scholarly journals Speaking up about patient-perceived serious visit note errors: Patient and family experiences and recommendations

2020 ◽  
Author(s):  
Barbara D Lam ◽  
Fabienne Bourgeois ◽  
Zhiyong J Dong ◽  
Sigall K Bell
Keyword(s):  
Response Rate ◽  
Free Text ◽  
Patient Portal ◽  
Quality Improvements ◽  
Speaking Up ◽  
Academic Medical ◽  
Supportive Culture ◽  
New Ideas ◽  
Northeast Us ◽  
Speak Up

Abstract Background Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can inform quality improvements. Objective To describe patient and family attitudes, experiences, and barriers related to speaking up about perceived serious note errors. Methods Mixed method analysis of a 2016 electronic survey of patients and families at 2 northeast US academic medical centers. Participants had active patient portal accounts and at least 1 note available in the preceding 12 months. Results 6913 adult patients (response rate 28%) and 3672 pediatric families (response rate 17%) completed the survey. In total, 8724/9392 (93%) agreed that reporting mistakes improves patient safety. Among 8648 participants who read a note, 1434 (17%) perceived ≥1 mistake. 627/1434 (44%) reported the mistake was serious and 342/627 (56%) contacted their provider. Participants who self-identified as Black or African American, Asian, “other,” or “multiple” race(s) (OR 0.50; 95% CI (0.26,0.97)) or those who reported poorer health (OR 0.58; 95% CI (0.37,0.90)) were each less likely to speak up than white or healthier respondents, respectively. The most common barriers to speaking up were not knowing how to report a mistake (61%) and avoiding perception as a “troublemaker” (34%). Qualitative analysis of 476 free-text suggestions revealed practical recommendations and proposed innovations for partnering with patients and families. Conclusions About half of patients and families who perceived a serious mistake in their notes reported it. Identified barriers demonstrate modifiable issues such as establishing clear mechanisms for reporting and more challenging issues such as creating a supportive culture. Respondents offered new ideas for engaging patients and families in improving note accuracy.

scholarly journals Speaking up about care concerns in the ICU: patient and family experiences, attitudes and perceived barriers

2018 ◽  
Vol 27 (11) ◽  
pp. 928-936 ◽  
Author(s):  
Sigall K Bell ◽  
Stephanie D Roche ◽  
Ariel Mueller ◽  
Erica Dente ◽  
Kristin O’Reilly ◽  
...  
Keyword(s):  
Perceived Barriers ◽  
Family Education ◽  
Speaking Up ◽  
Academic Medical Centre ◽  
Know How ◽  
Family Attitudes ◽  
Conflicting Information ◽  
Academic Medical ◽  
Internet Sample ◽  
Speak Up

BackgroundLittle is known about patient/family comfort voicing care concerns in real time, especially in the intensive care unit (ICU) where stakes are high and time is compressed. Experts advocate patient and family engagement in safety, which will require that patients/families be able to voice concerns. Data on patient/family attitudes and experiences regarding speaking up are sparse, and mostly include reporting events retrospectively, rather than pre-emptively, to try to prevent harm. We aimed to (1) assess patient/family comfort speaking up about common ICU concerns; (2) identify patient/family-perceived barriers to speaking up; and (3) explore factors associated with patient/family comfort speaking up.MethodsIn collaboration with patients/families, we developed a survey to evaluate speaking up attitudes and behaviours. We surveyed current ICU families in person at an urban US academic medical centre, supplemented with a larger national internet sample of individuals with prior ICU experience.Results105/125 (84%) of current families and 1050 internet panel participants with ICU history completed the surveys. Among the current ICU families, 50%–70% expressed hesitancy to voice concerns about possible mistakes, mismatched care goals, confusing/conflicting information and inadequate hand hygiene. Results among prior ICU participants were similar. Half of all respondents reported at least one barrier to voicing concerns, most commonly not wanting to be a ‘troublemaker’, ‘team is too busy’ or ‘I don’t know how’. Older, female participants and those with personal or family employment in healthcare were more likely to report comfort speaking up.ConclusionSpeaking up may be challenging for ICU patients/families. Patient/family education about how to speak up and assurance that raising concerns will not create ‘trouble’ may help promote open discussions about care concerns and possible errors in the ICU.

scholarly journals Policies and procedures governing patient portal use at an Academic Medical Center

JAMIA Open ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 479-488
Author(s):  
Bryan D Steitz ◽  
Joseph Isaac S Wong ◽  
Jared G Cobb ◽  
Brian Carlson ◽  
Gaye Smith ◽  
...  
Keyword(s):  
Government Regulation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Successful Implementation ◽  
Patient Portal ◽  
Patient Portals ◽  
Identity Verification ◽  
Policies And Procedures ◽  
Academic Medical ◽  
And Function

