Diaries as Technologies for Sense-making and Self-transformation in Times of Vulnerability.

Diaries have been generally understood as "windows" on sense-making processes when studying life ruptures. In this article, we draw on Michel Foucault's conceptualization of self-writing as a "technology of the self" and on sociocultural psychology to propose that diaries are not "windows" but technologies that aid in the sense-making. Concretely, we analyzed three non-exhaustive and non-exclusive uses of diary writing in times of vulnerability: (1) imagination of the future and preparation to encounter difficulties; (2) distancing from one's own experience; and (3) creating personal commitments. Our longitudinal data comprised three public online diaries written over more than twenty years, belonging to three anonymous individuals selected from a database of more than 400 diaries. We analyzed these three diaries by iterating between qualitative and quantitative analysis. We conclude that: (1) beyond their expressive dimension, diaries are technologies that support the sense-making process, but not without difficulties; (2) diaries form a self-generated space for dialogue with oneself in which the diarist also becomes aware of the social nature of her life story; (3) diaries are not only technologies for the Socratic "know thyself" but also technologies to work on oneself, especially in terms of the personal perspective on the past or the future; and (4) the practice of diary writing goes beyond sense-making towards personal development and the desire to transform one's life trajectory.

Social Psychology of and for World-Making.

ACADEMIC ABSTRACT: Social psychology's disconnect from the vital and urgent questions of people's lived experiences reveals limitations in the current paradigm. We draw on a related perspective in social psychology1-the sociocultural approach-and argue how this perspective can be elaborated to consider not only social psychology as a historical science but also social psychology of and for world-making. This conceptualization can make sense of key theoretical and methodological challenges faced by contemporary social psychology. As such, we describe the ontology, epistemology, ethics, and methods of social psychology of and for world-making. We illustrate our framework with concrete examples from social psychology. We argue that reconceptualizing social psychology in terms of world-making can make it more humble yet also more relevant, reconnecting it with the pressing issues of our time. PUBLIC ABSTRACT: We propose that social psychology should focus on "world-making" in two senses. First, people are future-oriented and often are guided more by what could be than what is. Second, social psychology can contribute to this future orientation by supporting people's world-making and also critically reflecting on the role of social psychological research in world-making. We unpack the philosophical assumptions, methodological procedures, and ethical considerations that underpin a social psychology of and for world-making. Social psychological research, whether it is intended or not, contributes to the societies and cultures in which we live, and thus it cannot be a passive bystander of world-making. By embracing social psychology of and for world-making and facing up to the contemporary societal challenges upon which our collective future depends will make social psychology more humble but also more relevant.

Patient Identification of Diagnostic Safety Blindspots and Participation in "Good Catches" Through Shared Visit Notes.

Policy Points Patients and families can identify clinically relevant errors, including "blindspots"-safety hazards that are difficult for clinicians or organizations to see. Health information transparency, including patient access to electronic visit notes, now federally mandated in the US and the subject of policy debate worldwide, creates a new opportunity to engage patients in diagnostic safety. However, not all patients access notes. Patient identification of blindspots in their notes underscores the need to systematically and equitably engage willing patients in safety, promote patient "good catches," and establish routine systems for patient feedback to help avoid preventable diagnostic errors and delays. CONTEXT: Policy shifts toward health information transparency provide a new opportunity for patients to contribute to diagnostic safety. We investigated whether sharing clinical notes with patients can support identification of "diagnostic safety blindspots"-potentially consequential breakdowns in the diagnostic process that may be difficult for clinical staff to observe. METHOD: We used mixed methods to analyze patient-reported ambulatory documentation errors among 22,889 patients at three US health care centers who read ≥ 1 visit note(s). We identified blindspots by tailoring a previously established taxonomy. We used multiple regression analysis to identify factors associated with blindspot identification. FINDINGS: 774 patients reported a total of 962 blindspots in 4 categories: (1) diagnostic misalignments (n = 421, 43.8%), including inaccurate symptoms or histories and failures or delay in diagnosis; (2) errors of omission (38.1%) including missed main concerns or next steps, and failure to listen to patients; (3) problems occurring outside visits (14.3%) such as tests, referrals, or appointment access; and (4) multiple low-level problems (3.7%) cascading into diagnostic breakdowns. Many patients acted on the blindspots they identified, resulting in "good catches" that may prevent potential negative consequences. Older, female, sicker, unemployed or disabled patients, or those who work in health care were more likely to identify a blindspot. Individuals reporting less formal education; those self-identifying as Black, Asian, other, or multiple races; and participants who deferred decision-making to providers were less likely to report a blindspot. CONCLUSION: Patients who read notes have unique insight about potential errors in their medical records that could impact diagnostic reasoning but may not be known to clinicians-underscoring a critical role for patients in diagnostic safety and organizational learning. From a policy standpoint, organizations should encourage patient review of visit notes, build systems to track patient-reported blindspots, and promote equity in note access and blindspot reporting.

