Centralization and democratization: Managing crisis communication in health care delivery.

BACKGROUND: Communication is an essential organizational process for responding to adversity. Managers are often advised to communicate frequently and redundantly during crises. Nonetheless, systematic investigation of how information receivers perceive organizational communication amid crises has remained lacking. PURPOSE: The aim of this study was to characterize features of effective internal crisis communication by examining how information-sharing processes unfolded during the initial stage of the COVID-19 pandemic. METHODOLOGY: Between June and August 2020, we conducted 55 semistructured interviews with emergency department workers practicing in a variety of roles. We analyzed interview transcripts following constructivist constant comparative methods. RESULTS: Our findings revealed that at the onset of COVID-19 pandemic response, emergency department workers struggled with immense fear and anxiety amid high uncertainty and equivocality. Frequent and redundant communication, however, resulted in information delivery and uptake problems, worsening anxiety, and interpersonal tension. These problems were ameliorated by the emergence of contextual experts who centralized and democratized communication. Centralization standardized information received across roles, work schedules, and settings while decoupling internal communication from turbulence in the environment. Democratization made information accessible in a way that all could understand. It also ensured information senders' receptiveness to feedback from information receivers. Centralization and democratization together worked to reduce sensed uncertainty and equivocality, which reduced anxiety and interpersonal tension. CONCLUSION: Establishing frequent and redundant communication strategies does not necessarily address the anxiety and interpersonal tension produced by uncertainty and equivocality in crises. PRACTICE IMPLICATIONS: Centralization and democratization of crisis communication can reduce anxiety, improve coordination, and promote a safer workplace and patient care environment.

Noncontact Injury Distribution and Relationship With Preseason Training Load and Nonmodifiable Risk Factors in Rugby Union Players Across Multiple Seasons.

ABSTRACT: Evans, SL, Whittaker, G, Elphinstone Davis, E, Jones, ES, Hardy, J, and Owen, JA. Noncontact injury distribution and relationship with preseason training load and non-modifiable risk factors in Rugby Union players across multiple seasons. J Strength Cond Res 37(7): 1456-1462, 2023-This study examined the distribution of noncontact injury during phases of the competitive season and the association between preseason training load (TL) and nonmodifiable risk factors on injury risk during these phases. Injury data were recorded from 1 senior academy team over 3 seasons (2017-2020) and analyzed across early-season, midseason, and late-season phases. A generalized estimating equation was used to model risk factors with noncontact injury for selected phases. The highest noncontact injury incidence occurred in the late-season phase (22.2 per 1,000 hours) compared with early (13.7 per 1,000 hours, p < 0.001) and midseason phases (15.5 per 1,000 hours, p = 0.001). Low preseason TL (8,949-12,589 arbitrary units; odds ratio [OR], 95% confidence interval [CI] = 4.7, 1.0-21.6; p = 0.04) and low preseason TL combined with high early-season TL and injury in the early-season phase (OR, 95% CI = 6.5, 1.1-35.5; p = 0.03) were associated with greater midseason noncontact injury risk. In addition, low preseason TL combined with previous injury was associated with increased risk of noncontact injury risk in the late season (OR, 95% CI = 12.2, 0.9-15.6, p = 0.05). Our results suggest players are at a greater injury risk during the late-season phase, with low preseason cumulative loads combined with a history of previous injury associated with increased in-season injury risk. Strength and conditioning coaches should therefore monitor cumulative preseason TL alongside screening for previous injury history to identify athletes at greater risk of noncontact injury risk during the competitive season.

Team and leadership factors and their relationship to burnout in emergency medicine during COVID-19: A 3-wave cross-sectional study.

