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Biomedical subjects

J Firth-Cozens

Publications and source records attributed to J Firth-Cozens.

At least 19 recordsLinked to original sources
PubMed2004

Organisational trust: the keystone to patient safety.

Trust is an essential part of health care-not only between clinicians and patients but also between staff and management. Research shows us that trust has a beneficial impact on many aspects of working life, including job satisfaction and organisational effectiveness, and both these factors have been shown to affect the quality of patient care. In addition, trust will now be the keystone for any system developed for services to learn from untoward incidents, such as the Reporting and Learning System of the National Patient Safety Agency in the UK. This type of trust is complex and is explored in terms of what staff need from management and the potential conflicts that might be involved in developing trust in a healthcare organisation. This paper looks at the societal and emotional context of health care today and at research from other organisations which shows the factors that must be in place to establish trust. It reviews the attributes of leaders who are seen as trustworthy, and looks at how all this can be used to increase the reporting of and learning from error.

Humans↗
PubMed2003

Can we select health professionals who provide safer care.

In order to improve patient safety, health services are looking to other industries' experiences and as a result are adopting a systems approach to learning from error, rather than simply focusing the blame on the individual. However, in health care the individual will remain an important contributor to safety and this paper looks at other literatures besides health to consider a number of individual characteristics and the role they might play in terms of work practices that affect patient safety. It considers the effects of a variety of personality profiles including sensation seeking, Type A, and those with high self esteem; looks at our ability to select for psychological wellbeing; and discusses the ways that psychometrics have been used in medicine to predict performance. It concludes that although rarely used, psychometrics has been shown to be useful in predicting some aspects of performance in medicine and suggests that this is an area well worth further study for the benefit of patient care. Nevertheless, we are a long way away from being able to select safer staff and should instead be developing this knowledge to enable us to recognise and address potential difficulties.

Health Personnel↗
PubMed2002

Stress in UK intensive care unit doctors.

BACKGROUND: Doctors have long been considered at risk of occupational stress. METHODS: A postal survey of all members of the Intensive Care Society using validated instruments. RESULTS: Eight-five per cent of members returned questionnaires and 70% were eligible for the study. Twenty-nine per cent were suffering General Health Questionnaire-12 (GHQ-12) identified distress and 12% Symptom Checklist-Depression (SCL-D) defined depression. There were no significant age or sex differences between staff suffering distress or depression and those who did not. Dissatisfaction with career correlated highly with both distress and depression (P<0.01). Twenty doctors (3%) were bothered by suicidal thoughts. The most stressful aspects of work were bed allocation, being over-stretched, effect of hours of work and stress on personal/family life, and compromising standards when resources are short. Logistic regression revealed mental health problems were predicted by five stressors: 'lack of recognition of one's own contribution by others'; 'too much responsibility at times'; 'effect of stress on personal/family life'; 'keeping up to date with knowledge'; and 'making the right decision alone'. CONCLUSIONS: Nearly one in three ICU doctors appeared distressed (GHQ), and one in 10 depressed (SCL-D); this is no greater than that reported in other specialities. Perceived stressors reveal some key areas of concern for the employer and the specialty.

Adult↗
PubMed2001

Interventions to improve physicians' well-being and patient care.

Concerns about the quality of medical care provided by health services appear to be increasing. Deficits in care are frequently found to be associated with stress and with the apparent lack of recognition of psychological problems when they occur in doctors. This paper looks briefly at the levels and sources of stress, depression and alcoholism in doctors, and the relationship of these to the care they provide. It goes on to use the research findings on causation to propose a system of organisational and individual primary and secondary interventions to address these psychological problems. The paper focusses upon a longitudinal study which follows up 314 medical students over 11 years, but also uses other relevant recent literature to discuss the issues that arise.

Alcoholism↗
PubMed2001

Medical student stress.

Explore the source record for details and available documents.

Education, Medical, Undergraduate↗
PubMed2001

Sickness absence in hospital physicians: 2 year follow up study on determinants.

OBJECTIVES: To identify determinants of sickness absence in hospital physicians. METHODS: The Poisson regression analyses of short (1--3 days) and long (>3 days) recorded spells of sickness absence relating to potential determinants of sickness absence were based on a 2 year follow up period and cohorts of 447 (251 male and 196 female) physicians and 466 controls (female head nurses and ward sisters). RESULTS: There were no differences in health outcomes, self rated health status, prevalence of chronic illness, and being a case on the general health questionnaire (GHQ), between the groups but physicians took one third to a half the sick leave of controls. All the health outcomes were strongly associated with sickness absence in both groups. Of work related factors, teamwork had the greatest effect on sickness absence in physicians but not in the controls. Physicians working in poorly functioning teams were at 1.8 (95% confidence interval (95% CI) 1.3 to 3.0) times greater risk of taking long spells than physicians working in well functioning teams. Risks related to overload, heavy on call responsibility, poor job control, social circumstances outside the workplace, and health behaviours were smaller. CONCLUSION: This is the first study of hospital physicians to show the association between recorded sickness absence and factors across various areas of life. In this occupational group, sickness absence is strongly associated with health problems, and the threshold for taking sick leave is high. Poor teamwork seems to contribute to the sickness absenteeism of hospital physicians even more than traditional psychosocial risks-such as overload and low job control. These findings may have implications for training and health promotion in hospitals.

Adult↗
PubMed2001

Leadership and the quality of care.

The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produced. Finally, the conflicts shown in terms of leadership within the context of health care are discussed, leading to the conclusion that development programmes must be specially tailored to address the complexities of this arena.

Administrative Personnel↗
PubMed2001

Cultures for improving patient safety through learning: the role of teamwork.

Improvements in patient safety result primarily from organisational and individual learning. This paper discusses the learning that can take place within organisations and the cultural change necessary to encourage it. It focuses on teams and team leaders as potentially powerful forces for bringing about the management of patient safety and better quality of care.

Cooperative Behavior↗
PubMed2000

New stressors, new remedies.

This paper looks at the stressors prominent in the workplace at the end of the 20th century--increases in workload, falls in social support, uncertainty and violence. It considers some of the pressures that have created these stressors and some of the interventions used to combat them; for example, better teamworking, different management style, an emphasis on quality, a more accurate analysis of the burgeoning costs of stress to organizations, and an increasing appreciation that parental stress affects children negatively and so makes our future society more at risk. It considers the rising emphasis on the individual role in stress, and on the increase in counselling services. It concludes that occupational health services have a very important role to play not only in providing secondary interventions but also in influencing preventive measures.

Counseling↗
PubMed2000

The effect of 1-year rotations on stress in preregistration house officers.

A comparison of stress levels in preregistration house officers demonstrated lower levels in those completing 1-year rotations compared with those completing 6-month posts in two different hospitals. One-year rotations provide a more stable environment, allow new doctors to become familiar with the workings of an organization from several viewpoints and permit a better sense of working within a multiprofessional team than the traditional arrangements.

Education, Medical, Graduate↗
PubMed1999

Specialty choice, stress and personality: their relationships over time.

A longitudinal questionnaire study of 314 medical students followed up as preregistration house officers (PRHOs) and again 7 years later showed laboratory-based doctors were the least happy with their choice of career and were the most stressed now, while surgeons were the most happy with their choice and the least stressed. These differences were apparent 10 years earlier. The study also describes perceived influences on specialty choice and explores how earlier factors, such as personality as students and stress in the PRHO year, may also have influenced specialty choice.

Career Choice↗