Why Talking Is Not Cheap: Adverse Events and Informal Communication.

Healthcare management faces significant challenges related to upward communication. Sharing information in healthcare is crucial to the improvement of person-centered, safe, and effective patient care. An adverse event (AE) is an unintended or unexpected incident that causes harm to a patient and may lead to temporary or permanent disability. Learning from adverse events in healthcare is crucial to the improvement of patient safety and quality of care. Informal communication channels represent an untapped resource with regard to gathering data about the development of AEs. In this viewpoint paper, we start by identifying how informal communication played a key factor in some high-profile adverse events. Then, we present three Critical Challenge points that examine the role of informal communication in adverse events by (1) understanding how the prevailing trends in healthcare will make informal communication more important, (2) explaining how informal communication is part of the group-level sensemaking process, and (3) highlighting the potential role of informal communication in "breaking the silence" around critical and adverse events. Gossip, as one of the most important sources of informal communication, was examined in depth. Delineating the role of informal communication and adverse events within the healthcare context is pivotal to understanding and improving team and upward communication in healthcare organizations. For clinical leaders, the challenge is to cultivate a climate of communication safety, whereby informal communication channels can be used to collect soft intelligence that are paths to improving the quality of care and patient safety.

The complete mitochondrial genome of a species of Cirrhipathes de Blainville, 1830 from Kaua'i, Hawai'i (Hexacorallia: Antipatharia).

This study reports the first mitogenome from the antipatharian (black coral) genus Cirrhipathes (GenBank accession number ON653414). The 20,452 bp mitochondrial genome of Cirrhipathes cf. anguina LS-2022 consists of 13 protein-coding genes, two rRNA genes, and two tRNA genes (trnM and trnW). The mitogenome is typical of other antipatharian families, including an A + T biased (64.1%) base composition and cytochrome c oxidase subunit I (COX1) intron with embedded homing endonuclease gene (HEG). A phylogenetic tree based on complete mitogenome sequences of currently available antipatharians indicates Cirrhipathes cf. anguina LS-2022 is sister and closely related to Stichopathes sp. SCBUCN-8849. However, it seems unlikely that intergeneric taxa share 99.97% similarity across their complete mitogenomes, raising questions about the current taxonomy of this group. This study highlights the need for additional vouchered antipatharian species to be sequenced so phylogenetic relationships can be compared with accepted taxonomy.

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

The Greek Burnout Assessment Tool: Examining Its Adaptation and Validity.

Burnout is a significant challenge in the workplace. Its extent is global and its unfavourable consequences are diverse, affecting the individual, the organization, and society. The aim of the present study was to examine the adaptation and assess the validity of the Greek version of the Burnout Assessment Tool (BAT). The adaptation process included the translation and back-translation of the BAT. Data were collected from 356 Greek employees from diverse sectors. Confirmatory factor analysis and item response theory were utilized to assess the validity of the Greek version of the BAT. According to the findings of the present research, the core symptoms scale and the secondary symptoms scale of BAT-23 and BAT-12 models demonstrated adequate structures for the analysis and measurement of burnout in the Greek context. Finally, the psychometric performance of the BAT-GR-12 compared to the BAT-GR-23 establishes it as a more optimum instrument for the assessment of burnout across Greek working adults.

Employee silence, job burnout and job engagement among teachers: the mediational role of psychological safety.

