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Using the DISC behavioral instrument to guide leadership and communication.

BEHAVIORAL INSTRUMENTS can be useful tools to help leaders gain insight into how to better communicate with coworkers. The DISC instrument classifies behaviors into four personality types (ie, Dominant, Influencer, Steady, Conscientious) and provides methods leaders can use to work with each personality type. LEADERS SHOULD STRIVE to have a good mix of personalities on their teams to achieve optimal success. THIS ARTICLE DESCRIBES the benefits of using the DISC behavioral evaluation method to better understand and work with team members and gives role-play scenarios for dealing with each personality.

Humans↗

Contextual factors influencing research use in nursing.

BACKGROUND: Contextual factors are perceived to be significant barriers to research-utilisation-related activity, but little is known about how context impacts on specific research-based decisions, or how the individual interacts with the organisation in the requirement for research-based change. AIM: This study describes the impact of contextual factors on the practical reasoning of nurse specialists in the construction of policy for practice. METHODS: Three groups of clinical nurse specialists were observed during a series of meetings convened to construct evidence-based guidelines for nursing practice. Transcripts of the meetings were analysed to identify and categorise the physical, social, political, and economic influences on 31 nursing issues. FINDINGS: Multiple contextual factors influenced each decision made, with decisions about nursing practice bounded by setting and system considerations, relationships with others in the care team, and resource constraints. Practitioners were involved in weighing up alternative scenarios, contexts, and contingencies for each decision, requiring strategies to adapt and reconstruct the nature of care, to influence others, and to affect organisational decision-making processes. DISCUSSION: The practical accomplishment of evidence-based practice required diverse skills: translating between evidence and practice; mediating the values, preferences, and working practices of multiple stakeholders; negotiating organisational complexity and the management of boundaries; and coordinating inter-organisational and inter-agency working. Nurse specialists in this study had a significant role in instigating, fuelling, and coordinating policy review, predominantly by communication across professional and organisational boundaries. IMPLICATIONS/CONCLUSIONS: Clinical specialists acting as organisational boundary spanners require skills in the informal cultural work of organising, facilitating, and maintaining links across professional, team, and organisational boundaries. If their role in the negotiation of evidence-based practice patterns across professional and organisational boundaries is to be successful, wider skills than information management need to be recognised and their development and enactment supported.

Decision Making, Organizational↗

Inter-facility transfer of patient information before and after HIPAA privacy measures.

OBJECTIVES: The study objectives were (1) to test whether interfacility communication of health information at the time of patient transfer changed as a result of implementation of US privacy protection measures (HIPAA) in April 2003, and (2) to examine patient, transfer, and illness characteristics correlated with interfacility transfer document completion. DESIGN: Observational study. PARTICIPANTS AND SETTING: Individuals transferred between a 514-bed urban nursing home and a 1171-bed academic hospital in New York City. MEASUREMENTS: Research staff reviewed medical records of patients transferred both ways between nursing home and hospital, examining interfacility transfer documents for 12 items important for continuity of care. Transfer document completeness equaled the percentage of items recorded and legible in transfer documents. Transfers were classified by direction (nursing home-to-hospital [NH-to-H] or hospital-to-nursing home [H-to-NH]), urgency (urgent or not), timing (weekday 9 am to 6 pm or other), and by whether they occurred before 12 am April 14, 2003 (pre-HIPAA), or after (post-HIPAA). RESULTS: Seventy-eight nursing home residents experienced 100 hospital admissions. NH-to-H transfer documents were more complete than H-to-NH documents (86.7% vs 69.0%; P = .002). There were no significant differences between content of transfer documents between pre- and post-HIPAA transfers in either direction of transfer, with and without controlling for patient and illness characteristics. Older age, female gender, dementia diagnosis, shorter duration of nursing home residence, and off-hours hospital transfer were associated with less complete NH-to-H transfer documents, and shorter hospital length of stay was associated with less complete H-to-NH transfer documents. CONCLUSION: There was no change in written health information communicated during patient transfer between an urban nursing home and an academic hospital before and after HIPAA privacy protection measures were implemented. This suggests that the rule's intent to not restrict the sharing of information needed to treat patients is being followed by providers at these sites in the situation of interfacility patient transfer.

