Surgeons' Leadership Style and Team Behavior in the Hybrid Operating Room: Prospective Cohort Study.

OBJECTIVE: This study aimed to assess the relationship between surgeons' leadership style and team behavior in the hybrid operating room through video coding. Secondly, possible fluctuations possible fluctuations in leadership styles and team behavior during operative phases were studied. BACKGROUND: Leadership is recognized as a key component to successful team functioning in high-risk industries. The 'full range of leadership' theory is commonly used to evaluate leadership, marking transformational, transactional, and passive. Few studies have examined the effects of these leadership styles on team behavior in surgery and/or their fluctuations during surgery. METHODS: A single-center study included patients planned for routine endovascular procedures. A medical data capture system was used to allow post hoc video coding through Behavior Anchored Rating Scales. Multilevel statistical analysis was performed to assess possible correlations between leadership style and 3 team behavior indicators (speaking up, knowledge sharing, and collaboration) on an operative phase level. RESULTS: Twenty-two cases were analyzed (47 hours recording). Transformational leadership is positively related to the extent to which team members work together (γ=0.20, P <0.001), share knowledge (γ=0.45, P <0.001), and speak up (γ=0.64, P <0.001). Passive leadership is significantly positively correlated with speaking up (γ=0.29, P =0.004). Leadership style and team behavior clearly fluctuate during a procedure, with similar patterns across different types of endovascular procedures. CONCLUSIONS: Consistent with other professional fields, surgeons' transformational leadership enhances team behavior, especially during the most complex operative phases. This suggests that encouraging surgeons to learn and actively implement a transformational leadership style is meaningful to enhance patient safety and team performance.

Development, Feasibility, and Knowledge Impact of a Massive Open Online Course on Radiation Safety: A Multicentre Prospective Cohort Study.

OBJECTIVE: This study reports the development of an innovative, interactive Massive Open Online Course (MOOC) teaching radiation safety principles in the vascular workplace, using stepwise e-learning with multiple choice question tests (MCQs), educational videos, and a serious game. The aim was to study the MOOC impact on radiation safety knowledge and assess its feasibility and acceptability. METHODS: An international multicentre prospective study included team members active in the hybrid operating room. The MOOC was offered voluntarily via a secure online learning platform. A standardised MCQ test (15 questions) assessed radiation safety knowledge pre- and post-course (range 0 - 100%). Acceptability and feasibility were tested via the previously validated, Evaluating e-learning system success (EESS) model, using five point Likert scales. RESULTS: In eight centres across four countries, 150 of 203 invited endovascular team members consented. Over a seven week study period, surgeons (28%, including vascular surgery trainees and consultants), nurses (27%, including scrub, circulating and anaesthetic nurses), anaesthetists (43%, including trainees and consultants), and radiographers (3%) participated. Of those, 67% completed the course. The average radiation knowledge improved by 22.8% (95% CI 19.5 - 26.0%; p < .001) after MOOC completion, from 48% to 71% (standard deviation [SD] 14 and 15% respectively), requiring a mean time investment of 169 minutes (SD 89 minutes). In centres with a radiographer, mean knowledge gain after MOOC completion was significantly smaller (14%, SD 19% vs. 24%, SD 16%, p = .036). The course was deemed feasible and acceptable according to the EESS model with a total mean score of 3.68/5. CONCLUSION: This newly developed, multimodal MOOC was deemed feasible and effective across multiple international centres. The MOOC significantly contributes to radiation safety education of the entire endovascular team, improving radiation safety knowledge. The course may optimise workplace radiation safety behaviour and therefore enhance team and patient safety.

Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults.

