scholarly journals A qualitative system dynamics model for effects of workplace violence and clinician burnout on agitation management in the emergency department

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Ambrose H. Wong ◽  
Nasim S. Sabounchi ◽  
Hannah R. Roncallo ◽  
Jessica M. Ray ◽  
Rebekah Heckmann
Keyword(s):  
System Dynamics ◽  
Workplace Violence ◽  
Model Building ◽  
Current Model ◽  
The United States ◽  
Iterative Refinement ◽  
Mutual Trust ◽  
Physical Restraints ◽  
Qualitative System Dynamics ◽  
Perceptions Of Safety

Abstract Background Over 1.7 million episodes of agitation occur annually across the United States in emergency departments (EDs), some of which lead to workplace assaults on clinicians and require invasive methods like physical restraints to maintain staff and patient safety. Recent studies demonstrated that experiences of workplace violence contribute to symptoms of burnout, which may impact future decisions regarding use of physical restraints on agitated patients. To capture the dynamic interactions between clinicians and agitated patients under their care, we applied qualitative system dynamics methods to develop a model that describes feedback mechanisms of clinician burnout and the use of physical restraints to manage agitation. Methods We convened an interprofessional panel of clinician stakeholders and agitation experts for a series of model building sessions to develop the current model. The panel derived the final version of our model over ten sessions of iterative refinement and modification, each lasting approximately three to four hours. We incorporated findings from prior studies on agitation and burnout related to workplace violence, identifying interpersonal and psychological factors likely to influence our outcomes of interest to form the basis of our model. Results The final model resulted in five main sets of feedback loops that describe key narratives regarding the relationship between clinician burnout and agitated patients becoming physically restrained: (1) use of restraints decreases agitation and risk of assault, leading to increased perceptions of safety and decreasing use of restraints in a balancing feedback loop which stabilizes the system; (2) clinician stress leads to a perception of decreased safety and lower threshold to restrain, causing more stress in a negatively reinforcing loop; (3) clinician burnout leads to a decreased perception of colleague support which leads to more burnout in a negatively reinforcing loop; (4) clinician burnout leads to negative perceptions of patient intent during agitation, thus lowering threshold to restrain and leading to higher task load, more likelihood of workplace assaults, and higher burnout in a negatively reinforcing loop; and (5) mutual trust between clinicians causes increased perceptions of safety and improved team control, leading to decreased clinician stress and further increased mutual trust in a positively reinforcing loop. Conclusions Our system dynamics approach led to the development of a robust qualitative model that illustrates a number of important feedback cycles that underly the relationships between clinician experiences of workplace violence, stress and burnout, and impact on decisions to physically restrain agitated patients. This work identifies potential opportunities at multiple targets to break negatively reinforcing cycles and support positive influences on safety for both clinicians and patients in the face of physical danger.

scholarly journals A Qualitative System Dynamics Model for Effects of Workplace Violence and Clinician Burnout on Agitation Management in the Emergency Department

2021 ◽  
Author(s):  
Ambrose H Wong ◽  
Nasim S Sabounchi ◽  
Hannah R Roncallo ◽  
Jessica M Ray ◽  
Rebekah Heckmann
Keyword(s):  
System Dynamics ◽  
Workplace Violence ◽  
Model Building ◽  
Current Model ◽  
The United States ◽  
Iterative Refinement ◽  
Mutual Trust ◽  
Physical Restraints ◽  
Qualitative System Dynamics ◽  
Perceptions Of Safety

Introduction Over 1.7 million episodes of agitation occur annually across the United States in emergency departments (EDs), some of which lead to workplace assaults on clinicians and require invasive methods like physical restraints to maintain staff and patient safety. Recent studies demonstrated that experiences of workplace violence lead to symptoms of burnout, which may impact future decisions regarding use of physical restraints on agitated patients. To capture the dynamic interactions between clinicians and agitated patients under their care, we applied qualitative system dynamics methods to develop a model that describes causal feedback mechanisms of clinician burnout and the use of physical restraints to manage agitation. Methods We convened an interprofessional panel of clinician stakeholders and agitation experts for a series of model building sessions to develop the current model. The panel derived the final version of our model over ten sessions of iterative refinement and modification, each lasting approximately three to four hours. We incorporated findings from prior studies on agitation and burnout as a result of workplace violence, identifying interpersonal and psychological factors likely to influence our outcomes of interest to form the basis of our model. Results The final model resulted in five main sets of feedback loops that describe key narratives regarding the relationship between clinician burnout and agitated patients becoming physically restrained: (1) use of restraints decreases agitation and risk of assault, leading to increased perceptions of safety and decreasing use of restraints in a balancing feedback loop which stabilizes the system; (2) clinician stress leads to a perception of decreased safety and lower threshold to restrain, causing more stress in a negatively reinforcing loop; (3) clinician burnout leads to a decreased perception of colleague support which leads to more burnout in a negatively reinforcing loop; (4) clinician burnout leads to negative perceptions of patient intent during agitation, thus lowering threshold to restrain and leading to higher task load, more likelihood of workplace assaults, and higher burnout in a negatively reinforcing loop; and (5) mutual trust between clinicians causes increased perceptions of safety and improved team control, leading to decreased clinician stress and further increased mutual trust in a positively reinforcing loop. Conclusions Our system dynamics approach led to the development of a robust qualitative model that illustrates a number of important feedback cycles that underly the relationships between clinician experiences of workplace violence, stress and burnout, and impact on decisions to physically restrain agitated patients. This work identifies potential opportunities at multiple targets to break negatively reinforcing cycles and support positive influences on safety for both clinicians and patients in the face of physical danger.