Objective: We examined the relationship of team and leadership attributes with clinician feelings of burnout over time during the corona virus disease 2019 (COVID-19) pandemic. Methods: We surveyed emergency medicine personnel at 2 California hospitals at 3 time points: July 2020, December 2020, and November 2021. We assessed 3 team and leadership attributes using previously validated psychological scales (joint problem-solving, process clarity, and leader inclusiveness) and burnout using a validated scale. Using logistic regression models we determined the associations between team and leadership attributes and burnout, controlling for covariates. Results: We obtained responses from 328, 356, and 260 respondents in waves 1, 2, and 3, respectively (mean response rate = 49.52%). The median response for feelings of burnout increased over time (2.0, interquartile range [IQR] = 2.0-3.0 in wave 1 to 3.0, IQR = 2.0-3.0 in wave 3). At all time points, greater process clarity was associated with lower odds of feeling burnout (odds ratio [OR] [95% confidence interval (CI) = 0.36 [0.19, 0.66] in wave 1 to 0.24 [0.10, 0.61] in wave 3). In waves 2 and 3, greater joint problem-solving was associated with lower odds of feeling burnout (OR [95% CI] = 0.61 [0.42, 0.89], 0.54 [0.33, 0.88]). Leader inclusiveness was also associated with lower odds of feeling burnout (OR [95% CI] = 0.45 [0.27, 0.74] in wave 1 to 0.41 [0.24, 0.69] in wave 3). Conclusions: Process clarity, joint problem-solving, and leader inclusiveness are associated with less clinician burnout during the COVID-19 pandemic, pointing to potential benefits of focusing on team and leadership factors during crisis. Leader inclusiveness may wane over time, requiring effort to sustain.

Match and training injury risk in semi-professional rugby union: A four-year study.

OBJECTIVES: Describe medical-attention and time-loss injuries during matches and training in a Welsh Premiership Rugby Union team. DESIGN: Prospective cohort observational study. METHODS: Injury incidence, severity, burden, location, type, and cause were determined in sixty-nine players from one semi-professional Rugby Union team. RESULTS: Medical-attention and time-loss injury incidence was greater for matches (incidence, 95% confidence interval = 122.8, 108.9-138.4 and 99.8, 87.3-114.0) than training (incidence, 95% confidence interval = 2.2, 1.8-2.6 and 1.7, 1.4-2.1) per 1000 player-hours. Injury severity was similar for matches (time-loss ± standard deviation = 24.9 ± 30.8 days) and training (time-loss ± SD = 22.4 ± 29.1 days), with injury burden greater for matches (burden, 95% confidence interval = 3148.8, 3019.8-6479.2) than training (burden, 95% confidence interval = 49.7, 36.7-129.6). Lower-limb time-loss injuries were most common during matches (incidence, 95% confidence interval = 46.0, 37.9-55.9) and training (incidence, 95% confidence interval = 1.3, 1.0-1.7) per 1000 player-hours, whilst upper-limb injuries were most severe in matches (time-loss, 95% confidence interval = 38.8, 28.3-44.4 days) and training (time-loss, 95% confidence interval = 45.9, 17.5-52.7 days). The prevalent cause of contact-injury was tackling (31%) with running (11%) the common cause of non-contact injury. CONCLUSIONS: Time-loss match-injury incidence, severity, and burden were similar to data reported in the professional tier, with similar patterns of injuries for location, type, and inciting event. These figures are greater than previously reported for semi-professional Rugby Union, warranting further investigation at this level of play.

How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty.

BACKGROUND: Psychological safety-the belief that it is safe to speak up-is vital amid uncertainty, but its relationship to feeling heard is not well understood. PURPOSE: The aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty. METHODOLOGY: We conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020. The survey measured psychological safety, feeling heard, overall burnout, worsening burnout, and perceived process adaptation during the COVID-19 crisis. We assessed descriptive statistics and construct measurement properties, and we assessed relationships among the variables using generalized structural equation modeling. RESULTS: Psychological safety and feeling heard demonstrated acceptable measurement properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological safety. Psychological safety and feeling heard were both statistically significantly associated with lower burnout and greater process adaptation. Only psychological safety exhibited a statistically significant relationship with less worsening burnout during crisis. We found evidence that feeling heard mediates psychological safety's relationship to burnout and process adaptation. CONCLUSION: Psychological safety is important but not sufficient for feeling heard. Feeling heard may help mitigate burnout and enable adaptation during uncertainty. PRACTICE IMPLICATIONS: For health care leaders, expanding beyond psychological safety to also establish a feeling of being heard may further reduce burnout and improve care processes.

