Implementing Home Office Work at a Large Psychiatric University Hospital in Switzerland During the COVID-19 Pandemic: Field Report.

BACKGROUND: During the COVID-19 pandemic in 2020, psychiatric hospitals all over the world had to adapt their services to the prevailing governmental regulations. As a consequence, home office use and telepsychiatry boomed. OBJECTIVE: The purpose of this study was to evaluate the potential of home office use, its adoption, and the association of home office use with employees' mental health in a large psychiatric university hospital in Switzerland. METHODS: We obtained and analyzed home office implementation and use data from the psychiatric university hospital's information technology services. We also conducted a cross-sectional web-based survey to assess the employees' attitudes toward the clinic's crisis management during the COVID-19 pandemic in early 2020. Part of this web-based survey consisted of questions about home office use between March and June 2020, attitudes toward home office implementation, and mental health. Three mental health measures assessed depressive symptoms (Patient Health Questionnaire [PHQ]-2), anxiety (General Anxiety Disorder [GAD]-2), and stress factors (stress module of the PHQ-D); a cut-off score ≥3 was used for the PHQ-2 and GAD-2. RESULTS: Of the 200 participating employees, 69 reported that they had worked from home at least partially (34.5%). Home office use differed significantly across professional groups (χ162=72.72, P≤.001, n=200). Employees experienced neither depressive symptoms (mean 0.76, SD 1.14) nor anxiety (mean 0.70, SD 1.03). The employees reported minor psychosocial stressors (mean 2.83, SD 2.92). The number of reported stress factors varied significantly across groups with different levels of home office use (χ42=9.72, P=.04). CONCLUSIONS: In general, home office implementation appears to be feasible for large psychiatric hospitals, however, it is not equally feasible for all professional groups. Professional groups that require personal contact with patients and technical or manual tasks must work onsite. Further evaluation of home office use in psychiatric hospitals up to the development of clinics that function merely online will follow in future research. The situation created by the COVID-19 pandemic served as a stepping stone to promote home office use and should be used to improve employees' work-life balance, to save employers costs and foster other benefits.

Patient Safety in Hospitals: What We Do and What We Need-Focus Groups With Stakeholders of Hospitals in Southern Germany.

OBJECTIVES: To provide the basis for designing an interprofessional patient safety training for medical treatment teams, the current situation regarding patient safety and existing training programs in southern German hospitals should be explored. Moreover, need-based content regarding the subject areas teamwork, safety culture, and patient involvement should be derived, a conducive learning format suggested, and wishes and concerns regarding the training explored. METHODS: Qualitative design (focus groups) in five hospitals with different levels of care involving a total of 39 members of interprofessional teams, administration, and quality management team. Structured contents analysis was used for evaluation. RESULTS: The need for training to improve patient safety was highlighted. Related contents regarding the subject areas were derived: teamwork (team-building exercises, interprofessional teamwork, interprofessional communication), safety culture (dealing with criticism, appraisals, open handling of errors/proactive error reporting), and patient involvement (inclusion of patients and/or relatives, question types). The combination of e-learning and interprofessional in-person training was emphasized as a conducive learning format. The desire for practical tips, Continuing Medical Education credits, and intuitive review of theories was expressed. CONCLUSIONS: The study initially presents the current situation regarding patient safety, existing training, teamwork, safety culture, and patient involvement in southern German hospitals and gives recommendations for related content and learning format. Based on our results, we recommend to develop a combination of e-learning and interprofessional in-person training. This training should systematically link all three subject areas and address the derived content from the focus groups to improve patient safety.

A Two-Day Acceptance and Commitment Therapy (ACT) Workshop Increases Presence and Work Functioning in Healthcare Workers.