Online patient feedback as a safety valve: An automated language analysis of unnoticed and unresolved safety incidents.

Safety reporting systems are widely used in healthcare to identify risks to patient safety. But, their effectiveness is undermined if staff do not notice or report incidents. Patients, however, might observe and report these overlooked incidents because they experience the consequences, are highly motivated, and independent of the organization. Online patient feedback may be especially valuable because it is a channel of reporting that allows patients to report without fear of consequence (e.g., anonymously). Harnessing this potential is challenging because online feedback is unstructured and lacks demonstrable validity and added value. Accordingly, we developed an automated language analysis method for measuring the likelihood of patient-reported safety incidents in online patient feedback. Feedback from patients and families (n = 146,685, words = 22,191,427, years = 2013-2019) about acute NHS trusts (hospital conglomerates; n = 134) in England were analyzed. The automated measure had good precision (0.69) and excellent recall (0.98) in identifying incidents; was independent of staff-reported incidents (r = -0.04 to 0.19); and was associated with hospital-level mortality rates (z = 3.87; p < 0.001). The identified safety incidents were often reported as unnoticed (89%) or unresolved (21%), suggesting that patients use online platforms to give visibility to safety concerns they believe have been missed or ignored. Online stakeholder feedback is akin to a safety valve; being independent and unconstrained it provides an outlet for reporting safety issues that may have been unnoticed or unresolved within formal channels.

An analysis of complaints about hospital care in the Republic of Ireland.

BACKGROUND: Patients and family members make complaints about their hospital care in order to express their dissatisfaction with the care received and prompt quality improvement. Increasingly, it is being understood that these complaints could serve as important data on how to improve care if analysed using a standardized tool. The use of the Healthcare Complaints Analysis Tool (HCAT) for this purpose has emerged internationally for quality and safety improvement. Previous work has identified hot spots (areas in care where harm occurs frequently) and blind spots (areas in care that are difficult for staff members to observe) from complaints analysis. This study aimed to (i) apply the HCAT to a sample of complaints about hospital care in the Republic of Ireland (RoI) to identify hot spots and blind spots in care and (ii) compare the findings of this analysis to a previously published study on hospital complaints in the UK. METHODS: A sample of complaints was taken from 16 hospitals in the RoI in Quarter 4 of 2019 (n = 641). These complaints were coded using the HCAT to classify complaints by domain, category, severity, stage of care and harm. Chi-squared tests were used to identify hot spots, and logistic regression was used to identify blind spots. The findings of this study were compared to a previously published UK study that used HCAT to identify hot spots and blind spots. RESULTS: Hot spots were identified in Irish hospital complaints while patients were receiving care on the ward, during initial examination and diagnosis, and while they were undergoing operations or procedures. This aligned with hot spots identified in the UK study. Blind spots were found for systemic problems, where patients experience multiple issues across their care. CONCLUSIONS: Hot spots and blind spots for patient harm can be identified in hospital care using the HCAT analysis. These in turn could be used to inform improvement interventions, and direct stakeholders to areas that require urgent attention. This study also highlights the promise of the HCAT for use across different healthcare systems, with similar results emerging from the RoI and the UK.

