The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project.

BACKGROUND: Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture. METHODS: During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital's repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT. RESULT: Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction. CONCLUSIONS: Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learning.

Naturalistic Decision Making in After-Action Review Meetings: The Implementation of and Learning from Post-Fall Huddles.

The purpose of this study was to add to our understanding of Naturalistic Decision Making (NDM) in healthcare, and how After Action Reviews (AARs) can be utilized as a learning tool to reduce errors. The study focused on the implementation of a specific form of AAR, a post-fall huddle, to learn from errors and reduce patient falls. Utilizing 17 hospitals that participated in this effort, information was collected on 226 falls over a period of 16 months. The findings suggested that the use of self-guided post-fall huddles increased over the time of the project, indicating adoption of the process. Additionally, the results indicate that the types of errors identified as contributing to the patient fall changed, with a reduction in task and coordination errors over time. Finally, the proportion of falls with less adverse effects (such as non-injurious falls) increased during the project time period. The results of this study fill a void in the NDM and AAR literature, evaluating the role of NDM in healthcare specifically related to learning from errors. Over time, self-guided AARs can be useful for some aspects of learning from errors.

Nurses' Experience Implementing an Automated Video Monitoring System to Decrease the Risk of Patient Falls during a Global Pandemic.

Healthcare is a complex sociotechnical system where information systems (IS) and information technology (IT) intersect to solve problems experienced by patients and providers alike. One example of IS/IT in hospitals is the Ocuvera automated video monitoring system (AVMS), which has been implemented in more than 30 hospitals. The purpose of this study was to evaluate nurses' attitudes toward AVMS implementation over time as they received the training program developed for this intervention. Consistent with the job demands-resources (JDR) model, we found that perceptions of AVMS usefulness increased over time and were positively associated with perceptions of social influence and behavioral control. These results were consistent with our finding that there was a significant decrease in the risk of unassisted falls from the bed from baseline to intervention. Leaders in hospital systems and healthcare organizations may want to consider implementing an AVMS as researchers continue to test, verify, and demonstrate the effectiveness of these interventions for improving patient well-being.

Teams in Small Organizations: Conceptual, Methodological, and Practical Considerations.

Research on teams and teamwork has flourished in the last few decades. Much of what we know about teams and teamwork comes from research using short-term student teams in the lab, teams in larger organizations, and, more recently, teams in rather unique and extreme environments. The context in which teams operate influences team composition, processes, and effectiveness. Small organizations are an understudied and often overlooked context that presents a rich opportunity to augment our understanding of teams and team dynamics. In this paper, we discuss how teams and multi-team systems in small organizations may differ from those found in larger organizations. Many of these differences present both methodological and practical challenges to studying team composition and processes in small complex organizational settings. We advocate for applying and accepting new and less widely used methodological approaches to advance our understanding of the science of teams and teamwork in such contexts.

Creativity as a Means to Well-Being in Times of COVID-19 Pandemic: Results of a Cross-Cultural Study.

The coronavirus disease 2019 (COVID-19) pandemic has brought about unprecedented uncertainty and challenges to the worldwide economy and people's everyday life. Anecdotal and scientific evidence has documented the existence of a positive relationship between the experience of crisis and creativity. Though this appears to be ubiquitous, the crisis-creativity-well-being relationship has not been sufficiently examined across countries and using a working adult sample. The current study drew on a sample consisting of 1,420 employees from China (n = 489, 40% females), Germany (n = 599, 47% females), and the United States (n = 332, 43% females) to examine whether creativity can function as an effective means to cope with crisis and to achieve both flourishing and social well-being. Multivariate analyses showed that perceived impact of COVID-19 was positively related to creative process engagement, which was positively related to employees' self-reported creative growth. Creative growth was associated with a higher level of flourishing well-being. This sequential mediation model was significant across the three samples. Creativity also mediated the relationship between perceived impact of COVID-19 and social well-being (social connectedness), but this connection was only found for the Chinese sample. Further data analyses revealed that individualism moderated this serial mediation model in that the positive coping effect of creativity on both flourishing and social well-being was stronger for individuals who hold more collectivistic views. Results of the study have implications for crisis management, personal development, and positive functioning of individuals and society.

Which Divergent Thinking Index Is More Associated With Problem Finding Ability? The Role of Flexibility and Task Nature.