BACKGROUND: In this controlled naturalistic study performed in healthcare workers we examined the effect of a two-day acceptance commitment therapy (ACT) workshop on work presence and productivity, i.e. the influence the workshop had on treatment efficacy in a routine hospital care setting. AIM: To examine the influence of ACT on productivity and presence in healthcare workers. METHOD: Study participants were all healthcare workers (nurses, medical doctors, physiotherapists, social workers, and art therapists) of four inpatient wards for depression. Half of the healthcare workers attended the workshop. Measures were evaluated 3 months after the intervention in the study participants and the patients treated by them in the same time period. RESULTS: A significantly higher treatment efficacy [as measured with HoNOS (Health of the nation outcome scales) change in the patients treated by the participants] has been observed in the healthcare workers who attended the ACT workshop when compared to the control group who did not attend the workshop. Moreover, the work presence of the participants of the ACT workshop was increased when compared with the time period before the intervention and with the presence of the control group. A cost analysis showed that ACT workshops lead to a significant return of investment for the employer as the costs for the workshop were ten times compensated by the increase of work presence in participants of the workshop. CONCLUSION: These findings provide support that ACT interventions motivate healthcare workers to work and increase their patients' treatment quality. To our knowledge this is the first study showing an ACT workshop in healthcare workers can influence HoNOS outcome in the treated patients.

Long-term effects of an e-learning course on patient safety: A controlled longitudinal study with medical students.

BACKGROUND: To improve patient safety, educational interventions on all system levels, including medical school are necessary. Sound theoretical knowledge on elements influencing patient safety (such as error management or team work) is the basis for behavioral changes of health care professionals. METHODS: A controlled, quasi-experimental study with repeated measures was deployed. The intervention group participated in a mandatory e-learning course on patient safety (ELPAS) between October 2016 and December 2016. The control group did not receive any didactic session on patient safety. In both groups we measured technical knowledge and attitudes towards patient safety before the intervention (T0), directly after the intervention (T1) and one year after the intervention (T2). Participants were 309 third-year medical students in the intervention group and 154 first- and second-year medical students in the control group. RESULTS: Technical knowledge in the intervention group (but not the control group) improved significantly after the intervention and remained high after one year (F(2, 84) = 13.506, p < .001, η2 = .243). Students of the intervention group felt better prepared for safe patient practice, even one year after the intervention F(2, 85) = 6.743, p < .002, η2 = .137). There was no sustainable significant effect on attitudes towards patient safety. CONCLUSION: This study shows, that eLearning interventions can produce significant long-term effects on patient safety knowledge, however, the study did not show long-term effects on attitudes towards patient safety. Our study implies two potential developments for future research: e-learning might be used in combination with face-to-face sessions, or more intensive (in terms of frequency and duration) e-learning sessions may be needed to achieve lasting changes in attitude.

Self-regulated learning and critical reflection in an e-learning on patient safety for third-year medical students.

OBJECTIVES: To explore the influence of critical thinking, self-regulated learning and system usability on the acceptance of e-learning on patient safety. METHODS: A cross-sectional study was conducted, using a 32-question online survey. One hundred ninety-three (n=193 medical students participated in the study and were asked to rate levels of reflective thinking, self-regulated learning and attitudes towards patient safety using scales from the Questionnaire for Reflective Thinking, the Attitudes to Patient Safety Questionnaire and the System Usability Scale. Differences between reflection levels were calculated using paired t-tests, associations between critical thinking and self-regulated learning were calculated using linear correlations. We performed linear multiple regression analysis to identify predictors for student acceptance of the e-learning. RESULTS: Students (n=193) engaged in intermediate levels of reflection (5-point Likert, M=3.62, SD=0.73) and significantly (t(143)=15.15, p<0.001, d=1.57) lower levels (M=2.35, SD=0.87) of critical reflection. Most students showed high (≥ 4; 44.1%) or intermediate (<4 level > 2; 29.4 %) levels of self-regulated learning. A regression model indicated that 5 predictors (Reflection, critical reflection, self-regulated learning, relevance, usability) explained 65.3% of the variance (R²=0.653, F(5, 96)=39.02, p<0.01) of perceived total quality. CONCLUSIONS: This study shows that reflection and learning skills are important factors for e-learning acceptance, but perceived relevance and system usability play a more important role.  From a didactic perspective, it is indispensable to provide the students with sufficient examples and links to professional practice to enhance the perception of relevance and to improve system usability permanently.