Academic Medical Centers↗

Yours, mine, and ours: the importance of scientific collaboration in advancing the field of behavior change research.

The Behavior Change Consortium (BCC) has provided a unique opportunity to combine and explore resources, data, processes, and knowledge as a means of strengthening the validity, reliability, and outcomes that compose the field of behavioral science. The workgroups of the BCC were able to transcend disciplinary boundaries by developing a collaborative framework that fused scholarship and creativity to explore research problems in the area of health behavior change theory and intervention. We have identified seven common elements that emerged from each workgroup and fostered inclusion, progress, and ultimately results. These elements were (a) establishing communication channels, (b) identifying objectives, (c) utilizing common measures, (d) obtaining financial support, (e) seeking outside feedback, (f) engaging "big picture" thinking, and (g) bridging theory to practice. In this article we describe the various processes involved in the creation and sustainability of the BCC, including internal and external communications, leadership, workgroup roles, private and public partnerships, and issues associated with data sharing. We also discuss why, in the case of the BCC, the whole is far greater than the sum of its parts. We present this example of unparalleled multibehavioral research collaboration as a model to other collaborative efforts that will be spawned by the new National Institutes of Health Roadmap initiative.

Behavior Therapy↗

[Interprofessional communication and cooperation training in ward rounds for medical and nursing students: a pilot project].

This study reports on a pilot study of the effect of an inter-professional course for medical and nursing students in how to collaborate in the conduct of a ward round. A mixed group of 13 medical and 12 nursing students attended a one-day course. They worked together in small groups training in communication and collaborative skills using a framework for ward rounds in a simulated clinical ward environment. The course was evaluated on standard evaluation forms and through focus group interviews. The programme was highly rated by both of the groups and considered most relevant, well situated and efficient. Next term the training course will be extended to include twice as many students.

Cooperative Behavior↗

CTRM raises the bar for patient safety and staff productivity.

Ever since the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) included medical communications among its National Patient Safety Goals, hospital administrators have become increasingly aware of this weak link in healthcare delivery. A growing number of hospitals, including Parkland Memorial Hospital in Dallas, are implementing critical test result management (CTRM) technology that specifically addresses and solves the problem of critical values reporting. CTRM technology did not even exist until 2-3 years ago. Now that it is here, it will likely become standard practice for hospitals everywhere.

Accreditation↗

The COPe program: communicational, organizational and personal factors influencing the transplant process and the number of donor reports.

In this article a supporting program for increasing donor rates is described. Beside medical knowledge and skills, communication and organisation as well as personal values and beliefs are determining factors for the success of every single step in the whole process of organ transplantation. Training for the sensibility in communication, developing concepts for the organization within the team and the work with personal attitudes and values, not only with skills and tools are necessary. In already evaluated sections of our program we markedly improved personal attitudes, self-management and stress resistance of the participants. We conclude that the holistic approach, which combines the three factors of COPe with the nine steps of the transplant process, is a promising attempt to improve the donor rates.

Clinical Competence↗

The multidisciplinary meeting: An indispensable aid to communication between different specialities.

Multidisciplinary team meetings (MDT's) form part of the daily work in most hospitals caring for cancer patients as a form of institutionalised communication. The degree of organisation and the type of communication in these MDTs has a direct impact on the quality of patient care provided. One resulting decision from a multidisciplinary discussion is more accurate and effective than the sum of all individual opinions. Other benefits include consistency in the standard of patient management offered, a teaching element for junior doctors and improvement in communication between different specialists. An MDT needs mature leadership to produce a democratic climate allowing for open and constructive discussion. Controversies, which are inevitable within a team who are striving to reach decisions concerning complex situations, therefore require a variety of approaches for dealing with them when they occur. As MDT's are a key component in a professional's routine, it is worthwhile spending time considering the organisations, targets, documentation and collaboration within the MDT.

Decision Making↗

Writing effective consultation letters: 12 tips for teachers.