Bulls in a China Shop: Narcissism, Intragroup Conflict, and Task Cohesion.

When given opportunities for personal glory in individual settings, people high in narcissism excel. However, less is known about narcissists' influence in team contexts. Across two studies (utilizing cross-sectional and two-wave longitudinal designs) involving 706 athletes from 68 teams in total, we tested a conceptual model linking narcissism to task cohesion, via intragroup conflict, moderated by narcissistic group composition. We tested a new sports-oriented measure of intragroup conflict using Bayesian estimation and evaluated our theorizing using a multilevel conditional indirect effect hybrid model. Across both studies, we found that narcissism influenced perceptions of task cohesion via process conflict only, with a negative influence at low narcissistic group composition that was weakened (Study 1) or nullified (Study 2) at high narcissistic team composition. Collectively, these findings offer the first example of how narcissism influences task cohesion in team settings and the contextual effects of narcissistic group composition.

Valued Insight or Act of Insubordination? How Context Shapes Coaches' Perceptions of Challenge-Oriented Followership.

Effective leadership is a collaborative effort, requiring a degree of complementarity in how people enact roles of leadership and followership. Using a novel online vignette methodology, we experimentally tested how three contextual factors influenced coaches' responses to challenge-oriented acts of followership, as well as investigated two potential mechanisms. Coaches (N = 232) watched videos of an athlete provided unsolicited challenge-oriented feedback to a coach. Videos varied by the (a) athlete's status, (b) presence of third-party observers, and (c) stage of the decision-making process. Following the video, we assessed coaches' evaluations of the athlete. Challenge-oriented followership was perceived more favorably when enacted by an athlete in one-on-one (vs. in a group) and before a decision has been reached (vs. after a decision is reached). Coaches may appreciate proactivity from athletes in positions of followership, but challenge-oriented followership behaviors enacted at the wrong time and place can elicit negative reactions.

Relative age effect? No "flipping" way! Apparatus dependent inverse relative age effects in elite, women's artistic gymnastics.

In contrast to research on team-sports, delayed maturation has been observed in higher-skilled gymnasts, leading to atypical distributions of the relative age effect. Recent studies have reported intra-sport differences in the relative age effect and given the task demands across gymnastics apparatus, we expected to find evidence for the influence of apparatus specialism. We examined the presence of a relative age effects within a sample of elite, international, women's artistic gymnasts (N = 806, Ncountries = 87), and further sampled our data from vault, bars, beam, and floor major competition finalists. Poisson regression analysis indicated no relative age effect in the full sample (p = .55; R2 adj. = .01) but an effect that manifested when analysing apparatus independently. The Index of Discrimination (ID) analysis provided evidence of an inverse relative age effect identified for beam (p = .01; ID = 1.27; R2 adj. = .12), a finding that was corroborated by a marginal effect in our vault finalists (p = .08; ID = 1.21; R2 adj. = .06). These novel findings can be attributed to the integrated influence of self-fulfilling prophecy upon coach and gymnast expectations, as well as the technical mechanisms underpinning skill development involved in the underdog hypothesis.

Masked and distanced: a qualitative study of how personal protective equipment and distancing affect teamwork in emergency care.

BACKGROUND: Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines. OBJECTIVE: We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting. METHODS: We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles. We then performed a thematic analysis to identify and construct patterns of teamwork challenges into themes. RESULTS: We discovered two types of challenges to teamwork: material barriers related to wearing masks, gowns and powered air-purifying respirators, and spatial barriers implemented to conserve PPE and limit coronavirus exposure. Both material and spatial barriers resulted in disrupted communication, roles and interpersonal relationships, but they did so in unique ways. Material barriers muffled information flow, impeded team member recognition and role/task division, and reduced belonging and cohesion while increasing interpersonal strain. Spatial barriers resulted in mediated communication and added physical and emotional distance between teammates and patients. CONCLUSION: Our findings identify specific aspects of how intensified PPE use disrupts teamwork and can inform efforts to ensure care quality and safety in emergency settings as PPE use continues during and, potentially beyond, the coronavirus disease-2019 pandemic.