How could the topic patient safety be embedded in the curriculum? A recommendation by the Committee for Patient Safety and Error Management of the GMA.

The topic of patient safety is of fundamental interest for the health care sector. In view of the realisation of the National Competence-Based Learning Objectives Catalogue for Undergraduate Medical Education (NKLM) this topic now has to be prepared for medical education. For a disciplinary and content-related orientation the GMA Committee developed the Learning Objectives Catalogue Patient Safety for Undergraduate Medical Education (GMA-LZK). To ensure an optimal implementation of the GMA-LZK we recommend a longitudinal embedding into the existing curriculum. This position paper supports the implementation of the GMA-LZK and is aimed at everyone who wants to establish teaching courses on the topic patient safety and embed them in the curriculum. In light of this, we will initially describe the key features for a structured analysis of the current situation. Based on three best-practice-examples, as seen in the faculties of Freiburg, Bonn and Munich, different approaches to the implementation of the GMA-LZK will be illustrated. Lastly, we will outline the methodical requirements regarding the curriculum development as well as the disciplinary and methodical competences that the lecturers will have to hold or develop to fulfil the requirements.

[Influence of an "Open Door Policy" on Ward Climate: Impact on Treatment Quality]. / Einfluss einer "Offenen-Tür-Politik" auf die Stationsatmosphäre: Auswirkungen auf die Behandlungsqualität.

OBJECTIVE: To compare the ward atmosphere, safety, therapeutic hold, and patients' coherence on recently opened (1 year), opened (4 years) and open (> 20 years) psychiatric wards in a longitudinal naturalistic study design. The question was if a patient shift from formerly locked to open wards might deteriorate the ward atmosphere on the open and opened wards. METHODS: Ward atmosphere on two recently opened (n = 2), opened (n = 2) and open (n = 2) wards was examined using the Essen Climate Evaluation Schema (EssenCES) in a follow-up study after 4 years. Structural as well as clinical data were extracted. RESULTS: Global ward atmosphere, safety, and patients' coherence on the recently opened wards was significantly increased; on always opened wards and long-term opened wards it remained unchanged. Coercive measures and discharges against medical advice decreased during the open door process. CONCLUSION: Opening locked psychiatric wards can help to establish a positive therapeutic atmosphere without changing the therapeutic climate on the other already open wards. A better ward atmosphere might be connected with a better therapeutic quality.

Effects of a case-based interactive e-learning course on knowledge and attitudes about patient safety: a quasi-experimental study with third-year medical students.

BACKGROUND: Patient safety (PS) is influenced by a set of factors on various levels of the healthcare system. Therefore, a systems-level approach and systems thinking is required to understand and improve PS. The use of e-learning may help to develop a systems thinking approach in medical students, as case studies featuring audiovisual media can be used to visualize systemic relationships in organizations. The goal of this quasi-experimental study was to determine if an e-learning can be utilized to improve systems thinking, knowledge, and attitudes towards PS. METHODS: A quasi-experimental, longitudinal within- subjects design was employed. Participants were 321 third-year medical students who received online surveys before and after they participated in an e-learning course on PS. Primary outcome measures where levels of systems thinking and attitudes towards PS. Secondary outcome measures were the improvement of PS specific knowledge through the e-learning course. RESULTS: Levels of systems thinking showed significant improvement (58.72 vs. 61.27; p < .001) after the e-learning. Student's attitudes towards patient safety improved in several dimensions: After the course, students rated the influence of fatigue on safety higher (6.23 vs. 6.42, p < .01), considered patient empowerment more important (5.16 vs. 5.93, p < .001) and realized more often that human error is inevitable (5.75 vs. 5.97, p < .05). Knowledge on PS improved from 36.27 % correct answers before to 76.45 % after the e-learning (p < .001). CONCLUSIONS: Our results suggest that e-learning can be used to teach PS. Attitudes towards PS improved on several dimensions. Furthermore, we were able to demonstrate that a specifically designed e-learning program can foster the development of conceptual frameworks such as systems thinking, which facilitates the understanding of complex socio-technical systems within healthcare organisations.