Exploring pediatric disclosure of medical errors: Saying sorry when bad stuff happens

The disclosure of medical errors in pediatrics is a complex process. We present findings from three studies on pediatric disclosure of medical errors. Given the prevalence of errors, we invite attendees to consider the nuances and challenges associated with disclosure in pediatrics and how these insights can inform practice

The rules of the game: interprofessional collaboration on the intensive care unit team

BACKGROUND: The intensive care unit (ICU) is a nexus for interspecialty and interdisciplinary tensions because of its pivotal role in the care of the hospital's most critically ill patients and in the management of critical care resources. In an environment charged with temporal, financial and professional tensions, learning how to get results collaboratively is a critical aspect of professional competence. This study explored how team members in the ICU interact to achieve daily clinical goals, delineate professional boundaries and negotiate complex systems issues. METHODS: Seven 1-hour focus groups were conducted with ICU team members in two hospitals. Participants consisted of four nursing groups (n = 27), two resident groups (n = 6) and one intensivist group (n = 4). Interviews were audio-recorded, anonymized and transcribed. With the use of a standard qualitative approach, transcripts were analyzed iteratively for recurrent themes by four researchers. RESULTS: Team members articulated their perceptions of the mechanisms by which team collaboration was achieved or undermined in a complex and high-pressure context. Two mechanisms were recurrently described: the perception of 'ownership' and the process of 'trade'. Analysis of these mechanisms reveals how power is commodified, possessed and exchanged as team members negotiate their daily needs and goals with one another. CONCLUSION: Our data provide a non-idealized depiction of how health care professionals function on a team so as to meet both individual and collective goals. We contend that the concept of 'team' must move beyond the rhetoric of 'cooperation' and towards a more authentic depiction of the skills and strategies required to function in the competitive setting of the interprofessional health care team

Exploring interprofessional collaboration during the integration of diabetes teams into primary care

BACKGROUND: Specialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes. This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work. METHOD: Data from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators’ reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software. RESULTS: Four major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange. CONCLUSIONS: Our findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success

Developing virtual gaming simulations for complex clients with substance use through international collaborations

Background The aim of this paper was to describe how six nurse educators and three nursing students from Canada, Northern Ireland and Finland developed a virtual gaming simulation (VGS) on a client with a complex medication profile to fill a gap in an undergraduate nursing curriculum. The VGS navigates learners to engage in a scenario with a client admitted for an acute exacerbation of chronic obstructive pulmonary disease. Method The international collaboration occurred through continuous dialogue and reflective practice to ensure the inclusion of country-specific practices and laws. Lessons Learned The international collaboration allowed educators and students to take a unified approach to address country specific best practices, such as medication administration and the intricacies of cannabis legality. A theoretical lens enhanced the development and structure of the VGS. The student voice provided a holistic perspective. Conclusion International collaborations with nurse educators and students can enhance the VGS design process by facilitating diverse perspectives. This VGS invited learners to engage in a clinical scenario to learn about the importance of providing person-centered care to a client with a complex profile

Canadian Framework for Teamwork and Communication

Although the value of good teamwork and communication is well-recognized in healthcare, the complexity of healthcare and the dynamics among healthcare providers creates a myriad of challenges to creating sound practices. Considering these challenges and the broadness of the topic, the Working Group members felt that the most valuable contribution they could make would be to help organizations navigate the extensive literature and resources available. The goal of this document is therefore to provide a framework for organizations to understand and convey to their teams the importance and impact of teamwork and communication in healthcare, and to select appropriate training tools to improve this. To this end, the Working Group conducted research on strategies to support effective teamwork and communication in the Canadian context through: A comprehensive review of the literature on effective teamwork and communication; A needs assessment to understand the status of teamwork and communication within Canadian healthcare organizations; A review of teamwork and communication training programs; and Consultation with national and international experts in teamwork and communicatio

Error and reporting in surgery: exploring team and patient perceptions

This thesis presents a research study, conducted for my PhD. This research used mixed qualitative and quantitative methods to address four central questions: How do interdisciplinary team members perceive error and error reporting? How do patients perceive error and error reporting? What are the areas of congruence and conflict between different healthcare professionals' approaches to error and patients' needs and perspectives? Why are certain events not described as errors and not addressed in a systematic fashion that would improve patient safety? This study was conducted in the grounded theory tradition and included two phases. The first phase investigated the perceptions of OR team members and patients regarding error definition and error reporting; the second phase sought to elaborate two of the dominant themes from the first phase. The first three chapters of this thesis provide background information about the context, theoretical foundation, and design of the research. The following three chapters present the results of the study in the form of three self-contained articles that have been published or submitted to academic journals. The first of these articles describes and compares surgical team members' and patients' perceptions of error, its reporting, and its disclosure from the first phase of the study. It is published in the journal Surgery. The second article explores operating room (OR) nurses' error reporting preferences from the second phase of the study. This article has been submitted to an applied nursing research journal. The third article sought to probe the factors influencing whether team members saw error events in everyday work as problematic or whether they rationalized such occurrences to support the status quo. The analysis draws on three concepts from organizational and psychological theory to explore team members' responses to these error scenarios. This article has been submitted to the journal Quality and Safety in Healthcare. The final chapter draws the three papers together into an extended discussion about the significance and future implications of this work.Ph.D

Views of children, parents, and health-care providers on pediatric disclosure of medical errors

Despite the prevalence of medical errors in pediatrics, little research examines stakeholder perspectives on the disclosure of adverse events, particularly in the case of children’s own perspectives. Stakeholder perspectives, however, are integral to informing processes for pediatric disclosure. Building on a systematic review of the literature, this article presents findings from a series of focus groups with key pediatric stakeholders where perspectives were sought on the disclosure of medical errors. Focus groups were conducted with three stakeholder groups. Participants included child members of the Children’s Council from a large pediatric hospital ( n = 14), parents of children with chronic medical conditions ( n = 5), and health-care providers including physicians, nurses, and patient safety professionals ( n = 27). Children acknowledged various disclosure approaches while citing the importance of children’s right to know about errors. Parents generally identified the need for full disclosure and the uncovering of hidden errors. Health-care providers were concerned about the process of disclosure and whether it always served the best interest of the child or family. While some health-care providers addressed the need for more clarity in pediatric policies, most stakeholders agreed that a case-by-case approach was necessary for supporting variations in how medical errors are disclosed. </jats:p