Abstract Background and Objective Patient portal use has increased over the last two decades in response to consumer demand and government regulation. Despite growing adoption, few guidelines exist to direct successful implementation and governance. We describe the policies and procedures that have governed over a decade of continuous My Health at Vanderbilt (MHAV) patient portal use. Methods We examined MHAV usage data between May 2007 and November 2017. We classified patient portal activity into eight functional categories: Appointment, Billing, Document Access, Genetics, Health Result, Immunization, Medication, and Messaging. We describe our operating policies and measure portal uptake, patient account activity, and function use over time. Results By the end of the study period, there were 375 517 registered accounts. Policies made MHAV available to competent adults and adolescents 13 and over. Patients signed up for a limited access account online, which could be upgraded to a full-access account after identity verification. Patients could assign proxy accounts to family and caregivers, which permitted nonpatient access to select MHAV functions. Laboratory and radiology results were accessible via MHAV. Results were classified into three groups based on sensitivity, which govern the length of delay before results appeared in MHAV. Discussion and Conclusion Patient portals offer significant opportunity to engage patients in their healthcare. However, there remains a need to understand how policies can promote uptake and use. We anticipate that other institutions can apply concepts from our policies to support meaningful patient portal engagement.

scholarly journals Standardized patient program: Student feedback

2016 ◽  
Vol 7 (5) ◽  
pp. 102-107 ◽  
Author(s):  
PR Shankar ◽  
NR Dwivedi ◽  
A Nandy ◽  
AK Dubey
Keyword(s):  
Response Rate ◽  
Clinical Skills ◽  
Student Perception ◽  
Student Feedback ◽  
Standardized Patient ◽  
Free Text ◽  
Medical Sciences ◽  
First Semester ◽  
The Mean ◽  
Teaching Learning

Objective: Standardized patients (SPs) are widely used in medical and other health professions education. At xxxx SPs have been used for teaching-learning and assessment of basic science medical students since January 2013. The opinion of SPs about their involvement in teaching-learning and assessment of students has been recently studied. The present study had the objective of studying student perception about various aspects of the program.Materials and Methods: The study was conducted towards end of March and beginning of April 2016. Student perception regarding the program was studied by noting their degree of agreement with a set of 25 statements. Free text comments were also obtained. Gender, nationality and semester of study of the respondents was noted. The total score was compared among different subgroups of respondents.Results: Ninety-eight of the 107 students (91.6%) participated. The mean ± SD total score was 92.33 ± 13.68 (maximum possible score being 125). The scores were significantly higher among first semester students compared to other semesters. Students agreed that interacting with SPs will prepare them for interacting with patients, for their licensing exams and improve their clinical skills. Students learn how to interact with persons from a different cultural background. Suggestions for further improvement were also obtained.    Conclusions: The response rate was high and students’ perception of the SP program was positive. Our experiences would be of special interest to educators in other medical schools with small and/or new SP programs. Similar feedback could be obtained from other xxx schools with SP programs.Asian Journal of Medical Sciences Vol.7(5) 2016 102-107

Becoming Active Citizens

2017 ◽  
Author(s):  
Ruth Braunstein
Keyword(s):  
Religious Discourse ◽  
Active Citizenship ◽  
American Democracy ◽  
Speaking Up ◽  
Standing Up ◽  
Civil Discourse ◽  
Waking Up ◽  
Speak Up

Chapter 2 focuses on similarities in the ways in which members of Interfaith and the Patriots described their choice to become more active citizens, despite significant differences in their demographic compositions and policy demands. For members of both groups, this process involved waking up, standing up, and speaking up—acts that were described as democratic and sacred responsibilities alike. In justifying their choices and distinguishing them from alternatives, participants in both groups drew loosely on a “civil discourse” that valorized the qualities associated with active citizenship, while critiquing or distancing themselves from fellow citizens who chose not to wake up, stand up and speak up. In the process, they also drew on “civil religious discourse” that infused active citizenship and American democracy itself with sacred significance.

Integrating Course Quality within a Community of Practice

2014 ◽  
pp. 415-434
Author(s):  
Jocelyn Sherman ◽  
Michelle Yener ◽  
Casey Price ◽  
Linda Grant ◽  
Karla Gable ◽  
...  
Keyword(s):  
Community Of Practice ◽  
Steering Committee ◽  
Course Development ◽  
Quality Improvements ◽  
Senior Leaders ◽  
Course Quality ◽  
Core Group ◽  
Quality Guidelines ◽  
New Ideas

Online institutions continue to seek quality guidelines related to effective course development and quality improvements. The struggle lies in getting support from institutional leaders to implement new ideas. While perseverance and serendipity always play a part when these efforts are successful, a few of Capella’s strategies were vital to their implementation of systematic course quality: 1. Selecting a course quality assurance partner that was a good fit, 2. Piloting the program for fit and to build experienced supporters, 3. Forming a core group that was accountable for the implementation, 4. Building a steering committee of senior leaders from across the institution, 5. Nurturing a community of practice with many avenues for genuine participation, and 6. Establishing and being held accountable for measurable goals. This case study describes Capella University’s implementation of a course quality system through a community of practice (CoP) model that facilitated genuine buy-in rather than top-down implementation.