Getting the whole story: Integrating patient complaints and staff reports of unsafe care.

OBJECTIVE: It is increasingly recognized that patient safety requires heterogeneous insights from a range of stakeholders, yet incident reporting systems in health care still primarily rely on staff perspectives. This paper examines the potential of combining insights from patient complaints and staff incident reports for a more comprehensive understanding of the causes and severity of harm. METHODS: Using five years of patient complaints and staff incident reporting data at a large multi-site hospital in London (in the United Kingdom), this study conducted retrospective patient-level data linkage to identify overlapping reports. Using a combination of quantitative coding and in-depth qualitative analysis, we then compared level of harm reported, identified descriptions of adjacent events missed by the other party and examined combined narratives of mutually identified events. RESULTS: Incidents where complaints and incident reports overlapped (n = 446, reported in 7.6%' of all complaints and 0.6% of all incident reports) represented a small but critical area of investigation, with significantly higher rates of Serious Incidents and severe harm. Linked complaints described greater harm from safety incidents in 60% of cases, reported many surrounding safety events missed by staff (n = 582), and provided contesting stories of why problems occurred in 46% cases, and complementary accounts in 26% cases. CONCLUSIONS: This study demonstrates the value of using patient complaints to supplement, test, and challenge staff reports, including to provide greater insight on the many potential factors that may give rise to unsafe care. Accordingly, we propose that a more holistic analysis of critical safety incidents can be achieved through combining heterogeneous data from different viewpoints, such as through the integration of patient complaints and staff incident reporting data.

Cockpit voice recorder transcript data: Capturing safety voice and safety listening during historic aviation accidents.

Cockpit Voice Recorder (CVR) transcripts capture audio data within cockpit environments. This aids the investigation of causal factors contributing to aviation accidents by revealing communication and other sounds prior to aviation accidents. This dataset contains 172 unique CVR transcripts (with 21,626 lines of transcript: averaging: 106.001 conversational turns; SD = 51.727, range: 1-641), and capturing approximately 15% of historic aviation fatalities in commercial and corporate aviation between 1962 and 2018. CVR transcripts involved airlines registered across 42 countries, with accidents occurring across 50 countries. The dataset was compiled by extracting CVR transcripts from three primary data sources and excluding duplicate and non-English entries. The data contains variables describing the (i) raw data, (ii) content and characteristics of the CVR transcripts, and (iii) behaviours coded by research assistants in support of the associated research article. The data existed of conversational turns amongst flight crew (total = 19,393; within transcripts: m = 112.750; SD = 124.829) and other data (n = 2213; within transcripts: m = 12.866; SD = 14.452; e.g., background sounds, transcriber notes). Conversational turns were uttered by junior (39.00%) and senior (35.44%) flight crew, and others (25.56%). The dataset enables future research through providing the first integrated dataset on communication behaviours prior to historic aviation accidents. Moreover, the dataset may support safety management through enabling the identification of communication behaviours contributing to accidents and the design of novel interventions. This data-in-brief is a co-submission associated with the research article: M. C. Noort, T.W. Reader, A. Gillespie. (2021). Safety voice and safety listening during aviation accidents: Cockpit voice recordings reveal that speaking-up to power is not enough. Safety Science.

Sounds of silence: Data for analysing muted safety voice in speech.