Problem finding (PF) and divergent thinking (DT) are considered to be indicators of creative potential. Previous studies, with different goals, suggest a positive correlation between PF and DT. However, none of these works have explicitly examined which index of DT is more associated with PF. The current investigation examined the association between PF and three main indexes of DT: fluency, flexibility, and originality. It also tested whether such a relation differs based on task nature (verbal vs. figural). The sample consisted of 90 sixth graders who completed three tests: (a) a verbal DT test, (b) a figural DT test, and (c) a PF test. Correlational analysis showed that flexibility was highly correlated with PF in the verbal DT test, whereas originality was significantly correlated with PF in the figural test. Results of the path analysis confirmed the results from correlational analyses and showed that verbal flexibility strongly predicted PF fluency, flexibility, and originality more than any other variable. Likelihood ratio test showed that using 1 or 3% cutoff for scoring originality did not significantly altered the results in both figural and verbal DT (vs. PF), while the likelihood ratio test showed significant differences between the figural and verbal DT. Finally, predictor variables in the verbal DT accounted for 40-58% of the variance in PF skills, whereas predictor variables in the figural DT accounted for 28-37% of the variance in PF skills. As suggested by experts in the field of PF, the role of flexibility in PF is a fertile area to be considered in future studies.

A Mixed-Methods Study of Creative Problem Solving and Psychosocial Safety Climate: Preparing Engineers for the Future of Work.

The future of work is forcing the world to adjust to a new paradigm of working. New skills will be required to create and adopt new technology and working methods. Additionally, cognitive skills, particularly creative problem-solving, will be highly sought after. The future of work paradigm has threatened many occupations but bolstered others such as engineering. Engineers must keep up to date with the technological and cognitive demands brought on by the future of work. Using an exploratory mixed-methods approach, our study sought to make sense of how engineers understand and use creative problem solving. We found significant associations between engineers' implicit knowledge of creativity, exemplified creative problem solving, and the perceived value of creativity. We considered that the work environment is a potential facilitator of creative problem-solving. We used an innovative exceptional cases analysis and found that the highest functioning engineers in terms of knowledge, skills, and perceived value of creativity, also reported working in places that facilitate psychosocially safe environments to support creativity. We propose a new theoretical framework for a creative environment by integrating the Four Ps (Person, Process, Product, and Press) and psychosocial safety climate theory that management could apply to facilitate creative problem solving. Through the acquisition of knowledge to engage in creative problem solving as individuals or a team, a perception of value must be present to enforce the benefit of creativity to the engineering role. The future of work paradigm requires that organisations provide an environment, a psychosocially safe climate, for engineers to grow and hone their sought-after skills that artificial technologies cannot currently replace.

Group and Organizational Safety Norms Set the Stage for Good Post-Fall Huddles.

We explored group and organizational safety norms as antecedents to meeting leader behaviors and achievement of desired outcomes in a special after-action review case-a post-fall huddle. A longitudinal survey design was used to investigate the relationship between organizational/group safety norms, huddle leader behavior, and huddle meeting effectiveness. The sample included healthcare workers in critical access hospitals (N = 206) who completed a baseline safety norm assessment and an assessment of post-fall huddle experiences three to six months later. Findings indicate that organizational and group safety norms relate to perceived huddle meeting effectiveness through appropriate huddle leader behavior in a partial mediated framework. In contrast to previous research showing after-action reviews predicting group and organizational safety norms, the longitudinal study presented here suggests that group and organizational safety norms set the stage for the enactment of post-fall huddles in an effective manner.

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.

OBJECTIVE: To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. DATA SOURCES/STUDY SETTING: Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. STUDY DESIGN: A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. DATA COLLECTION: Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. PRINCIPAL FINDINGS: The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. CONCLUSIONS: Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.

The Effect of Problem Construction on Team Process and Creativity.

Although research on the benefits of problem construction within the creative process is expanding, research on team problem construction is limited. This study investigates the cognitive process of problem construction and identification at the team level through an experimental design. Furthermore, this study explores team social processes in relation to problem construction instructions. Using student teams solving a real-world problem, the results of this study revealed that teams that engaged in problem construction and identification generated more original ideas than teams that did not engage in such processes. Moreover, higher satisfaction and lower conflict was observed among groups that engaged in problem construction compared to groups that did not engage in problem construction. These findings highlight the utility of problem construction for teams engaging in creative problem-solving.

Debriefs: Teams learning from doing in context.