Background: Teaching is a highly demanding profession, with teachers reporting increasing levels of burnout. Accumulated evidence indicates that inhibiting the expression of one's thoughts, emotions, and behaviors continuously can take a psychological toll actively resulting in physiological and psychological symptoms (e.g. stress, emotional exhaustion, strain). The purpose of this study was to assess the different types of employee silence among teachers and examine their relationship with job burnout, job engagement and psychological safety. Methods: A convenience sampling method approach was used whereby 150 primary school education teachers from Greece participated in a survey. Self-reported measures for burnout, work-engagement, psychological safety and employee silence motives were used in this cross-sectional study. Results: Psychological safety mediated the relationship between burnout and employee silence, and more specifically between the three core components of burnout and both acquiescent and quiescent silence, but not prosocial silence. In terms of engagement, the indirect effect was significant between vigor/dedication and both quiescent and acquiescent silence. Conclusions: The present research highlighted the importance of acquiescent and quiescent silence, two forms of silence that are rooted in fear and hopelessness respectively. This research adds to the growing picture of teaching as a profession that is characterized by increasing levels of burnout, employee silence and low levels of psychological safety.

Creating healthy workplaces in healthcare: Are we delaying progress by focusing on what we can do rather than what we should do?

All the available evidence points to the fact that healthcare is under considerable stress, and while change is urgently needed there is no quick fix; systemic and sustained changes in organizational cultures within healthcare are required. Moreover, the fragility of healthcare systems globally has been starkly exposed by the Coronavirus 2019 pandemic. We have gathered enough evidence to know what is driving poor wellbeing, and how these processes impact on quality of care and patient safety. Indeed, we have a good idea of what we need to do to improve the situation. Therefore, this begs a simpler question; If we know how to create healthy workplaces, why is it so difficult to achieve this in healthcare? In the following perspective paper, we will argue that we can do better if we address the following three issues: (1) we are ignoring the real problems, (2) limited successes that we are achieving are moving us further from tackling the real problems, (3) culture change is accepted as crucial, but we are not accepting what the evidence is telling us about healthcare culture. Tackling burnout is useful and necessary, but we must increase dignity among healthcare employees. Moreover, we need to train line managers to recognize and facilitate the need of employees to feel competent and be appreciated by others, while helping them set wellbeing boundaries.

A Two-Wave Study On The Associations Of Burnout With Depression And Anxiety: The Mediating And Moderating Role Of Perceived Family Support.

Studies have shown strong associations between burnout and depression and burnout and anxiety but their exact interrelationships still remain unclear. Few studies have examined the psychosocial mechanisms that might underlie these two relationships. Non-work social factors such as perceived family support can affect mental health. The present study investigated the distinctiveness and the reciprocal associations between burnout and depression, and burnout and anxiety by collecting data twice over an 8 month interval. Perceived family support was examined as a mediating and a moderating factor underlying the two relationships. The Maslach Burnout Inventory-General Survey, the Hospital Depression and Anxiety Scale, and the Julkunen Family Support Scale were administered to employees of the general working population (N = 52). First, our results revealed moderate associations between burnout and depression, and burnout and anxiety, supporting the distinctiveness of burnout from the two psychological phenomena. Second, the exhaustion and cynicism burnout dimensions showed reciprocal associations with depression. Moreover, anxiety was found to be a consequence of cynicism while it presented reciprocal associations with the exhaustion dimension of burnout. Perceived family support did not mediate the burnout-depression and burnout-anxiety relationships. However, it moderated the depression-exhaustion relationship in a direction opposite from our hypothesis.

Employee silence in health care: Charting new avenues for leadership and management.

ISSUE: Health care management is faced with a basic conundrum about organizational behavior; why do professionals who are highly dedicated to their work choose to remain silent on critical issues that they recognize as being professionally and organizationally significant? Speaking-up interventions in health care achieve disappointing outcomes because of a professional and organizational culture that is not supportive. CRITICAL THEORETICAL ANALYSIS: Our understanding of the different types of employee silence is in its infancy, and more ethnographic and qualitative work is needed to reveal the complex nature of silence in health care. We use the sensemaking theory to elucidate how the difficulties to overcoming silence in health care are interwoven in health care culture. INSIGHT/ADVANCE: The relationship between withholding information and patient safety is complex, highlighting the need for differentiated conceptualizations of silence in health care. We present three Critical Challenge points to advance our understanding of silence and its roots by (1) challenging the predominance of psychological safety, (2) explaining how we operationalize sensemaking, and (3) transforming the role of clinical leaders as sensemakers who can recognize and reshape employee silence. These challenges also point to how employee silence can also result in a form of dysfunctional professionalism that supports maladaptive health care structures in practice. PRACTICE IMPLICATIONS: Delineating the contextual factors that prompt employee silence and encourage speaking up among health care workers is crucial to addressing this issue in health care organizations. For clinical leaders, the challenge is to valorize behaviors that enhance adaptive and deep psychological safety among teams and within professions while modeling the sharing of information that leads to improvements in patient safety and quality of care.