BACKGROUND: The spread of COVID-19 has affected people's daily lives, and the lockdown may have led to a disruption of daily activities and a decrease of people's mental health. AIM: To identify correlates of adults' mental health during the COVID-19 lockdown in Belgium and to assess the role of meaningful activities in particular. METHODS: A cross-sectional web survey for assessing mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), meaning in activities (Engagement in Meaningful Activities Survey), and demographics was conducted during the first Belgian lockdown between April 24 and May 4, 2020. The lockdown consisted of closing schools, non-essential shops, and recreational settings, employees worked from home or were technically unemployed, and it was forbidden to undertake social activities. Every adult who had access to the internet and lived in Belgium could participate in the survey; respondents were recruited online through social media and e-mails. Hierarchical linear regression was used to identify key correlates. RESULTS: Participants (N = 1781) reported low mental health (M = 14.85/36). In total, 42.4% of the variance in mental health could be explained by variables such as gender, having children, living space, marital status, health condition, and resilience (ß = -.33). Loss of meaningful activities was strongly related to mental health (ß = -.36) and explained 9% incremental variance (R2 change = .092, p < .001) above control variables. CONCLUSIONS: The extent of performing meaningful activities during the COVID-19 lockdown in Belgium was positively related to adults' mental health. Insights from this study can be taken into account during future lockdown measures in case of pandemics.

Development and validation of a behavioural video coding scheme for detecting mental workload in manual assembly.

Manual assembly in the future Industry 4.0 workplace will put high demands on operators' cognitive processing. The development of mental workload (MWL) measures therefore looms large. Physiological gauges such as electroencephalography (EEG) show promising possibilities, but still lack sufficient reliability when applied in the field. This study presents an alternative measure with a substantial ecological validity. First, we developed a behavioural video coding scheme identifying 11 assembly behaviours potentially revealing MWL being too high. Subsequently, we explored its validity by analysing videos of 24 participants performing a high and a low complexity assembly. Results showed that five of the behaviours identified, such as freezing and the amount of part rotations, significantly differed in occurrence and/or duration between the two conditions. The study hereby proposes a novel and naturalistic method that could help practitioners to map and redesign critical assembly phases, and researchers to enrich validation of MWL-measures through measurement triangulation. Practitioner summary: Current physiological mental workload (MWL) measures still lack sufficient reliability when applied in the field. Therefore, we identified several observable assembly behaviours that could reveal MWL being too high. The results propose a method to map MWL by observing specific assembly behaviours such as freezing and rotating parts. Abbreviations: MWL: mental workload; EEG: electroencephalography; fNIRS: functional near infrared spectroscopy; AOI: area of interest; SMI: SensoMotoric Instruments, ETG: Eye-Tracking Glasses; FPS: frames per second; BORIS: Behavioral Observation Research Interactive Software; IRR: inter-rater reliability; SWAT: Subjective Workload Assessment Technique; NASA-TLX: National Aeronautics and Space Administration Task Load Index; EL: emotional load; DSSQ: Dundee Stress State Questionnaire; PHL: physical load; SBO: Strategisch Basis Onderzoek.

Private life telepressure and workplace cognitive failure among hospital nurses: The moderating role of mobile phone presence.

AIM: To examine whether the presence of a mobile phone has a moderating role in the relationship between nurses' private life telepressure and workplace cognitive failure. DESIGN: Cross-sectional quantitative study using self-report questionnaires. METHODS: Data were collected between December 2019 - January 2020. In total, 849 Registered Nurses from three Belgian hospitals completed the online survey. Data were analysed with hierarchical regression analyses and simple slope tests. RESULTS: Overall, the positive relationship between private life telepressure and workplace cognitive failure was moderated by mobile phone presence. Specifically, the experience of private life telepressure did only relate to higher workplace cognitive failure when nurses kept their mobile phone nearby (i.e. in their pockets). Additional exploratory analyses revealed that this moderation effect only held among nurses in young adulthood and regardless of the notification settings of their mobile phone. CONCLUSIONS: The present findings indicate the unintended risk of mobile phone presence at work as it relates to higher workplace cognitive failure in nurses who experience private life telepressure. Ensuring there are clear organizational policies and practises in place to store away personal belongings of healthcare personnel during work hours would therefore seem beneficial for hospitals. IMPACT: Considering the increased presence of mobile phones nowadays, a more detailed understanding is necessary on how these devices might distract personnel in a healthcare setting. The present study gives further insight into this topic and shows that in particular nurses in young adulthood who experience telepressure towards personal messages report more cognitive failure when their personal mobile phones are present, even when they do not actually use these devices. This furnishes additional evidence in support of hospitals' formal policy to forbid personal mobile phones of healthcare personnel when at work.

The relation between social capital and burnout: a longitudinal study.

