Emergency Physician Perceptions of Abuse by Consultants: Negative Effects on Patient Care and Physician Wellness

Abstract Background and Purpose. The purpose of this qualitative study was to examine how a move to program management (PM) from a traditional department structure affected the professional practice of physical therapists in a large Canadian teaching hospital. Subjects. Twenty-five physical therapists participated in 1 of 5 focus groups, and 4 physical therapists participated in individual interviews. Methods. Focus groups and structured interviews were conducted by an experienced facilitator who was not a physical therapist. All focus groups and interviews were audiotaped and transcribed. Using an open-coding technique, 2 investigators undertook line-by-line analysis of each transcript to identify and code specific events related to the physical therapists' experiences. The investigators reached a consensus on all coding categories and then identified themes. Results. Seven themes that addressed issues of affect (a sense of loss, low morale, and positive coping), professional practice (loss of professional development activities, professional advantages, the assuming of multiple roles), and patient care were identified. Discussion and Conclusion. Physical therapists who were deployed from a department to a program described both positive and negative effects of the move to PM on their practice. There were reported influences on their personal affect, professional practice, and patient care. Staff and physical therapy administrators need to be aware of potential implications of an organization's move to PM on the professional practice of frontline staff.

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An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center

PeerJ ◽

10.7717/peerj.1783 ◽

2016 ◽

Vol 4 ◽

pp. e1783 ◽

Cited By ~ 25

Author(s):

Iris Schrijver ◽

Keri J.S. Brady ◽

Mickey Trockel

Keyword(s):

Focus Group ◽

Patient Care ◽

Work Motivation ◽

Scientific Discovery ◽

Group Discussion ◽

Meaningful Work ◽

Extrinsic Factors ◽

Work Related ◽

Physician Wellness ◽

Professional Fulfillment

Background.Physician wellness is a vital element of a well-functioning health care system. Not only is physician wellness empirically associated with quality and patient outcomes, but its ramifications span individual, interpersonal, organizational, and societal levels. The purpose of this study was to explore academic physicians’ perceptions about their work-related wellness, including the following questions: (a) What are the workplace barriers and facilitators to their wellness? (b) What workplace solutions do theythinkwouldimprove their wellness? (c)What motivates their work? and (d) What existing wellness programs are they aware of?Methods.A multi-method design was applied to conduct a total of 19 focus group sessions in 17 clinical departments. All academic faculty ranks and career lines were represented in the 64 participating physicians, who began the sessions with five open-ended survey questions pertaining to physician wellness in their work environment. Participants entered their answers into a web-based survey program that enabled anonymous data collection. The initial survey component was followed by semi-structured focus group discussion. Data analysis of this qualitative study was informed by the general inductive approach as well as a review of extant literature through September 2015 on physician wellness, professional fulfillment, satisfaction, dissatisfaction, burnout and work-life.Results.Factors intrinsic to the work of physicians dominated the expressed reasons for work motivation. These factors all related to the theme of overall contribution, with categories of meaningful work, patient care, teaching, scientific discovery, self-motivation and matching of career interests. Extrinsic factors such as perceptions of suboptimal goal alignment, inadequate support, restricted autonomy, lack of appreciation, and suboptimal compensation and benefits dominated the risk of professional dissatisfaction.Discussion.Our findings indicate that the factors that enhance professional fulfillment and those that precipitate burnout are distinct: motivation and quality of work performed were supported by domains intrinsic to the work itself, whereas external dysfunctional work aspects resulted in frustration. Thus, it can be anticipated that optimization of physician wellness would require tailored approaches in each of these dimensions with sustained funding and support for wellness initiatives. Physicians identified the availability of resources to enable them to thrive and provide excellent patient care as their most important wellness-enhancing factor.

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The Not So Obvious Impact of COVID 19: The Hidden “Curriculum”

Immunology and Inflammation Diseases Therapy ◽

10.31579/2637-8876/025 ◽

2022 ◽

Vol 5 (1) ◽

pp. 01-04

Author(s):

Fatimah Lateef

Keyword(s):

Technology Adoption ◽

Patient Care ◽

Emergency Physician ◽

Academic Medicine ◽

Hidden Curriculum ◽

Psychological Safety ◽

Healthcare Staff ◽

Medical Educator ◽

Self Development ◽

Direct Awareness

The last two years of the Covid 19 pandemic has certainly brought on and inculcated a variety of changes, new practices, innovative approaches and altered mindsets. Some of these were intended, planned and incorporated into pathways and practices. There were many lessons and new experiences. Without our complete realization, there were also many less obvious lessons: the hidden curriculum. This refers to the unwritten, unspoken, unplanned and less obvious values, behaviour and norms practised or experienced during the pandemic. The hidden curriculum is conveyed and communicated without our direct awareness and intent. The hidden curriculum will certainly contribute towards healthcare staff resilience, handling of stressors, decisions on utilization of resources and patient care. Not to be forgotten, it will also impact how they develop friendships, partnerships, collaborations, negotiate their self-development and strengthen their sense of purpose and challenge assumptions. In this paper, the author, who worked at the frontline during the pandemic shares some of her views on the new healthcare landscape, mindset changes, technology adoption, psychological safety and the meaning of ‘staying home’. They represent her views, coloured by her experiences as an emergency physician, a medical educator, academic medicine practitioner and researcher.

