Impact of organizational culture on preventability assessment of selected adverse events in the ICU: evaluation of morbidity and mortality conferences.

PURPOSE: To determine whether organizational culture is associated with preventability assessment of reported adverse events (AE) in intensive care units (ICU). DESIGN: Blind review of time randomly distributed case notes written in the form of structured abstracts by the nurses who participated in recently implemented morbidity and mortality conferences from December 2006 to June 2010 in a 18-bed ICU in France. Ninety-five abstracts summarizing the discussions of 95 AE involving 95 patients were reviewed by two external blinded pairs (each comprised of one senior intensivist and one psychologist). METHODS: A score for each organizational culture style was determined, with the highest scorer being considered the dominant style present in the abstract. RESULTS: Reliability of the classification and quantification of culture traits between pairs was very good or good for 13 dimensions and moderate for two others. The two pairs deemed 32/95 and 43/95 of AE preventable (κ = 0.59). Concordance was very good (κ = 0.85) between the external pairs for evaluation of the dominant culture style. The Cochran-Armitage trend test indicated an increasing trend for change of the dominant organizational culture style over time: the team-satisfaction-oriented culture took a leading role (p = 0.02), while the people-security-oriented culture decreased dramatically (p < 0.001). The task-security-oriented culture was significantly associated with a preventable judgment, while the people-security-oriented culture was significantly associated with an unpreventable judgment (p < 0.001). CONCLUSIONS: This study demonstrated a strong relationship between preventability assessment of AE reported by caregivers and their organizational culture in the ICU.

Level of emotional awareness in the general French population: effects of gender, age, and education level.

The Levels of Emotional Awareness Scale (LEAS) developed by Lane et al. (1990) measures the ability of a subject to discriminate his or her own emotional state and that of others. The scale is based on a cognitive-developmental model in which emotional awareness increases in a similar fashion to intellectual functions. Because studies performed using North American and German populations have demonstrated an effect of age, gender, and level of education on the ability to differentiate emotional states, our study attempts to evaluate whether these factors have the same effects in a general French population. 750 volunteers (506 female, 244 male), who were recruited from three regions of France (Lille, Montpellier, Paris), completed the LEAS. The sample was divided into five age groups and three education levels. The results of the LEAS scores for self and others and the total score showed a difference in the level of emotional awareness for different age groups, by gender and education level. A higher emotional level was observed for younger age groups, suggesting that emotional awareness depends on the cultural context and generational societal teachings. Additionally, the level of emotional awareness was higher in women than in men and lower in individuals with less education. This result might be explained by an educational bias linked to gender and higher education whereby expressive ability is reinforced. In addition, given the high degree of variability in previously observed scores in the French population, we propose a standard based on our French sample.

Emotional awareness in substance-dependent patients.

We explored emotional awareness in substance-dependent patients and its relationships to self-reported alexithymia. Sixty-four outpatients with drug dependence or alcohol dependence were evaluated before the beginning of treatment with the Hamilton Depressive Scale and the Covi Anxiety Scale, and they completed the Toronto Alexithymia Scale (TAS-20) and the Levels of Emotional Awareness Scale (LEAS). Subjects exhibited low levels of emotional awareness and TAS-20 scores were high. Both measures were not related to depressive and anxious symptomatology. This research is the first to provide LEAS results with substance-dependent patients and highlights their deficits in emotions' differentiation and complexity. The lack of a relationship between LEAS and TAS-20 is discussed from the methodological and theoretical points of view.