Designing a qualitative system dynamics model of crowdfunding by document model building

2019 ◽  
Vol 12 (2) ◽  
pp. 197-224 ◽  
Author(s):  
Ali Haji Gholam Saryazdi ◽  
Ali Rajabzadeh Ghatari ◽  
Alinaghi Mashayekhi ◽  
Alireza Hassanzadeh
Keyword(s):  
System Dynamics ◽  
Design Methodology ◽  
Model Building ◽  
Review Of The Literature ◽  
System Dynamics Model ◽  
Dynamics Model ◽  
Content Type ◽  
Leverage Points ◽  
Qualitative System Dynamics ◽  
First Time

Purpose The purpose of this paper is to design a qualitative model of crowdfunding dynamics through the document model building (DMB). Design/methodology/approach Methodology in this paper is the qualitative system dynamics through DMB. In DMB, the authors identify the variables that are drivers of its growth and collapse, and the model will be developed by using the systematic review of the literature. Findings Designing of the dynamics of crowdfunding model through DMB. Identifying variables that are drivers of crowdfunding growth and collapse. Determining leverage points in crowdfunding diffusion. Originality/value This paper, for the first time, with the aim of identifying and explaining the efficient positive and negative dynamics in this method, examines crowdfunding systematically and structurally.

scholarly journals Qualitative System Dynamics Model for Analyzing of Behavior Patterns of SMEs

2021 ◽  
Vol 2 (1) ◽  
pp. 9-19
Author(s):  
Ali Haji Gholam Saryazdi ◽  
Dariush Poursarrajian
Keyword(s):  
System Dynamics ◽  
Model Building ◽  
Science And Technology ◽  
Behavioral Patterns ◽  
Dynamics Modeling ◽  
Senior Managers ◽  
Policy Makers ◽  
Science And Technology Parks ◽  
Technology Parks ◽  
Qualitative System Dynamics

In Iran the Small and Medium Knowledge based Enterprise (SMEs), in the development and shaping stage, face with lots of problems. Before maturity and stability, they fail. Nearly a decade passed, since science and technology parks formation happened. They were seen as a mechanism for sustainable economic development based on knowledge; through creation, support and guidance of founded SMEs. Officials and policy makers, seriously concern about sustainable success, development and growth of these SMEs which must be appropriate for needs of Iran. Identify the behavioral patterns of the stages of life (birth, growth, decline, etc.) which lead to inefficiency and decline, is essential. This helps to avoid mistake repetition and eventually reduces costs. This paper, by using participative model building tries to extract prevailed patterns which govern the behavior of SMEs in Yazd Science and Technology Park. This paper attempts to introduce positive leverage points for policy makers and senior managers who are responsible and also SMEs which are located in the Park. Therefore, in this article, while drawing the behavioral patterns of SMEs, using qualitative system dynamics modeling, the structure governing the behavior of SMEs was drawn. This structure consists of 4 reinforcing loops and 8 balancing loops. Finally, based on these loops, 12 corrective policies were proposed. Doi: 10.28991/HIJ-2021-02-01-02 Full Text: PDF

scholarly journals Participatory water resources planning and management in an Agriculturally Intensive Watershed in Quebec, Canada using Stakeholder Built System Dynamics Models

2011 ◽  
Vol 43 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Jan Adamowski ◽  
Johannes Halbe
Keyword(s):  
System Dynamics ◽  
Model Building ◽  
Social Processes ◽  
Watershed Planning ◽  
Water Resources Planning ◽  
Planning And Management ◽  
Qualitative System Dynamics ◽  
Dynamics Models ◽  
Resources Planning ◽  
Participatory Model