Transcribed text from simulated hazards contains important content relevant for preventing harm. By capturing and analysing the content of speech when people raise (safety voice) or withhold safety concerns (safety silence), communication patterns may be identified for when individuals perceive risk, and safety management may be improved through identifying potential antecedents. This dataset contains transcribed speech from 404 participants (nstudents = 377; nfemale = 277, Age M(sd) = 22.897(5.386)) engaged in a simulated hazardous scenario (walking across an unsafe plank), capturing 18,078 English words (M(sd) = 46.117(37.559)). The data was collected through the Walking the plank paradigm (Noort et al, 2019), which provides a validated laboratory experiment designed for the direct observation of communication in response to hazardous scenarios that elicit safety concerns. Three manipulations were included in the design: hazard salience (salient vs not salient), responsibilities (clear vs diffuse) and encouragements (encouraged vs discouraged). Speech between two set timepoints in the hazardous scenario was transcribed based on video recordings and coded in terms of the extent to which speech involved safety voice or safety silence. Files contain i) a .csv containing the raw data, ii) a .csv providing variable description, iii) a Jupyter notebook (v. 3.7) providing the statistical code for the accompanying research article, iv) a .html version of the Jupyter notebook, v) a .html file providing the graph for the .html Jupyter notebook, vi) speech dictionaries, and vii) a copy of the electronic questionnaire. The data and supplemental files enable future research through providing a dataset in which participants can be distinguished in terms of the extent to which they are concerned and raise or withhold this. It enables speech and conversation analyses and the Jupyter notebook may be adapted to enable the parsing and coding of text using provided, existing and custom dictionaries. This may lead to the identification of communication patterns and potential interventions for unmuting safety voice. This data-in-brief is published alongside the research article: M. C. Noort, T.W. Reader, A. Gillespie. (2021). The sounds of safety silence: Interventions and temporal patterns unmute unique safety voice content in speech. Safety Science.

Identifying and encouraging high-quality healthcare: an analysis of the content and aims of patient letters of compliment.

BACKGROUND: Although healthcare institutions receive many unsolicited compliment letters, these are not systematically conceptualised or analysed. We conceptualise compliment letters as simultaneously identifying and encouraging high-quality healthcare. We sought to identify the practices being complimented and the aims of writing these letters, and we test whether the aims vary when addressing front-line staff compared with senior management. METHODS: A national sample of 1267 compliment letters was obtained from 54 English hospitals. Manual classification examined the practices reported as praiseworthy, the aims being pursued and who the letter was addressed to. RESULTS: The practices being complimented were in the relationship (77% of letters), clinical (50%) and management (30%) domains. Across these domains, 39% of compliments focused on voluntary non-routine extra-role behaviours (eg, extra-emotional support, staying late to run an extra test). The aims of expressing gratitude were to acknowledge (80%), reward (44%) and promote (59%) the desired behaviour. Front-line staff tended to receive compliments acknowledging behaviour, while senior management received compliments asking them to reward individual staff and promoting the importance of relationship behaviours. CONCLUSIONS: Compliment letters reveal that patients value extra-role behaviour in clinical, management and especially relationship domains. However, compliment letters do more than merely identify desirable healthcare practices. By acknowledging, rewarding and promoting these practices, compliment letters can potentially contribute to healthcare services through promoting desirable behaviours and giving staff social recognition.

Stakeholders in safety: Patient reports on unsafe clinical behaviors distinguish hospital mortality rates.

Patient safety research has adapted concepts and methods from the workplace safety literature (safety climate, incident reporting) to explain why patients experience unintentional harm during clinical treatment in hospital (adverse events). Consequently, patient safety has primarily been studied through data generated by health care staff. However, because adverse events relate to patient injuries, it is suggested that patients and their families may also have valuable insights for investigating patient safety in hospitals. We conceptualized this idea by proposing that patients are stakeholders in hospital safety who, through their experiences of treatments and independence from institutional culture, can provide valid and supplementary data on unsafe clinical care. In 59 United Kingdom hospitals we investigated whether patient evaluations of care (N = 23,287 surveys) and the safety information contained in health care complaints (N = 2,017, containing 2.5 million words) explained variance in excess patient deaths (hospital mortality) beyond staff evaluations of care (N = 49,302 surveys) and incident reports (N = 242,859). The severity of reports on unsafe clinical behaviors (error and neglect) communicated in patient' health care complaints explained additional variance in hospital-level mortality rates beyond that of staff-generated data. The results indicate that patients provide valid and supplementary data on unsafe care in hospitals. Generalized to other organizational domains, the findings suggest that nonemployee stakeholders should be included in assessments of safety performance if they experience or observe unsafe behaviors. Theoretically, it is necessary to further examine how concepts such as safety climate can incorporate the observations and outcomes of stakeholders in safety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Semantic contact and semantic barriers: reactionary responses to disruptive ideas.