Korea - The Forgotten War (1950-1953).

A summary of the British Army's contribution to dental provision for Commonwealth troops engaged in the Korean War including the personal recollections of James Donaldson, a Royal Army Dental Corps veteran. It outlines the planning and setting up of dental facilities in the theatre of war, some of the problems encountered and how these were overcome while operating under difficult and, at times, extreme weather conditions.

Health service utilisation and health outcomes of residential aged care residents referred to a hospital avoidance program: A multi-site retrospective quasi-experimental study.

OBJECTIVE: To compare the health system utilisation patterns and health outcomes of residential aged care facility (RACF) residents reviewed by a hospital avoidance program to those of RACF residents who received usual care. METHODS: A retrospective evaluation of a hospital avoidance program provided by a hospital-based medical and nursing outreach team. Residents reviewed by the program were randomly matched 1:1 to comparison group residents based on age group, sex and number of co-morbidities. Number of hospital admissions, excess hospital length of stay and excess hospital treatment costs were compared. RESULTS: Residents reviewed by the program spent an average 9-10 days fewer in hospital with AUD$2,091 to $8,014 lower hospital treatment costs compared to comparison group residents. CONCLUSION: Rapid provision of outreach services for the management of acute care of RACF residents may reduce the number of days residents spend in hospital, as well as reducing the associated hospital treatment costs.

Increases in exposure calls related to selected cleaners and disinfectants at the onset of the COVID-19 pandemic: data from Canadian poison centres. / Augmentation du nombre d'appels relatifs à une exposition à certains nettoyants et désinfectants au début de la pandémie de COVID-19 : données des centres antipoison canadiens.

Little is known about the use or misuse of cleaning products during the COVID-19 pandemic. We compiled data from January to June in 2019 and 2020 from Canadian poison centres, and report on calls regarding selected cleaning products and present year-overyear percentage change. There were 3408 (42%) calls related to bleaches; 2015 (25%) to hand sanitizers; 1667 (21%) to disinfectants; 949 (12%) to chlorine gas; and 148 (2%) to chloramine gas. An increase in calls occurred in conjunction with the onset of COVID-19, with the largest increase occurring in March. Timely access to Canadian poison centre data facilitated early communication of safety messaging for dissemination to the public.

The Canadian Surveillance System for Poison Information (CSSPI) led by Health Canada is a developing network of poison centres, health authorities and regulatory agencies that facilitates early detection of poisoning incidents and alerting at the national level to inform harm reduction interventions. In response to the COVID-19 pandemic, concerns were raised over the potential for misuse of cleaning products and disinfectants; the CSSPI network monitored and assessed these concerns. An overall increase in calls about select cleaning products and disinfectants occurred concurrently with the pandemic, with percentage increases for selected products as high as 400% compared to the same period in the previous year.

Le Système canadien de surveillance des données sur les intoxications (SCSDI), dirigé par Santé Canada, est un réseau en développement composé de centres antipoison, d'autorités sanitaires et d'organismes de réglementation, qui facilite la détection précoce des incidents d'empoisonnement et une alerte rapide au niveau national afin d'éclairer les interventions en matière de réduction des risques. En réponse à la pandémie de COVID-19, des préoccupations ayant émergé quant au risque de mauvaise utilisation de produits de nettoyage et de désinfectants, le SCSDI a surveillé et évalué ces préoccupations. Une augmentation globale du nombre d'appels concernant plusieurs produits de nettoyage et désinfectants a eu lieu en concomitance avec la pandémie, certaines augmentations pouvant atteindre jusqu'à 400 % pour certains produits par rapport à la même période de l'année précédente.

Comparison of health service use trajectories of residential aged care residents reviewed by a hospital avoidance program versus usual care.