Participatory water resources planning and management in an Agriculturally Intensive Watershed in Quebec, Canada using Stakeholder Built System Dynamics Models The participation of stakeholders is an important component in integrated and adaptive watershed planning and management. In Quebec, Canada watershed organizations are in the process of implementing participatory based watershed planning and management schemes. However, there is a lack of simple and readily implementable frameworks and methods to explicitly involve stakeholders, as well as integrate physical and social processes, in watershed planning and management in Quebec. This paper describes the application of the first three stages of a newly proposed five stage stepwise Participatory Model Building framework that was developed to help facilitate the participatory investigation of problems in watershed planning and management through the use of qualitative system dynamics models. In the agriculturally intensive Du Chene watershed in Quebec, eight individual stakeholder interviews were conducted in cooperation with the local watershed organization to develop qualitative system dynamics models that represent the main physical and social processes in the Du Chene watershed. The proposed Participatory Model Building framework was found to be accessible for all the interviewees, and was deemed to be very useful by the watershed organization to develop an overview of the different perspectives of the main stakeholders in the watershed, as well as to help develop watershed policies and strategies. The individual qualitative system dynamics models developed in this study can subsequently be converted into an overall group built system dynamics model (describing the socio-economic-political components of the watershed), which in turn can be quantified and coupled with a physically based model such as HEC-HMS or SWAT (describing the physical components of the watershed).

scholarly journals Study protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036982
Author(s):  
Ambrose H Wong ◽  
Jessica M Ray ◽  
Marc A Auerbach ◽  
Arjun K Venkatesh ◽  
Caitlin McVaney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Workplace Violence ◽  
Intervention Development ◽  
Interrupted Time Series ◽  
Iterative Refinement ◽  
Clinical Environment ◽  
Physical Restraints ◽  
Restraint Use ◽  
Ethical Approval ◽  
Scientific Meetings

IntroductionEmergency department (ED) visits for behavioural conditions are rising, with 1.7 million associated episodes of patient agitation occurring annually in acute care settings. When de-escalation techniques fail during agitation management, patients are subject to use of physical restraints and sedatives, which are associated with up to 37% risk of hypotension, apnoea and physical injuries. At the same time, ED staff report workplace violence due to physical assaults during agitation events. We recently developed a theoretical framework to characterise ED agitation, which identified teamwork as a critical component to reduce harm. Currently, no structured team response protocol for ED agitation addressing both patient and staff safety exists.Methods and analysisOur proposed study aims to develop and implement the agitation code team (ACT) response intervention, which will consist of a standardised, structured process with defined health worker roles/responsibilities, work processes and clinical protocols. First, we will develop the ACT response intervention in a two-step design loop; conceptual design will engage users in the creation of the prototype, and iterative refinement will occur through in situ simulated agitated patient encounters in the ED to assess and improve the design. Next, we will pilot the intervention in the clinical environment and use a controlled interrupted time series design to evaluate its effect on our primary outcome of patient restraint use. The intervention will be considered efficacious if we effectively lower the rate of restraint use over a 6-month period.Ethics and disseminationEthical approval by the Yale University Human Investigation Committee was obtained in 2019 (HIC #2000025113). Results will be disseminated through peer-reviewed publications and presentations at scientific meetings for each phase of the study. If this pilot is successful, we plan to formally integrate the ACT response intervention into clinical workflows at all EDs within our entire health system.

scholarly journals Patient-Specific Predictive Antibiogram in Decision Support for Empiric Antibiotic Treatment

2020 ◽  
Vol 41 (S1) ◽  
pp. s521-s522
Author(s):  
Debarka Sengupta ◽  
Vaibhav Singh ◽  
Seema Singh ◽  
Dinesh Tewari ◽  
Mudit Kapoor ◽  
...  
Keyword(s):  
Machine Learning ◽  
Antimicrobial Resistance ◽  
Model Building ◽  
Medical Center ◽  
Bacterial Species ◽  
Model Performance ◽  
The United States ◽  
Patient Specific ◽  
Gradient Boosting ◽  
Comparative Performance

