Creating psychological safety in interprofessional simulation for health professional learners: a scoping review of the barriers and enablers.

Interprofessional simulation-based education (IP-SBE) supports the acquisition of interprofessional collaborative competencies. Psychologically safe environments are necessary to address socio-historical hierarchies and coercive practices that may occur in IP-SBE, facilitating fuller student participation. A scoping review was conducted to understand the barriers and enablers of psychological safety within IP-SBE. Research papers were eligible if they included two or more undergraduate and/or post-graduate students in health/social care qualifications/degrees and discussed barriers and/or enablers of psychological safety within simulation-based education. Sources of evidence included experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, and mixed-methodological peer-reviewed studies. English or English-translated articles, published after January 1, 1990, were included. Data were extracted by two members of the research team. Extraction conflicts were resolved by the principal investigators. In total, 1,653 studies were screened; 1,527 did not meet inclusion criteria. After a full-text review, 99 additional articles were excluded; 27 studies were analyzed. Psychological safety enablers include prebriefing-debriefing by trained facilitators, no-blame culture, and structured evidenced-based simulation designs. Hierarchy among/between professions, fear of making mistakes, and uncertainty were considered barriers. Recognition of barriers and enablers of psychological safety in IP-SBE is an important first step towards creating strategies that support the full participation of students in their acquisition of IPC competencies.

What percentage of patients presenting for routine eye examinations require referral for secondary care? A study of referrals from optometrists to ophthalmologists.

BACKGROUND: The aim was to investigate the percentage of asymptomatic patients presenting for routine optometric eye examinations that have pathology or pathology-related risk factors warranting referral for ophthalmological consultation. METHODS: This was a retrospective, cohort case study and the inclusion criteria for participants included: (i) the patient presented for routine optometric eye care during a specified period of time; (ii) the patient was found to have pathology (or showed enough risk of pathology) resulting in referral to an ophthalmologist; and (iii) a referral report was received from the consulting ophthalmologist stating the diagnosis and the treatment plan. The data set was further reviewed to indicate presenting symptoms and patient age. Adult patients, ages 20 to 64 years, were reviewed separately; this age group is not covered by provincial health services for routine eye care in Nova Scotia. Files were obtained from two clinics through an electronic charting program. A database was created that included date of referral, clinical reasons for the referral, diagnosis and treatment plan. Clinical reasons for referral were extracted from the referral letters and reports and sorted into six disease categories: age-related macular degeneration, cataract, glaucoma, diabetic retinopathy, retinopathy and 'other'. RESULTS: The overall referral rate for the combined data set was nine per cent for all ages; 2.4 per cent of the overall patients were asymptomatic. There was a similar number of asymptomatic patients referred in the adult (20 to 64 years) age group compared to all ages (2.5 per cent). CONCLUSION: A significant number of patients that present for routine eye examinations without any symptoms indicative of ocular disease are subsequently found to have a degree of pathology or risk thereof requiring referral for ophthalmological consultation. These referrals occur for adults under 64 years as much as for all patients of all ages.

The contribution of work environment to nurses' assessments of the quality of patient care.

The quality of patient care was found to be significantly correlated with work environment measures in a quasi-experimental study in the Saskatoon Health Region. Since first line supervisors face multiple pressures in organizing the work of their units, they need to be supported by senior leadership for continuity in instilling a common purpose and shared values to the patient care staff. The role of supervision and leadership is crucial in strategically managing the human, financial and technical resources in our healthcare system, especially when such resources are likely to remain limited.

Self-reported medical errors in seven countries: implications for Canada.

The purpose of this study was to determine the rate of self-reported errors in Canada compared with other countries, and to identify risk factors for medical error. In 2007, the Commonwealth Fund surveyed a sample of adults in seven industrialized nations, including Canada. Data from this source were used to perform a bivariate analysis comparing those individuals who reported having experienced a medical error with those who did not, followed by a logistic regression model to delineate the relationship between medical error and several explanatory variables. Overall, 11,910 respondents from seven countries were included in the analysis. The rate of self-reported medical error ranged from 12 to 20% in the seven nations. Approximately one in six Canadians reported having experienced at least one error in the past two years, which translates to 4.2 million adult Canadians. Several variables were found to have a statistically significant relationship to self-reported medical errors in the final regression model, including high prescription drug use, the presence of a chronic condition, a lack of physician time with the patient, age under 65, a lack of patient involvement in care, perceived inadequate nursing staffing and an absence of a regular doctor. Identification of several patient, provider and system characteristics associated with self-reported medical error should aid in the development of strategies to address this problem by healthcare decision-makers and clinicians.

Creating a culture of accountability in health care.

Health care providers are constantly striving to improve quality and efficiency by using performance management systems and quality improvement initiatives. Creating and maintaining a culture of accountability are important for achieving this end because accountability is the reason for measuring and improving performance. The keys to creating a culture of accountability will be explicated by examining the extant literature, and from this, 6 methods will be outlined for creating such a culture.

Making customer-service a priority in health care organizations.

Improving customer-service in health care organizations has been linked to better patient care, satisfied staff, a reduction in preventable medical errors, fewer malpractice lawsuits and improved revenue. However, it has been observed that there is sometimes a gap between the level of customer-service provided by health care organizations and their clients' expectations. This paper integrates, synthesizes and extends theory and practice from existing literature to provide health care organizations with strategies for closing this gap. Methods are also outlined for creating, implementing and evaluating an organizational plan for improving customer-service.