OBJECTIVES: Although social capital approach has showed its merits in predicting well-being and health in the working environment, studies examining the relation between social capital and burnout are scarce and limited to cross-sectional studies in the health care sector. This study aims to explore the longitudinal relationship between workplace social capital and burnout in a Belgian company in the energy sector. An additional aim was to assess whether the relation between workplace social capital and the dimensions of burnout was independent of job characteristics, i.e., the level of decision-making autonomy and task variety, and demographical variables. METHODS: Analyses are conducted on the questionnaire data of 473 workers who participated at the two waves (2013 and 2014) of a longitudinal study. RESULTS: The results showed a negative relation between social capital and distance and a positive relation between social capital and competence, after 1-year follow-up and after adjustments for baseline levels of the respective burnout dimension. In contrast with the literature, no relation between social capital and emotional exhaustion was found after adjustment for baseline level of emotional exhaustion. After additional adjustments were made for the job characteristics 'decision-making autonomy' and 'task variety', the relation between social capital and competence disappeared. CONCLUSIONS: This study delivered evidence for the lagged relation between social capital and distance, even after controlling for demographical and job characteristics. Therefore, the findings suggest that organizations should pay attention to strategies enhancing social interaction, enabling to increase the levels of support, reciprocity, sharing and trust, in the prevention of burnout.

Authentic leadership and thriving among nurses: the mediating role of empathy.

AIM: To examine the relationship between perceived authentic leadership and two dimensions of thriving (learning and vitality) among nurses, and to study the mediating role of empathy in this relationship. BACKGROUND: Nurses' thriving is a key asset for health care organisations, and its significant role warrants the need to identify the underlying key determinants and psychological mechanisms. METHOD: A cross-sectional design was carried out in a large hospital in September 2013. Self-administered questionnaires were distributed to 360 nurses. The main hypotheses were tested through hierarchical regression analyses. RESULTS: The significant positive relationship between perceived authentic leadership and vitality was mediated by perceived empathy. This mediation, however, was not confirmed in relation to learning. CONCLUSIONS: Nurse managers' authentic leadership enhances nurses' thriving at work. Furthermore, empathic nurse managers seem to increase the vitality of their nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Training nurse managers in authentic leadership skills is important for the nursing field, as those skills help nurse managers to better express empathy and consequently foster thriving in nursing.

Combined spinal epidural analgesia for labor using sufentanil epidurally versus intrathecally: a retrospective study on the influence on fetal heart trace.

OBJECTIVE: We retrospectively compared a protocol using sufentanil and ropivacaine intrathecally with a protocol in which only ropivacaine was administered intrathecally and sufentanil was used epidurally to evaluate whether banning sufentanil from the intrathecal space results in a decreased incidence of adverse fetal heart rate changes. METHODS: Some 520 cardiotocographic tracings were examined for changes in fetal heart rate and uterine activity following two different protocols of combined spinal epidural analgesia. Charts were consulted for neonatal and labor outcome. RESULTS: When sufentanil was used epidurally instead of intrathecally, the incidence of adverse changes in fetal heart trace was less, demonstrated by a higher percentage of normal reassuring tracings (74.5% vs. 60.4% when sufentanil was used intrathecally; P=0.007), less tracings showing bradycardia (7.5% vs. 14.1%; P=0.035), and more tracings displaying 3 or more accelerations in fetal heart rate in 45 min (93.5% vs. 83.9%; P=0.003) together with less episodes of tachycardia (3.5% vs. 11.4%; P=0.005). There were no differences in labor and neonatal outcome. CONCLUSIONS: Based on fetal heart tracing, it seems favorable to ban sufentanil from the intrathecal compartment.

Transformational leadership and safety performance among nurses: the mediating role of knowledge-related job characteristics.