OBJECTIVE: To compare health service use trajectories of residential aged care facility (RACF) residents reviewed by the Aged Care Rapid Response Team (ARRT) to RACF residents who received usual care. METHODS: A retrospective group-based trajectory analysis of RACF residents aged ≥65 years who were reviewed by ARRT during 1 July 2015 to 30 June 2016 was conducted. Health service use trajectories were followed for two years to 30 June 2018 and compared to RACF residents aged ≥65 years who lived in the same Local Health District and received usual care. RESULTS: There were 2,245 ARRT-reviewed resident hospitalisations and 11,892 usual care resident hospital admissions during 2015-16. Trajectory analysis categorised ARRT-reviewed residents into four groups and usual care residents into three groups. Age, comorbid health conditions and dementia were predictors of group membership in both ARRT-reviewed RACF residents and usual care RACF residents. Additionally, gender predicted group membership in ARRT-reviewed RACF residents and fall-related injuries predicted group membership in usual care RACF residents. CONCLUSION: The identification of health service use trajectories assists in understanding hospital use by older RACF residents and may offer guidance in the design of prevention measures, including hospital avoidance programs.

Strengthening surveillance of consumer products in Canada: the vaping example. / Renforcer la surveillance des produits de consommation au Canada : l'exemple du vapotage.

INTRODUCTION: The overall objective of this study was to demonstrate how information collected by the Consumer Product Safety Program ("the Program") can be used to identify emerging hazards. Specifically, this study characterized and quantified trends associated with vaping reports received by the Program over the past five years. METHODS: Data collated by the Program were extracted for the period from 1 January, 2015 to 30 September, 2019. The data were summarized using descriptive statistics and trends were quantified for annual percent change. In order to compare characteristics of vaping reports, the proportionate injury ratios (PIRs) and corresponding 95% CIs were used to compare vaping-related injuries to all other reports received by the Program. RESULTS: A total of 71 vaping-related reports were received between 1 January, 2015 and 30 September, 2019. During this period, the annual percent change increase in the number of reports received was approximately 73% annually (p < .05). Among the reported injuries, 41% were burn injuries. Proportionally, there were more vaping reports involving males (PIR = 1.89; 95% CI: 1.51-2.36) and individuals between the ages of 15 and 19 years (PIR = 11.53; 95 % CI: 4.95-26.8) as compared to all other reports submitted to the Program. CONCLUSIONS: While the number of reports relating to vaping products is small, the results of this analysis suggest that certain groups, including males and youth, are more likely to be the subject of a vaping-related incident.

Mind and body: Psychophysiological profiles of instructional and motivational self-talk.

Self-talk is a psychological skill that benefits motor performance by controlling and organizing performers' thoughts. While the behavioral effects of self-talk are clear, research on the mechanisms underpinning the effects of different modes of self-talk is sparse. To address this issue, we propose and test a psychophysiological model of the effects of self-talk on motor performance. Forty golf novices practiced a golf putting task while using either instructional or motivational self-talk preceding each putt. We measured performance (radial error), technique (club kinematics and muscle activity), cardiac activity (heart-rate and event-related heart-rate change), as well as electroencephalographic alpha power and connectivity in a randomized (group: instructional self-talk, motivational self-talk) experimental design. Instructional self-talk promoted superior technique and was associated with greater parietal alpha power and weaker connectivity between frontal and parietal electrodes and all other scalp sites, possibly indicative of increased top-down control of action. These findings provide initial evidence for an information-processing mechanism underlying the benefits of instructional self-talk. They also cast doubt on the validity of left-frontotemporal connectivity as a measure of verbal-analytic processing during motor tasks. Motivational self-talk led to increased heart-rate and reduced event-related heart rate variability, suggesting an effort-based mechanism to explain the benefits of motivational self-talk. Our study represents the most complete multi-measure investigation of self-talk to date. We hope that our psychophysiological model of self-talk will encourage researchers to move beyond the exclusive reliance on behavioral and self-report measures to discover the mechanisms underlying the benefits of self-talk for performance.

Endorsement and Constructive Criticism of an Innovative Online Reflexive Self-Talk Intervention.