Cognitive functioning in non-clinical burnout: Using cognitive tasks to disentangle the relationship in a three-wave longitudinal study.

Burnout is often characterized by cognitive deficits and it has been associated with depression and anxiety. However, it is not clear whether cognitive impairment is a burnout consequence or employees with poor cognitive skills are more prone in developing burnout. Moreover, the exact nature of the association between burnout and depression, and burnout and anxiety is still unknown. Depression and anxiety are also related to cognitive impairments but their prospective associations are not fully understood. The aim of the present three-wave longitudinal study was to investigate the causality between cognitive functioning, burnout, depression, and anxiety among non-clinical burnout employees. The cause-effect associations of burnout with depression and anxiety were also explored. Perceived family support as a protective factor against cognitive decline, burnout, depression and anxiety was examined as well. A wide range of cognitive tasks tapping different cognitive domains were administered to employees of the general working population. Burnout, depression, anxiety, and perceived family support were assessed with self-reported questionnaires. Present results suggest that visuospatial functioning deficits are a burnout consequence and they indicate the role of automatic processing skills and executive functions in burnout onset. Additionally, current findings support that burnout is differentiated from depression and anxiety but it is reciprocally associated with the two psychological phenomena. Lastly, current results support the inclusion of perceived family support as an intervention to help individuals who suffer from mental health and cognitive difficulties.

Concerted Collusion: Studying Multiagency Institutional Cover-Up.

Many important organizational events do not lend themselves easily to experimental manipulation, and thus, one can only study them retrospectively by combining the investigative tools provided by both the social sciences and humanities. A cover-up, meaning an attempt to prevent the public from discovering information about a serious crime or mistake, is such a phenomenon. The objective of the present paper is to develop an initial taxonomy of how organizational researchers can study what happens when multiple organizations and institutions conspire to cover-up the causes of a tragedy. For this purpose, the 1989 United Kingdom Hillsborough tragedy and the 27 year cover-up will be analyzed. Hillsborough is the best (and worst) example of a cover-up, in that the objective facts were known from early on but the subjective elements (i.e., attitudes, bias, and collusion) resulted in a 27 year search for justice for the victims. It deserves special attention as an example of multiagency institutional cover-up, in that the range and diversity of institutional actors pitted against the victims grossly outweighed them in terms of material resources, social power (in terms of social class differences), and the ability to control the narrative of the tragedy. Using a thematic analysis approach, five main themes were identified as: (1) Unwilling, but compliant, participants who are unlikely to be whistleblowers, (2) Suppressing/withholding important information, (3) Proactively engaging the support of related actors/institutions that helps create a critical mass, (4) Owning the narrative, and (5) Moral disengagement.

Understanding the Link Between Burnout and Sub-Optimal Care: Why Should Healthcare Education Be Interested in Employee Silence?