Background: The rising trend of antibiotic resistance imposes a heavy burden on healthcare both clinically and economically (US$55 billion), with 23,000 estimated annual deaths in the United States as well as increased length of stay and morbidity. Machine-learning–based methods have, of late, been used for leveraging patient’s clinical history and demographic information to predict antimicrobial resistance. We developed a machine-learning model ensemble that maximizes the accuracy of such a drug-sensitivity versus resistivity classification system compared to the existing best-practice methods. Methods: We first performed a comprehensive analysis of the association between infecting bacterial species and patient factors, including patient demographics, comorbidities, and certain healthcare-specific features. We leveraged the predictable nature of these complex associations to infer patient-specific antibiotic sensitivities. Various base-learners, including k-NN (k-nearest neighbors) and gradient boosting machine (GBM), were used to train an ensemble model for confident prediction of antimicrobial susceptibilities. Base learner selection and model performance evaluation was performed carefully using a variety of standard metrics, namely accuracy, precision, recall, F1 score, and Cohen κ. Results: For validating the performance on MIMIC-III database harboring deidentified clinical data of 53,423 distinct patient admissions between 2001 and 2012, in the intensive care units (ICUs) of the Beth Israel Deaconess Medical Center in Boston, Massachusetts. From ~11,000 positive cultures, we used 4 major specimen types namely urine, sputum, blood, and pus swab for evaluation of the model performance. Figure 1 shows the receiver operating characteristic (ROC) curves obtained for bloodstream infection cases upon model building and prediction on 70:30 split of the data. We received area under the curve (AUC) values of 0.88, 0.92, 0.92, and 0.94 for urine, sputum, blood, and pus swab samples, respectively. Figure 2 shows the comparative performance of our proposed method as well as some off-the-shelf classification algorithms. Conclusions: Highly accurate, patient-specific predictive antibiogram (PSPA) data can aid clinicians significantly in antibiotic recommendation in ICU, thereby accelerating patient recovery and curbing antimicrobial resistance.Funding: This study was supported by Circle of Life Healthcare Pvt. Ltd.Disclosures: None

Exploring construction workers' attitudinal ambivalence: a system dynamics approach

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sheng Xu ◽  
Mengge Zhang ◽  
Bo Xia ◽  
Jiangbo Liu
Keyword(s):  
System Dynamics ◽  
Model Building ◽  
Safety Management ◽  
Negative Attitude ◽  
Construction Workers ◽  
Group Model ◽  
Group Model Building ◽  
Content Type ◽  
Work Pressure ◽  
Safety Attitude

PurposeThis study aimed to identify driving factors of safety attitudinal ambivalence (AA) and explore their influence. Construction workers' intention to act safely can be instable under conflicting information from safety management, co-workers and habitual unsafe behaviour. Existing research explained the mechanism of unsafe behaviours as individual decisions but failed to include AA, as the co-existence of both positive and negative attitude.Design/methodology/approachThis study applied system dynamics to explore factors of construction workers' AA and simulate the process of mitigating the ambivalence for less safety behaviour. Specifically, the group model building approach with eight experts was used to map the causal loop diagram and field questionnaire of 209 construction workers were used to collect empirical data for initiating parameters.FindingsThe group model building identified five direct factors of AA, namely the organisational safety support, important others' safety attitude, emotional arousal, safety production experience and work pressure, with seven feedback paths. The questionnaire survey obtained the initial values of the factors in the SD model, with the average ambivalence at 0.389. The ambivalence between cognitive and affective safety attitude was the highest. Model simulation results indicated that safety experience and work pressure had the most significant effects, and safety experience and positive attitude of co-workers could compensate the pressure from tight schedule and budget.Originality/valueThis study provided a new perspective of the dynamic safety attitude under the co-existence of positive and negative attitude, identified its driving factors and their influencing paths. The group model building approach and field questionnaire surveys were used to provide convincible suggestions for empirical safety management with least and most effective approaches and possible interventions to prevent unsafe behaviour with tight schedule and budget.

scholarly journals Editors View the Continuous Publication Model as a Satisfactory Alternative for Open Access LIS Journals

2014 ◽  
Vol 9 (3) ◽  
pp. 83
Author(s):  
Richard Hayman
Keyword(s):  
Open Access ◽  
Information Science ◽  
Current Model ◽  
The United States ◽  
Library And Information Science ◽  
Volume Model ◽  
Satisfaction Rate ◽  
Open Access Journals ◽  
High Satisfaction ◽  
High Satisfaction Rate