AIMS: To report the impact of transformational leadership on two dimensions of nurses' safety performance (i.e. safety compliance and safety participation) and to study the mediating role of knowledge-related job characteristics in this relationship. BACKGROUND: Safety performance refers to the behaviours that employees exhibit to adhere to safety guidelines and to promote health and safety at their workplace. Nurses' safety performance is a major challenge for healthcare settings, urging the need to identify the key determinants and psychological mechanisms that influence it. DESIGN: A cross-sectional survey study. METHODS: The study was carried out in September 2010 in a large Belgian hospital. We used self-administered questionnaires; 152 nurses participated. The hypotheses were tested using hierarchical regression analyses. RESULTS/FINDINGS: In line with our first hypothesis, the results show that transformational leadership exerted a significant positive impact on both dimensions of nurses' safety performance. This positive relation was mediated by knowledge-related job characteristics, supporting our second hypothesis. CONCLUSION: Head nurses' transformational leadership can enhance nurses' compliance with and participation in safety. Furthermore, transformational head nurses are able to influence the perception that their nurses have about the kind and amount of knowledge in their job, which can also lead to increases in both dimensions of nurses' safety performance. This study therefore demonstrates the key impact that transformational head nurses have, both directly and indirectly, on the safety performance of their nurses.

The Relationship between Food Safety Culture Maturity and Cost of Quality: An Empirical Pilot Study in the Food Industry.

In the food industry, a mature food safety culture (FSC) is linked to better food safety performance. However, the relationship between FSC maturity and key economical performance indicators, such as cost allocation, remains unexplored. This research is the first pilot study to empirically explore the association between FSC maturity and cost of quality (CoQ). A CoQ survey was developed and pretested. CoQ data were collected through collaboration with company management. FSC maturity was assessed through a validated mixed-method assessment (diagnostic instrument, questionnaires, and interviews). A convenience sample of five food processing companies was assembled and subjected to FSC and CoQ assessment. Results revealed that monitoring CoQ is not yet standard practice in the food industry: three out of five companies were unable to specify all failure costs. For prevention and appraisal costs, results showed descriptively and statistically that when these costs are higher, FSC is more mature. Considering the theoretical context of the research (CoQ models and available literature), these results present the first empirical evidence to substantiate that FSC could replace product/service quality in CoQ models. Findings justify the push for a shift in perception, from considering FSC as a task on the list of resource demanding activities toward a narrative in which FSC contributes to financial health.

Food safety culture maturity and its relation to company and employee characteristics.

Three facets of food safety culture (FSC) (i.e., food safety management system (FSMS), human-organizational and human-individual building block), were diagnosed through a validated mixed-method assessment in twenty food processing companies. Many underdeveloped dimensions were detected in the FSMS and the human-organizational building block, while the human-individual building block was more mature. It was explored whether company (e.g., company size) and employee characteristics (e.g. leaders vs. non-leaders) are associated with FSC maturity (based on 1410 employee responses) through a cluster analysis and statistical (Mann-Whitney U and Kruskal-Wallis) tests. Results revealed significant differences (p-value <0.05) based on company characteristics (significant differences based on: size, belonging to a larger group, product type, place in the supply chain, training frequency, certificates, maturity of control and assurance activities) and employee characteristics (significant differences based on: leaders vs. non-leaders, daily direct contact with food or not, seniority, time since training and psychosocial well-being). These findings are useful to develop tailored food safety culture improvement interventions to enhance the maturity of food safety culture in food companies, as these might focus on lower perceiving (sub)groups of employees or lower perceiving (sub)groups of companies.

Does workplace telepressure get under the skin? Protocol for an ambulatory assessment study on wellbeing and health-related physiological, experiential, and behavioral concomitants of workplace telepressure.