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Emergency Physician Perceptions of Electronic Health Record Usability and Safety

Journal of Patient Safety ◽

10.1097/pts.0000000000000849 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Zoe M. Pruitt ◽

Jessica L. Howe ◽

Aaron Z. Hettinger ◽

Raj M. Ratwani

Keyword(s):

Electronic Health Record ◽

Emergency Physician ◽

Health Record ◽

Physician Perceptions ◽

Electronic Health

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Broad System Factors Influence Physician Wellness, Patient Care

Psychiatric News ◽

10.1176/appi.pn.2018.3b9 ◽

2018 ◽

Vol 53 (6) ◽

Author(s):

David Pollack,

Keyword(s):

Patient Care ◽

Physician Wellness ◽

System Factors

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Emergency Physician Perceptions of Shared Decision-making

Academic Emergency Medicine ◽

10.1111/acem.12627 ◽

2015 ◽

Vol 22 (4) ◽

pp. 399-405 ◽

Cited By ~ 51

Author(s):

Hemal K. Kanzaria ◽

Robert H. Brook ◽

Marc A. Probst ◽

Dustin Harris ◽

Sandra H. Berry ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Emergency Physician ◽

Shared Decision ◽

Physician Perceptions

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MP02: The impact of adoption of an electronic health record on emergency physician work: a time motion study

CJEM ◽

10.1017/cem.2020.150 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S42-S43

Author(s):

S. Calder-Sprackman ◽

G. Clapham ◽

T. Kandiah ◽

J. Choo-Foo ◽

S. Aggarwal ◽

...

Keyword(s):

Electronic Health Record ◽

Patient Care ◽

Emergency Physician ◽

Chart Review ◽

Direct Patient Care ◽

Health Record ◽

Physical Movement ◽

Time Motion ◽

Motion Study ◽

The Impact

Introduction: Adoption of a new Electronic Health Record (EHR) can introduce radical changes in task allocation, work processes, and efficiency for providers. In June 2019, The Ottawa Hospital transitioned from a primarily paper based EHR to a comprehensive EHR (Epic) using a “big bang” approach. The objective of this study was to assess the impact of the transition to Epic on Emergency Physician (EP) work activities in a tertiary care academic Emergency Department (ED). Methods: We conducted a time motion study of EPs on shift in low acuity areas of our ED (CTAS 3-5). Fifteen EPs representing a spectrum of pre-Epic baseline workflow efficiencies were directly observed in real-time during two 4-hour sessions prior to EHR implementation (May 2019) and again in go live (August 2019). Trained observers performed continuous observation and measured times for the following EP tasks: chart review, direct patient care, documentation, physical movement, communication, teaching, handover, and other (including breaks). We compared time spent on tasks pre Epic and during go live and report mean times for the EP tasks per patient and per shift using two tailed t-test for comparison. Results: All physicians had a 17% decrease in patients seen after Epic implementation (2.72/hr vs 2.24/hr, p < 0.01). EPs spent the same amount of time per patient on direct patient care and chart review (direct patient care: 9min06sec/pt pre vs 8min56sec/pt go live, p = 0.77; chart review: 2min47sec/pt pre vs 2min50sec/pt go live, p = 0.88), however, documentation time increased (5min28sec/pt pre vs 7min12sec/pt go live, p < 0.01). Time spent on shift teaching learners increased but did not reach statistical significance (31min26sec/shift pre vs 36min21sec/shift go live, p = 0.39), and time spent on non-patient-specific activities – physical movement, handover, team communication, and other – did not change (50min49sec/shift pre vs 50min53sec/shift go live, p = 0.99). Conclusion: Implementation of Epic did not affect EP time with individual patients - there was no change in direct patient care or chart review. Documentation time increased and EP efficiency (patients seen per hr on shift) decreased after go live. Patient volumes cannot be adjusted in the ED therefore anticipating the EHR impact on EP workflow is critical for successful implementation. EDs may consider up staffing 20% during go live. Findings from this study can inform how to best support EDs nationally through transition to EHR.

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