This study prospectively followed the experiences of skilled athletes who were involved in an innovative reflexive self-talk online intervention targeting goal-directed self-talk. Four experienced female athletes between the ages of 20 and 40 years were invited to an initial interview, a 4-week intervention, and two post-intervention interviews. Two applied sport psychologists used an online Socratic questioning approach to encourage their athletes to describe challenging scenarios, think about their use of self-talk and its effectiveness, and explore alternative self-statements that could be used in future situations. Data were multi-sourced stemming from the psychologists, athletes, and third parties (e.g., coach). Three athletes completed the intervention, whereas one athlete withdrew prematurely, mainly because the Socratic questioning approach and the online mode of delivery did not meet her preferences. From the three athlete who had completed the intervention, there was endorsement and constructive criticism of the intervention and its online delivery mode. The intervention, largely due to the accompanying raised awareness of self-talk use and refined content, seemingly benefited a range of variables including emotions, motivation, and confidence, both inside and outside of the athletes' sports life domain. Accordingly, this new type of online intervention warrants further consideration in the literature.

To me, to you: How you say things matters for endurance performance.

Self-talk enhances physical performance. Nothing is known however about the way that a subtle grammatical difference in self-talk, using first or second person pronouns, may effect performance. As second person self-talk supports self-regulation in non-exercise populations, we hypothesized that 10 km cycling time-trial performance would be superior following second versus first person self-talk. Using a randomized, counterbalanced, crossover design, sixteen physically active males (Mage = 21.99, SD = 3.04 years) completed a familiarization visit followed by a 10 km time-trial during two separate experimental visits using first and second person self-talk. A paired t-test revealed that second person self-talk generated significantly faster time-trial performance than first person self-talk (p = .014). This was reflected in a significantly greater power output throughout the time-trial when using second person self-talk (p = .03), despite RPE remaining similar between conditions (p = .75). This is the first evidence that strategically using grammatical pronouns when implementing self-talk can influence physical performance providing practitioners with a new aspect to consider when developing interventions. We discussed findings in the context of a self-distancing phenomenon induced by the use second person pronouns.

Chunking, Conscious Processing, and EEG During Sequence Acquisition and Performance Pressure: A Comprehensive Test of Reinvestment Theory.

This study was designed to test the theorized link between reinvestment, motor chunks, and conscious processing, to provide a thorough examination of reinvestment theory. The authors measured electroencephalographic power and connectivity alongside self-reported conscious processing and behavioral indices of chunking in a 2 (group) × 5 (block) mixed-model design. A total of 55 individuals acquired a motor sequence (blocks A1, A2, A3, and A4) by relatively explicit (errorful) or implicit (errorless) paradigms. Then they performed in a pressure condition (block T). Results confirmed that chunking characterizes both modes of acquisition. However, explicit acquisition resulted in quicker chunking, reduced conscious processing, and increased cortical efficiency (left-temporal high-alpha power). In support of reinvestment theory, self-reported conscious processing tended to increase under pressure among explicit trainees only. In contrast to reinvestment theory, this had no adverse effect on performance. The results endorse explicit acquisition as an effective mode of training and provide a new neurophysiological explanation of this phenomenon.

CLIPS (Communication Learning in Practice for Scientists): A New Online Resource Leverages Assessment to Help Students and Academics Improve Science Communication.

The ability to communicate is a crucial graduate outcome for science students; however, crowded curricula and large class sizes make it difficult to find time to explicitly teach foundational communication skills. In response to these challenges, we developed an online resource called Communication Learning in Practice for Scientists, or CLIPS. CLIPS provides a multi-point mentoring model that has allowed us to successfully integrate the teaching and learning of a complex set of tacitly-understood skills across multiple scientific disciplines. It also provides a flexible way for industry experts, academics, and students to learn from one another's experiences of, and expertise in, science communication. CLIPS leverages the student focus on assessment; students access CLIPS for pragmatic, detailed, and consistent advice when undertaking assessment tasks. In creating CLIPS, our philosophy was that communication is the core business of any scientific practice, not an add-on after the event. Extensive, repeated use of CLIPS by both students and academics indicates that the resource and its delivery model are considered useful, respected, and impactful for, and by, the intended audiences. We have provided CLIPS to the science education community through www.clips.edu.au.