Revolutions are not only fought in the streets, they are also fought at the level of ideas. I conceptualize how ideas collide in people's thought, talk and texts as semantic contact. The focus of my review is to identify how people use semantic barriers to subdue disruptive ideas attributed to outgroups in terms of three layers of defense. Avoiding entails denying outgroups any perspective. Delegitimizing entails acknowledging the perspectives of outgroups but dismissing them as uninformed or deceptive. Limiting entails acknowledging some validity in the outgroup perspective but isolating and rationalizing the implications. The reviewed research reveals that the outgroup is not only 'out there' but also lurks within the self's talk and thought, being resisted and suppressed in proportion to its disruptive potential.

Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights.

INTRODUCTION: A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling. AIM: To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement. METHOD: Literature screening and patient codesign shaped the review's aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances. RESULTS: A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture. DISCUSSION: If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.

Reproducibility in Psychology: Theoretical Distinction of Different Types of Replications.

Debates about replication in psychology have focused on methodological issues and how to strengthen the replication culture. In most cases, these discussions have tended to assume that the phenomena being investigated are universal. In this paper, we are going to propose a theoretical distinction of different types of replication. The distinction is based on the assumption that besides of universal psychological phenomena there are also phenomena, especially in social and cultural psychology, that are expected to vary between socio-cultural contexts and across history. Taking this insight to its logical conclusion it implies that the main purpose of a replication and interpretation of its results depends on the phenomenon being studied. In the case of the universal phenomena, the replication serves to validation purpose, while in the case of the socio-cultural phenomenon it serves to advance our theoretical understanding of how the given phenomenon is formatted by the socio-cultural-historical context.

Participants Over-Estimate How Helpful They Are in a Two-Player Game Scenario Toward an Artificial Confederate That Discloses a Diagnosis of Autism.

Research on how autistic people are perceived by neurotypical people indicates that disclosing a diagnosis leads to a positive discriminatory bias; however, autobiographical autistic accounts indicate that diagnostic disclosure often results in negative discriminatory behavior. We report on an exploratory study to compare people's self-reported helping behavior with their actual helping behavior toward an assumed autistic collaborator. We led 255 participants to believe that they were interacting online with a real person to play Dyad3D, a maze navigation game where players must work together to open doors, and complete the levels. However, participants were actually playing with an artificial confederate (AC) that is programmed to behave the same way across all interactions. This design enabled us to manipulate the diagnostic status of the AC that participants received prior to collaboration across three conditions: no disclosure, dyslexia-disclosure, and autism-disclosure. We use this method to explore two research questions: (1) is Dyad3D viable in creating a simulated interaction that could deceive participants into believing they were collaborating with another human player online? and (2) what are the effects of disclosing an autism diagnosis on social perception and collaboration? Combined with a post-game questionnaire, we compared differences between diagnostic conditions and differences between self-reported behavior and actual behavior in the game. Our findings show that Dyad3D proved to be an efficient and viable method for creating a believable interaction (deception success rate >96%). Moreover, diagnostic disclosure of autism results in the AC being perceived as more intelligent and useful, but participants also perceived themselves to be more helpful toward the AC than they actually were. We evaluate the strengths and limitations of the current method and provide recommendations for future research. The source code for Dyad3D is freely available (CC-BY-NC 4.0) so that the study is reproducible and open to future adaptation.

Walking the Plank: An Experimental Paradigm to Investigate Safety Voice.