BACKGROUND: The daily working life of many employees requires the use of modern information and communication technology (ICT) devices such as computers, tablets, and smartphones. The double-edged nature of digital work environments has been increasingly highlighted. Benefits such as increased flexibility come at a personal cost. One of the potential downsides is workplace telepressure, i.e., the experience of urge and preoccupation to quickly reply to work-related messages and demands using ICT. There is initial - mainly survey-based-evidence that workplace telepressure may have negative effects on a variety of wellbeing and health outcomes. AIMS AND HYPOTHESES: Adopting the Effort-Recovery Model and the concept of allostatic load as theoretical frameworks, the present study aims to investigate the hypothesis that workplace telepressure is significantly associated with increased "wear and tear", in the form of more psychosomatic complaints, worse sleep quality (self-reported and actigraphy-based), worse mood, and biological alterations (lower cardiac vagal tone, lower anabolic balance defined as the ratio of salivary dehydroepiandrosterone to salivary cortisol, and higher salivary alpha-amylase). Additionally, the study aims to investigate the hypothesis that connection to work defined as work-related workload and work-related perseverative cognition plays a significant role in the mediation of these relationships. METHODS: To test our hypotheses, we will conduct an ambulatory assessment study with a convenience sample of 120 healthy workers regularly using ICTs for job communication. For one week, participants will be asked to complete electronic diaries assessing their level of workplace telepressure, psychosomatic complaints, sleep quality, mood, work-related workload, and work-related perseverative cognition. They will also continuously wear the Bittium Faros 180L ECG monitor, the wrist-worn actigraph MotionWatch 8, and perform saliva sampling five times per day. DISCUSSION: This study will be the most comprehensive ambulatory investigation of workplace telepressure and its psychophysiological concomitants to date and constitutes an important step towards understanding how high levels of workplace telepressure may lead in the long term to secondary alterations (e.g., hypertension, chronic inflammation) and disease (e.g., heart disease). The findings of this study are also anticipated to contribute to guiding the development and implementation of interventions, programs, and policies relevant to employees' digital wellbeing.

Assessing endovascular team performances in a hybrid room using the Black Box system: a prospective cohort study.

BACKGROUND: The hybrid room (HR) is a complex, high-risk environment, requiring teams (surgeons, anesthesiologists, nurses, technologists) to master various skills, including the 'As Low As Reasonably Achievable' principle of radiation safety. This prospective single center cohort reports the first use of the Operating Room Black Box (ORBB) in a HR. This medical data recording system captures procedural and audio-visual data to facilitate structured team performance analysis. METHODS: Patients planned for endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR) or treatment of symptomatic iliac-femoral-popliteal atherosclerotic disease (Peripheral Vascular Interventions or PVI) were included. Validated measures and established assessment tools were used to assess (non-)technical skills, radiation safety performance and environmental distractions. RESULTS: Six EVAR and sixteen PVI procedures were captured. Technical performance for one EVAR was rated 19/35 on the procedure-specific scale, below the 'acceptable' score of 21. Technical skills were rated above acceptable in all PVI procedures. Shared decision making and leadership were rated highly in 12/22 cases, whereas surgical communication and nurses' task management were rated low in 14/22 cases. Team members rarely stepped back from the C-arm during digital subtraction angiography. Radiation safety behavior was scored below 'acceptable' in 14/22 cases. A median (interquartile range) number of 12 (6-23) auditory distractions was observed per procedure. CONCLUSIONS: The ORBB facilitates holistic workplace-based assessment of endovascular performance in a HR by combining objective assessment parameters and rating scale-based evaluations. Strengths and weaknesses were identified in team members' (non-)technical and radiation safety practices. This technology has the potential to improve vascular surgical practice, though human input remains crucial. (NCT04854278).

The underpinning of meaningful activities by brain correlates: a systematic review.

Introduction: Engaging in meaningful activities contributes to health and wellbeing. Research identifies meaningfulness by analysing retrospective and subjective data such as personal experiences in activities. Objectively measuring meaningful activities by registering the brain (fNIRS, EEG, PET, fMRI) remains poorly investigated. Methods: A systematic review using PubMed, Web of Science, CINAHL, and Cochrane Library. Findings: Thirty-one studies investigating the correlations between daily activities in adults, their degree of meaningfulness for the participant, and the brain areas involved, were identified. The activities could be classified according to the degree of meaningfulness, using the attributes of meaningfulness described in the literature. Eleven study activities contained all attributes, which means that these can be assumed to be meaningful for the participant. Brain areas involved in these activities were generally related to emotional and affective processing, motivation, and reward. Conclusion: Although it is demonstrated that neural correlates of meaningful activities can be measured objectively by neurophysiological registration techniques, "meaning" as such has not yet been investigated explicitly. Further neurophysiological research for objective monitoring of meaningful activities is recommended.

Perceived work ability and turnover intentions: a prospective study among Belgian healthcare workers.

