focusing on individual patient engagement and on the bilateral clinical dimension of relations with the medical staff. The second recognises co-production as a complex system of multiple relations between a cast of both single (patients, informal caregivers, clinical staff) and collective actors (the healthcare providers such as hospitals, trusts, local health communities), that involves patients in different service delivery phases and focuses on the change in the production processes when value is co-produced.

Promuovere l’engagement dei pazienti con malattie croniche: un percorso di ricerca collaborativa

L’engagement dei pazienti e riconosciuto come un elemento essenziale per la qualita dei servizi per le patologie croniche. Il contributo si propone di esplorare le dinamiche socioorganizzate che favoriscono l’engagement dei pazienti e la loro trasformazione da consumatori passivi di cura a partner. Sara presentata una ricerca collaborativa, realizzata con due servizi di un grande ospedale del Nord Italia, in cui pazienti e personale sanitario hanno cooperato per valutare e riorientare i percorsi diagnostico-terapeutici verso processi di lavoro partecipati centrati sul paziente. Strumenti di analisi delle pratiche sono stati l’analisi proattiva del rischio clinico (HFMEA) e l’analisi psicosociale degli snodi decisionali, applicati nell’ambito di focus group misti (pazienti, medici, infermieri, psicologi, assistenti sociali). I risultati hanno consentito di evidenziare l’intrecciarsi di aspetti clinici e organizzativi nelle rappresentazioni della natura dell’engagement e la sua caratterizzazione come un processo oscillante e instabile. Inoltre, attraverso l’analisi del processo d’indagine, e stato possibile identificare assunti e valori professionali che rischiano di dar vita ad una partecipazione apparente. La ricerca offre indicazioni per la progettazione di pratiche di gestione collaborativa dei percorsi di cura.

‘First, Do No Harm’: The Role of Negative Emotions and Moral Disengagement in Understanding the Relationship Between Workplace Aggression and Misbehavior

Workplace aggression is a critical phenomenon particularly in the healthcare sector, where nurses are especially at risk of bullying and third-party aggression. While workplace aggression has been frequently examined in relation to health problems, less is known about the possible negative impact such aggression may have on the (un)ethical behavior of victims. Our research aims to fill this gap. Drawing on literature on counterproductive work behavior (CWB) and the social-cognitive literature on aggression we investigated in two independent studies (NStudy1 = 439; NStudy2 = 416), the role of negative emotions – in particular anger, fear, and sadness, – and of moral disengagement (MD) in the paths between workplace aggression, CWB and health symptoms. The focus on these relationships is rooted in two reasons. First, misbehavior at work is a pervasive phenomenon worldwide and second, little research has been conducted in the healthcare sector on this type of behavior despite the potential importance of the issue in this context. We empirically tested our hypotheses considering a specific form of workplace aggression in each study: workplace bullying or third-party aggression. Results from the two empirical studies confirm the hypotheses that being target of workplace aggression (bullying or third-party aggression) is not only associated with health symptoms but also with misbehavior. In addition, the results of structural equation modeling attest the importance of examining specific discrete negative emotions and MD for better understanding misbehavior at work. In particular, this research shows for the first time that anger, fear, and sadness, generally aggregated into a single dimension, are indeed differently associated with MD, misbehavior and health symptoms. Specifically, in line with the literature on discrete emotions, while sadness is only associated with health symptoms, anger and fear are related to both health and misbehavior.

Will I make it? Self-perceived employability in the unemployed

The literature on career mobility has emphasized the role of perceived employability in handling occupational transitions. Following a multidimensional approach to the concept of perceived employability, this study developed a twosided model to analyse the self-employability perceptions of the unemployed. Combining two dimensions (beliefs relating to the occupational opportunities in the labour market and self-efficacy to intercept these opportunities), the model hypothesized four different profiles of self-perceived employability. The study aimed to verify this model and to explore how the different profiles of self-perceived employability are related to mental health, intention and motives for using employment agencies and reemployment outcomes. The research involved 136 workers who, after losing their job, applied to an employment agency. The study had a four-wave, multi-method design (questionnaire at the first contact with the agency and objective data on reemployment at 3, 6 and 9 months after the first contact). Self-perceived employability profiles were obtained through a two-step cluster analysis based on two variables (job search self-efficacy and perceived reemployment chances). The two-step cluster analysis resulted in a four-cluster structure, confirming the hypothesized model. The analysis showed significant differences between clusters, distress levels, and short- and medium-term employment outcomes: people who evaluate themselves as less employable have higher levels of distress and lower intentions to utilize the agency’s services. The relationship between the employability profile and reemployment at 3, 6 and 9 months shows interesting trends. Our study contributes to the literature on employability, highlighting the relevance of considering different self-perceived employability profiles of unemployed people. Moreover, its suggestions can be useful for career counsellors in profiling workers who are at risk of psychological distress during occupational transitions and who could give up searching for a job.

Divenire partner del team di cura: qualità del servizio e senso di appartenenza negli adulti con Beta Talassemia Major

Il contributo presenta i risultati di una ricerca che ha coinvolto 137 pazienti adulti affetti da Beta Talassemia Major. A partire da un’analisi della letteratura sulle dimensioni che caratterizzano un sistema di presa in carico della malattia cronica, e stato esaminato il rapporto tra elementi di gestione collaborativa della cura e la percezione di controllo della malattia in relazione a due outcomes: la soddisfazione per il servizio di cura e la soddisfazione per la qualita della vita. Inoltre si e voluto indagare in via esplorativa il contributo del costrutto senso di appartenenza alla comunita di cura nel legame con i livelli di soddisfazione per il servizio e la qualita della vita. I risultati confermano la rilevanza del senso di appartenenza alla comunita di cura quale significativo predittore di entrambi gli outcomes. La soddisfazione per le cure trova nella dimensione della fiducia l’altro significativo predittore, mentre la soddisfazione per la qualita della vita viene spiegata anche dall’apporto della percezione di controllo sulla malattia.