Evidence on the association of burnout with objective indicators of performance is scarce in healthcare. In parallel, healthcare professionals ameliorate the short-term impact of burnout by prioritizing some tasks over others. The phenomenon of employee silence can help us understand the evolution of how culture is molded toward the prioritization of some tasks over others, and how this contributes to burnout. Silence in healthcare has been associated with concealing errors, reduced patient safety, and covering up errors made by others. Conversely, there is evidence that in organizations where employees are encouraged to speak up about concerns, and where concerns are responded to appropriately, better patient outcomes such as improved patient safety and patient experience occur. Interventions to promote "speaking-up" in healthcare have not been successful and are rooted in a professional culture that does not promote speaking out. In this paper, we review the evidence that exists within healthcare to argue why healthcare education should be interested in employee silence, and how silence is a key factor in understanding how burnout develops and impacts quality of care. The following key questions have been addressed; how employee silence evolves during medical education, how is silence maintained after graduation, and how can leadership style contribute to silence in healthcare. The impact of withholding information on healthcare professional burnout, patient safety and quality of care is significant. The paper concludes with a suggested future research agenda and additional recommendations.

Burnout and Cognitive Functioning: Are We Underestimating the Role of Visuospatial Functions?

Job burnout is a psychological syndrome which results from chronic occupational stress and cognitive impairments are among its negative consequences. The demands of the COVID-19 pandemic have challenged the healthcare system increasing the risk of job burnout among healthcare professionals. The studies conducted so far have mainly focused on the effects of job burnout on executive functions. Visuospatial functions are a cognitive domain which plays an important role in healthcare workers' optimal performance. Healthcare workers are constantly relying on their visuospatial abilities in order to care for their patients as they are required to use techniques that involve manipulation of medical instruments, they need to have excellent hand-eye coordination and great perception of spatial anatomy, factors that can affect healthcare workers' performance is of significance and can put patient safety at risk. However, our understanding of how visuospatial functions are being affected in job burnout is limited. The scope of this mini-review is to examine the evidence concerning the relationship of job burnout with visuospatial functions. The sparsity of the relevant empirical evidence does not allow for definite conclusions. However, given the implications of diminished visuospatial abilities in patient safety we highlight the need for studies exploring the effects of job burnout on visuospatial functions. Limitations of studies are discussed.

Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions.

Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.

Emotional Labor and Burnout among Teachers: A Systematic Review.

A significant amount of emotional labor takes place during teaching. Teaching is a multitasking profession that consists of both cognitive and emotional components, with teachers engaging in emotional labor on a daily basis as an instrumental part of achieving teaching goals and positive learning outcomes. The purpose of the present review was to explore the relationship between emotional labor and burnout in school settings. The review focused specifically on teachers from elementary and high schools, between January 2006 and August 2021, and 21 studies fit the inclusion criteria. Overall, the review of the literature supports the significant associations between burnout and emotional labor with the majority of results pointing to the consistent relationship between surface acting and burnout. However, the results regarding the association of deep acting and naturally felt emotions with burnout were mixed. There is considerable scope for improvement in our study of emotional labor in terms of the study designs we employ, the variables we study and our appreciation of the historical and cultural factors that moderate and mediate the relationship between emotional labor and burnout.

Community similarity and species overlap between habitats provide insight into the deep reef refuge hypothesis.

The deep reef refuge hypothesis (DRRH) postulates that mesophotic coral ecosystems (MCEs) may provide a refuge for shallow coral reefs (SCRs). Understanding this process is an important conservation tool given increasing threats to coral reefs. To establish a better framework to analyze the DRRH, we analyzed stony coral communities in American Samoa across MCEs and SCRs to describe the community similarity and species overlap to test the foundational assumption of the DRRH. We suggest a different approach to determine species as depth specialists or generalists that changes the conceptual role of MCEs and emphasizes their importance in conservation planning regardless of their role as a refuge or not. This further encourages a reconsideration of a broader framework for the DRRH. We found 12 species of corals exclusively on MCEs and 183 exclusively on SCRs with another 63 species overlapping between depth zones. Of these, 19 appear to have the greatest potential to serve as reseeding species. Two additional species are listed under the U.S. Endangered Species Act, Acropora speciosa and Fimbriaphyllia paradivisa categorized as an occasional deep specialist and a deep exclusive species, respectively. Based on the community distinctiveness and minimal species overlap of SCR and MCE communities, we propose a broader framework by evaluating species overlap across coral reef habitats. This provides an opportunity to consider the opposite of the DRRH where SCRs support MCEs.