Organisational empowerment and assertive communication behaviours: a survey of Jordanian newly qualified nurses

2020 ◽  
Vol 29 (7) ◽  
pp. 419-425 ◽  
Author(s):  
Muhammad W Darawad ◽  
Mansour Mansour ◽  
Tahany Al-Niarat
Keyword(s):  
Two Dimensions ◽  
Early Years ◽  
Cross Sectional Survey ◽  
Speaking Up ◽  
Structural Empowerment ◽  
Cross Sectional ◽  
Clinical Scenarios ◽  
Communication Behaviours ◽  
Speak Up ◽  
The Impact

Background: Newly qualified nurses (NQNs) face several challenges in their early years of practice. Being empowered and able to speak up against unsafe practice are two important pillars for practising nursing safely and competently. Little research has examined the potential correlation between those two dimensions in the context of NQNs in Jordan. Aims: To investigate the correlation between NQNs' perceived structural empowerment in their work setting and their willingness to challenge unsafe practice in some hypothetical clinical scenarios. Methods: A cross-sectional survey involved 233 NQNs, who completed a self-administered questionnaire between January and March 2016. Findings: Participants reported moderate levels of both perceived structural empowerment and willingness to speak up against unsafe practice. There was a statistically significant positive correlation between the total structural empowerment score and the mean score for speaking up against unsafe practice. Conclusion: The findings highlight the impact of peer, managerial and overall organisational support on enabling NQNs to become more empowered and assertive. Concrete, collaborative and organisation-wide efforts must be considered to foster greater empowerment of NQNs, but also revisiting work priorities to include supporting and advocating assertive communication skills among the more vulnerable of the newly qualified cohort.

A new window through which to look at safety culture surveys: a case study at Arrow Energy

2018 ◽  
Vol 58 (1) ◽  
pp. 32 ◽  
Author(s):  
Michelle Zaunbrecher ◽  
Lisa Mealiff
Keyword(s):  
Safety Culture ◽  
Response Rate ◽  
Participation Rate ◽  
High Response Rate ◽  
Free Text ◽  
Gas Industry ◽  
Effective Learning ◽  
For Profit ◽  
Industry Group

This paper provides a case study of applying a different approach to executing a safety culture survey. Arrow Energy (Arrow) completed the Safer Together Safety Culture Survey, with an excellent participation rate of 90% of total employees. There were indications from other Safer Together member companies that the typical response rate when the survey was emailed out was 30%. Arrow took the approach to undertake the survey ‘live’, where each team manager or supervisor facilitated the team session; this approach was fundamental to achieving a high response rate. A total of 33 separate team sessions were undertaken, which enabled team-specific results. The survey technique and application was provided by Safer Together, a not-for-profit industry group representing the Queensland coal seam gas industry. The intent is to have all Safer Together member companies undertake the survey so that industry-wide benchmarking can be carried out. The survey was completed by each team all together in one room, and the consolidated results for the team were available as soon as all participants had completed all survey questions, which took ~30 min. The benefits of the Safer Together tool, and live participation compared with online, included: ▪ Visible safety leadership demonstrated by the team manager/supervisor ▪ Team-specific results generated allowing meaningful immediate discussion and follow-up actions ▪ Three layers of organisation results available including everyone, supervisors and managers ▪ Visibility of ‘Most impactful behaviours’ that need improvement ▪ Generation of comments by the participating teams, visible during session as free text. Overall it was a very meaningful exercise shining a light on key areas the employees believe need to be addressed including: ▪ Planning ▪ More effective learning from incidents ▪ Making the Arrow HSE Management System more accessible and available in relevant bite-sized pieces. The consolidated results indicate that Arrow has a maturing safety culture.

scholarly journals Rapid development of telehealth capabilities within pediatric patient portal infrastructure for COVID-19 care: barriers, solutions, results

2020 ◽  
Vol 27 (7) ◽  
pp. 1116-1120 ◽  
Author(s):  
Pious D Patel ◽  
Jared Cobb ◽  
Deidre Wright ◽  
Robert W Turer ◽  
Tiffany Jordan ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Rapid Development ◽  
Academic Medical Center ◽  
Security Policies ◽  
Patient Portal ◽  
Privacy And Security ◽  
Academic Medical ◽  
Adolescent Autonomy ◽  
National Emergency

Abstract The COVID-19 national emergency has led to surging care demand and the need for unprecedented telehealth expansion. Rapid telehealth expansion can be especially complex for pediatric patients. From the experience of a large academic medical center, this report describes a pathway for efficiently increasing capacity of remote pediatric enrollment for telehealth while fulfilling privacy, security, and convenience concerns. The design and implementation of the process took 2 days. Five process requirements were identified: efficient enrollment, remote ability to establish parentage, minimal additional work for application processing, compliance with guidelines for adolescent autonomy, and compliance with institutional privacy and security policies. Weekly enrollment subsequently increased 10-fold for children (age 0–12 years) and 1.2-fold for adolescents (age 13–17 years). Weekly telehealth visits increased 200-fold for children and 90-fold for adolescents. The obstacles and solutions presented in this report can provide guidance to health systems for similar challenges during the COVID-19 response and future disasters.

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