AIM: To report a study exploring prospective relations between nurses' perceived work ability and three forms of turnover intentions, respectively, intent to leave the ward, organization and profession. BACKGROUND: Turnover of nursing staff is a major challenge for healthcare settings and for healthcare in general, urging the need to improve retention. DESIGN: Survey. METHODS: Based on the longitudinal data of the Belgian sample from the European Nurses' Early Exit study, a total of 1531 healthcare workers who remained in their job, completed in 2003 and 1 year later a self-administered questionnaire including the Work Ability Index to assess work ability. Multiple logistic regression analysis was performed adjusting for possible confounding variables. RESULTS: In a population with low intent to leave at baseline prospective analyses showed that a poor work ability at baseline increased the risk of high intent to leave the ward and high intent to leave the organization, 1 year later. A substantial deterioration in work ability was a risk factor for developing high turnover intentions 1 year later. Social support had no effect on the relation between work ability and all three types of intent to leave but the relation between work ability and intent to leave the ward was borderline significantly moderated by good interpersonal relations. CONCLUSIONS: Poor work ability was a risk factor for developing turnover intentions. Maintaining good work ability and improving poor work ability becomes increasingly important to retain nurses.

When Thoughts Have No Off Switch: The Cost of Telepressure and Message-based Communication behaviour within Boundary-crossing Contexts.

Communication technology enables employees to be constantly connected at the cost of potentially blurring the boundaries between work and private life, which can be detrimental to their well-being. The present study utilised a quantitative diary approach (N = 269 employees, N = 1256 data points) to provide further evidence on the association between telepressure and ruminative thoughts within boundary-crossing contexts (i.e., including work-related behaviour and cognitions during leisure time as well as private-related behaviour and cognitions at work). On a day-to-day level, we examined if context-incongruent telepressure had a positive effect on context-incongruent affective rumination through context-incongruent message-based communication behaviour. Multilevel analyses supported our hypothesised mediation models. Altogether, findings reveal that quickly replying towards messages or its related cognition (i.e., telepressure) may result in a resource-draining experience in terms of affective rumination within both boundary-crossing contexts. Theoretical and practical implications as well as future research avenues are discussed.

An Exploratory Study on the Relation between Companies' Food Integrity Climate and Employees' Food Integrity Behavior in Food Businesses.

Given the need to prevent food fraud within the international food supply chain and the current lack of research on food integrity, in this paper, the relation between the organizational food integrity climate and employees' food integrity behavior is examined to understand the role of the individual or psychological dimension in food integrity. The construct of food integrity behavior was introduced and defined, and the conceptual model of the food integrity climate in relation to food integrity behavior was elaborated along with study variables and hypotheses. In the proposed model, the potential moderating role of employees' psychological well-being (i.e., burnout and job stress) was analyzed, and two mediating variables were also proposed (i.e., knowledge and motivation) which both could explain how the prevailing food integrity climate might influence employees' food integrity behavior. Data was collected through convenience sampling in four Belgian food companies with a total of 118 participating employees through a self-assessment questionnaire. Based on the statistical analysis, it was concluded that a well-developed organizational food integrity climate promotes positive employees' food integrity behavior. Specifically, results of this semi-quantitative study demonstrated that the companies' food integrity climate is positively related to the employees' food integrity behavior both directly and indirectly, and that food integrity knowledge is a partial mediator in the relation between food integrity climate and food integrity behavior, while food integrity motivation is a full mediator. Study limitations and implications are also discussed.

Job resources and matching active coping styles as moderators of the longitudinal relation between job demands and job strain.

BACKGROUND: Only in a few longitudinal studies it has been examined whether job resources should be matched to job demands to show stress-buffering effects of job resources (matching hypothesis), while there are no empirical studies in which the moderating effect of matching personal characteristics on the stress-buffering effect of job resources has been examined. PURPOSE: In this study, both the matching hypothesis and the moderating effect of matching active coping styles were examined with respect to the longitudinal relation between job demands, job resources, and job strain. METHOD: The study group consisted of 317 beginning teachers from Belgium. The two-wave survey data with a 1-year time lag were analyzed by means of structural equation modeling and multiple group analyses. RESULTS: Data did not support the matching hypothesis. In addition, no support was found for the moderating effect of specific active coping styles, irrespective of the level of match. CONCLUSION: To show stress-buffering effects of job resources, it seems to make no difference whether or not specific types of job demands and job resources are matched, and whether or not individual differences in specific active coping styles are taken into account.