Do critical incidents lead to critical reflection among medical students?

CONTEXT: Medical students are exposed during their training to a wide range of experiences and behaviors that can affect their learning regarding professionalism and their behavior and attitudes towards patient-centered care. The aim of the study is to explore learning associated with critical incidents and levels of critical reflection among medical students. APPROACH: Medical students' were invited to narrate a critical incident and reflect on the learning associated with it. All students' narratives were audio-recorded and analyzed thematically. Mezirow's theory of transformative learning was used to analyze the level of reflection reached in students' narratives. FINDINGS: For the present analysis critical incidents narrated by 70 clinical students (4th-6th year) were included. Fifty-two of them were females. Students' experiences are derived from three types of interactions: observed interactions between doctors and patients, personal interactions between students and patients, and interactions between doctors and students. Reflections deriving from the experiences included: behaving to patients as humans not as cases, emotional aspects of care, doctors as role models, skills needed when working under pressure, 'tasting' the real profession, emotional management, the importance of communication skills, teaching qualities of doctors, becoming a doctor, and reflections of future practice. Analyzing the actual level of reflection indicated that only 32 (45.7%) students were categorized as reflectors. CONCLUSIONS: Student interactions with doctors and patients provide insights about; the daily experience of being a doctor, the most common challenges, what qualities are necessary for being a doctor and what do they need to develop their professional identity. However, it is noteworthy that while the majority of students shared a critical incident crucial to their professional development, there is little evidence of critical reflection.

Burnout and Cognitive Performance.

The aim of this study was to investigate the relationship between burnout and cognitive functioning. The associations of depression, anxiety and family support with burnout and cognitive functioning were also examined both independently and as potential moderators of the burnout-cognitive functioning relationship. Seven different cognitive tasks were administered to employees of the general working population and five cognitive domains were assessed; i.e., executive functions, working memory, memory (episodic, visuospatial, prospective), attention/speed of processing and visuospatial abilities. Burnout, depression, anxiety and family support were assessed with the Maslach Burnout Inventory-General Survey, the Hospital Anxiety and Depression Scale and the Family Support Scale respectively. In congruence with the first and fourth (partially) Hypotheses, burnout and perceived family support are significantly associated with some aspects of cognitive functioning. Moreover, in line with the third Hypothesis, perceived family support is inversely related to burnout. However, in contrast to the second and fourth Hypotheses, depression, anxiety and perceived family support do not moderate the burnout-cognitive functioning relationship. Additional results reveal positive associations between burnout depression and anxiety. Overall findings suggest that cognitive deficits, depression and anxiety appear to be common in burnout while they underpin the role of perceived family support in both mental health and cognitive functioning. Implications for practice are discussed.

Can self-pampering act as a buffer against depression in women? A cross-sectional study.

Despite preliminary evidence that self-pampering can alleviate psychological burden that may lead to depression among women, no studies have so far examined the link between pampering and depression. The aim of this study was to explore the differential effect of pampering on depression depending on women's marital, parental, or caregiving status. A cross-sectional design was employed. The sample consisted of 154 women employees of the municipal authority of Thessaloniki, Greece. The Pampering Behaviors Inventory was developed for the purposes of the present study. Depression was assessed with the Hospital Anxiety and Depression Scale. Controlling for the effects of age, self-pampering was negatively related to depression (p=.001). Married women, women with children, and women caregivers engaged in self-pampering activities less frequently. Married women who did not use pampering were more depressed than married women who used pampering (p=.002). Women with children who did not use pampering were more depressed than women with children who used pampering (p=.004). Results of the present study contribute to a deeper understanding of the importance of self-pampering as a buffer against depression. Given the rising prevalence of depression today, it is essential to explore the potential of minimal interventions.