The investigation of people raising or withholding safety concerns, termed safety voice, has relied on report-based methodologies, with few experiments. Generalisable findings have been limited because: the behavioural nature of safety voice is rarely operationalised; the reliance on memory and recall has well-established biases; and determining causality requires experimentation. Across three studies, we introduce, evaluate and make available the first experimental paradigm for studying safety voice: the "Walking the plank" paradigm. This paradigm presents participants with an apparent hazard (walking across a weak wooden plank) to elicit safety voice behaviours, and it addresses the methodological shortfalls of report-based methodologies. Study 1 (n = 129) demonstrated that the paradigm can elicit observable safety voice behaviours in a safe, controlled and randomised laboratory environment. Study 2 (n = 69) indicated it is possible to elicit safety silence for a single hazard when safety concerns are assessed and alternative ways to address the hazard are absent. Study 3 (n = 75) revealed that manipulating risk perceptions results in changes to safety voice behaviours. We propose a distinction between two independent dimensions (concerned-unconcerned and voice-silence) which yields a 2 × 2 safety voice typology. Demonstrating the need for experimental investigations of safety voice, the results found a consistent mismatch between self-reported and observed safety voice. The discussion examines insights on conceptualising and operationalising safety voice behaviours in relationship to safety concerns, and suggests new areas for research: replicating empirical studies, understanding the behavioural nature of safety voice, clarifying the personal relevance of physical harm, and integrating safety voice with other harm-prevention behaviours. Our article adds to the conceptual strength of the safety voice literature and provides a methodology and typology for experimentally examining people raising safety concerns.

Neurodivergent intersubjectivity: Distinctive features of how autistic people create shared understanding.

Autistic people are neurologically divergent, yet approaches to studying autism are framed by neurotypical definitions of being social. Using the concept of intersubjectivity, which conceptualises a variety of ways of socially relating, we investigate distinctive features of how autistic people build social understanding. A total of 30 members of a charity supporting adults with autism were video-recorded during a social activity they enjoyed, namely collaborative video gaming. Mapping the coherence, affect and symmetry of each conversational turn revealed shifting patterns of intersubjectivity within each interaction. Focussing on clusters of consistent and fragmented turns led us to identify two features of neurodivergent intersubjectivity: a generous assumption of common ground that, when understood, led to rapid rapport, and, when not understood, resulted in potentially disruptive utterances; and a low demand for coordination that ameliorated many challenges associated with disruptive turns. Our findings suggest that neurodivergent intersubjectivity reveals potential for unconventional forms of social relating and that a within-interaction analysis is a viable methodology for exploring neurodivergent communication. Future research should examine the varieties of neurodivergent intersubjectivity, with associated problems and potentials, and how those forms of intersubjectivity can be enabled to flourish, particularly in autistic-to-neurotypical encounters.

Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety.

Policy Points: Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low-level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient-centered insights that localize issues and shed light on difficult-to-monitor problems. CONTEXT: The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data. METHODS: We analyzed 1,110 health care complaints from across England. "Hot spots" were identified by mapping reported harm and near misses onto stages of care and underlying problems. "Blind spots" concerning difficult-to-monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission. FINDINGS: The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty-three percent of problems entailed major or catastrophic harm, with significant regional variation (17%-31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low-level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns. CONCLUSIONS: The analysis of health care complaints reveals valuable and uniquely patient-centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry-exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.

Perspective-taking is two-sided: Misunderstandings between people with Asperger's syndrome and their family members.

Misunderstandings are social in nature, always having two sides. Yet the misunderstandings experienced by people with Asperger's syndrome are usually studied in terms of the individual with a diagnosis, with less emphasis on social relations. We use a two-sided methodology to map out misunderstandings within 22 dyads (n = 44) consisting of people with Asperger's syndrome and their family members. Both sides of the relationship were asked about 12 topics in terms of one's rating of Self, one's rating of Other and one's predicted rating by Other. The findings show that people with Asperger's are able to predict lower scores from family members, despite disagreeing with their view, and that family members often over-estimate the extent to which their relatives with Asperger's syndrome are egocentrically anchored in their own perspective. The research demonstrates that a two-sided methodology is viable, and it uses it to identify how representations of Asperger's syndrome can both support and hinder social understanding within relationships affected by Asperger's.