Debriefs are a type of work meeting in which teams discuss, interpret, and learn from recent events during which they collaborated. In a variety of forms, debriefs are found across a wide range of organizational types and settings. Well-conducted debriefs can improve team effectiveness by 25% across a variety of organizations and settings. For example, the U.S. military adopted debriefs decades ago to promote learning and performance across the various services. Subsequently, debriefs have been introduced in the medical field, the fire service, aviation, education, and in a variety of organizational training and simulation environments. After a discussion of various purposes for which debriefs have been used, we proceed with a historical review of development of the concepts and use in industries and contexts. We then review the psychological factors relevant to debrief effectiveness and the outcomes for individuals, teams, and organizations that deploy debriefs. Future directions of particular interest to team researchers across a variety of psychological disciplines are presented along with a review of how best to implement debriefs from a practical perspective. (PsycINFO Database Record

A theory-driven, longitudinal evaluation of the impact of team training on safety culture in 24 hospitals.

BACKGROUND: Effective teamwork facilitates collective learning, which is integral to safety culture. There are no rigorous evaluations of the impact of team training on the four components of safety culture-reporting, just, flexible and learning cultures. We evaluated the impact of a year-long team training programme on safety culture in 24 hospitals using two theoretical frameworks. METHODS: We used two quasi-experimental designs: a cross-sectional comparison of hospital survey on patient safety culture (HSOPS) results from an intervention group of 24 hospitals to a static group of 13 hospitals and a pre-post comparison of HSOPS results within intervention hospitals. Dependent variables were HSOPS items representing the four components of safety culture; independent variables were derived from items added to the HSOPS that measured the extent of team training, learning and transfer. We used a generalised linear mixed model approach to account for the correlated nature of the data. RESULTS: 59% of 2137 respondents from the intervention group reported receiving team training. Intervention group HSOPS scores were significantly higher than static group scores in three dimensions assessing the flexible and learning components of safety culture. The distribution of the adoption of team behaviours (transfer) varied in the intervention group from 2.8% to 31.0%. Adoption of team behaviours was significantly associated with odds of an individual reacting more positively at reassessment than baseline to nine items reflecting all four components of safety culture. CONCLUSIONS: Team training can result in transformational change in safety culture when the work environment supports the transfer of learning to new behaviour.

Exploring asynchronous brainstorming in large groups: a field comparison of serial and parallel subgroups.

OBJECTIVE: The aim of this study was to compare the results of two different modes of using multiple groups (instead of one large group) to identify problems and develop solutions. BACKGROUND: Many of the complex problems facing organizations today require the use of very large groups or collaborations of groups from multiple organizations. There are many logistical problems associated with the use of such large groups, including the ability to bring everyone together at the same time and location. METHODS: A field study involved two different organizations and compared productivity and satisfaction of group. The approaches included (a) multiple small groups, each completing the entire process from start to end and combining the results at the end (parallel mode); and (b) multiple subgroups, each building on the work provided by previous subgroups (serial mode). RESULTS: Groups using the serial mode produced more elaborations compared with parallel groups, whereas parallel groups produced more unique ideas compared with serial groups. No significant differences were found related to satisfaction with process and outcomes between the two modes. CONCLUSION: Preferred mode depends on the type of task facing the group. Parallel groups are more suited for tasks for which a variety of new ideas are needed, whereas serial groups are best suited when elaboration and in-depth thinking on the solution are required. APPLICATION: Results of this research can guide the development of facilitated sessions of large groups or "teams of teams."

The first anniversary: stress, well-being, and optimism in older widows.

The first anniversary for older widows (n = 47) has been explored during Months 11, 12, and 13. Concurrent correlations show that optimism inversely correlates with psychological (intrusion and avoidance) stress as measured with the Impact of Event Scale (r = -.52 to -.66, p < .005) and positively correlates with well-being (physical: r = .36 to .46, p < .025; psychosocial: r = .58 to .72, p < .005; spiritual: r = .50 to .69, p < .005). Lagged correlation patterns suggest that higher levels of optimism at a given time are associated with higher life satisfaction and spiritual well-being at later times. Psychological stress is higher at Month 12 when compared to Month 13, t(43) = 2.54, p = .01, but not when compared to Month 11, t(43) = 1.49, p > .10. There are no significant differences in physiologic stress (salivary cortisol) or well-being during the first anniversary of spousal bereavement.