A Review of: Cirasella, J., & Bowdoin, S. (2013). Just roll with it? Rolling volumes vs. discrete issues in open access library and information science journals. Journal of Librarianship and Scholarly Communication, 1(4). http://dx.doi.org/10.7710/2162-3309.1086 Abstract Objective – To understand the prevalence of, motivations for, and satisfaction with using a rolling-volume publishing model, as opposed to publishing discrete issues, across open access academic journals in library and information science. Design – A 12 question survey questionnaire. Setting – English-language, open access library and information science (LIS) journals published in the United States of America. Subjects – A total of 21 open access LIS journals identified via the Directory of Open Access Journals that were actively publishing, and that also met the authors’ standard of scholarliness, which they established by identifying a journal’s peer-review process or other evidence of rigorous review. Based on responses, 12 journals published using discrete issues, while 9 published as rolling volumes or as rolling volumes with some discrete issues. Methods – In late 2011, the study’s authors invited lead editors or primary journal contacts to complete the survey. Survey participants were asked to identify whether their journal published in discrete issues, rolling volumes, or rolling volumes with occasional discrete issues, with the latter two categories combined as one for ease of results analysis. Survey logic split respondents into two groups, either discrete-issue or rolling-volume. Respondents in both categories were posed similar sets of questions, with the key difference being that the questions directed at each category accounted for the publication model the journals themselves identified as using. Editors from both groups were asked about the reasons for using the publication model they identified for their journal: within the survey tool, authors provided 16 potential reasons for using a discrete-issue model, and 13 potential reasons for using a rolling-volume model. Respondents from both groups were asked to mark all reasons that applied for their respective journals. The survey also included questions about whether the journal had ever used the alternate publishing model, the editor’s satisfaction with their current model, and the likelihood of the journal switching to the alternate publishing model in the foreseeable future. Main Results – The authors collected complete responses from 21 of the original 29 journals invited to participate in the study, a response rate of 72%. For the 12 journals that identified as using discrete issues, ease of production workflow (91.7%), clear production deadlines (75.0%), and journal publicity and promotion (75.0%) were the three most common reasons for using a discrete-issue model. For the nine journals using rolling volumes, improved production workflow (77.8%), decreased dependence on production deadlines (77.8%), and increased speed of research dissemination (66.7%) were the three most common reasons cited for using a rolling-volume model. Findings show that overall satisfaction with a journal’s particular publication model was a common factor regardless of publishing model in use, though only the rolling-volume editors unanimously reported being very satisfied with their model. This high satisfaction rate is reflected in editors’ positions that they were very unlikely to switch away from the rolling-volume method. While a majority of editors of discrete-issue journals also reported being very satisfied or somewhat satisfied with their current model, the mixed responses to whether they would contemplate switching to the alternate model suggests that awareness of the benefits of rolling-volume publishing is increasing. Conclusion – Researchers discovered a greater incidence of rolling-volume model journals with open access LIS journals than anticipated, suggesting that this is an area where additional research is necessary. The relative newness of the rolling-volume model may be a contributing factor to the high satisfaction rate among editors of journals using this model, as journal editors are likely to be more deliberate in selecting this model over the traditional discrete-issue publishing model. Workflow and production practices were identified as key characteristics for selecting a publishing model regardless of the model selected, and therefore this is another area in need of further investigation.

Computational Simulation of Boil-Off Gas Formation inside Liquefied Natural Gas Tank Using Evaporation Model in ANSYS Fluent

2013 ◽  
Vol 393 ◽  
pp. 839-844 ◽  
Author(s):  
Mohamad Shukri Zakaria ◽  
Kahar Osman ◽  
Mohd Noor Asril Saadun ◽  
Muhammad Zaidan Abdul Manaf ◽  
Mohd Hafidzal Mohd Hanafi
Keyword(s):  
Natural Gas ◽  
Gulf Coast ◽  
Current Model ◽  
Computational Simulation ◽  
The United States ◽  
Liquefied Natural Gas ◽  
Ansys Fluent ◽  
Evaporation Model ◽  
Gas Formation ◽  
Lng Tank

Research on the waste energy and emission has been quite intensive recently. The formation, venting and flared the Boil-off gas (BOG) considered as one of the contribution to the Greenhouse Gas (GHG) emission nowadays. The current model or method appearing in the literature is unable to analyze the real behavior of the vapor inside Liquefied Natural Gas (LNG) tank and unable to accurately estimate the amount of boil-off gas formation. In this paper, evaporation model is used to estimate LNG Boil-Off rate (BOR) inside LNG tank. Using User Define Function (UDF) hooked to the software ANSYS Fluent. The application enable drag law and alternative heat transfer coefficient to be included. Three dimensional membrane type LNG cargos are simulated with selected boundary condition located in the United States Gulf Coast based on average weather conditions. The result shows that the value of BOR agrees well with the previous study done with another model and with International Marine organization (IMO) standard which is less than 0.15% weight per day. The results also enable us to visualize the LNG evaporation behaviors inside LNG tanks.

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