Written correspondence is the standard mode of communication between healthcare providers. Despite the importance of this skill and increased emphasis on ambulatory care, communication skills and professionalism in training programs, there has been very little written on the teaching and evaluation of consultation letter writing. Consultation letter writing is an essential skill that cannot be learned simply by reading others' letters and should be taught in a formal manner. This article describes the authors' experience in teaching the skill of writing effective consultation letters to residents and describes strategies for evaluating this skill.

Canada↗

Is silence killing your company?

Many times, often with the best of intentions, people at work decide it's more productive to remain silent about their differences than to air them. There's no time, they think, or no point in going against what the boss says. But as new research by the authors shows, silencing doesn't smooth things over or make people more productive. It merely pushes differences beneath the surface and can set in motion powerfully destructive forces. When people stay silent about important disagreements, they can begin to fill with anxiety, anger, and resentment. As long as the conflict is unresolved, their repressed feelings remain potent, making them increasingly distrustful, self-protective, and all the more fearful that if they speak up they will be embarrassed or rejected. Their sense of insecurity grows, leading to further acts of silence, more defensiveness, and more distrust, thereby setting into motion a destructive "spiral of silence." Sooner or later, they mentally opt out--sometimes merely doing what they're told but contributing nothing of their own, sometimes spreading discontent and frustration throughout the workplace that can lead them, and others, to leave without thinking it through. These vicious spirals of silence can be replaced with virtuous spirals of communication, but that requires individuals to find the courage to act differently and executives to create the conditions in which people will value the expression of differences. All too often, behind failed products, broken processes, and mistaken career decisions are people who chose to hold their tongues. Breaking the silence can bring an outpouring of fresh ideas from all levels of an organization--ideas that might just raise the organization's performance to a whole new level.

Anger↗

A framework for information system usage in collaborative care.

UNLABELLED: Clinical information systems (CIS) can affect the quality of patient care. In this paper, we focus on CIS use in the collaborative treatment of chronic diseases. We have developed a framework to determine which CIS functions have general usefulness for improving patient outcomes. METHODS: We reviewed the use of clinical information systems within a collaborative care environment, identifying CIS functions important in chronic disease care. We grouped the functions into categories of access, best practices, and communication (ABC). Three independent raters selected the most important collaborative care related functions from the HL7 Electronic Health Record Systems functional model, and mapped the HL7 functions against the ABC categories. We then built a model of CIS use and tested it on data from a cohort of patients with chronic illnesses. RESULTS: Of the 133 HL7 elements in the ABC model, 60 (45%) were ranked as important for collaborative care by two reviewers. Agreement was moderate for importance (kappa=.20) but high for ABC categorization (kappa=.67). In our data tests, for the 1105 patients, access 4.4+/-6.5, best practices 0.8+/-1.6, and communication 2.9+/-4.5. CIS functions were used per episode of care. We were able to identify several key functions that may affect patient care. For example, certain CIS functions related to best practices were associated with higher clinician adherence to testing guidelines. DISCUSSION: This framework may be useful to assess and compare CIS systems for collaborative care. Future refinements of the model are discussed.

Chronic Disease↗

A description of handover processes in an Australian public hospital.

Handover of patient care has been an ongoing problem within the health care sector. The process remains highly variable and there is a threat to patient safety. Despite the general belief that handover transitions in patient care have become routine, not enough attention or research has been directed at improving this period of care. For this reason there is a need to provide an analysis of the communication processes during handover. A study was conducted of the handover process among doctors during shift changes within a hospital setting. The results suggested a need for process change. Results revealed a handover process which was unstructured, informal and error prone, with the majority of doctors noting that there was no standard or formal procedure for handover. The research found that the majority of hospital doctors recognised the potential benefits of formalising and computerising this process.

Continuity of Patient Care↗

Improving information access for public health professionals.

Fundamental to our protection against biological weapons and the detection of disease outbreaks is the need to strengthen our surveillance systems. Improved electronic communications between local, state, and federal public health agencies provide a way for health officials to share information on unusual disease outbreaks and provide important health alert information. This article describes a model of a partnership between a regional medical library of the National Library of Medicine, a school of public health, and federally qualified community health centers. This project upgraded technology and provided public health professional training on Internet information and resources for local public health agencies.

Bioterrorism↗

Operationalizing integrated care on a clinical level: the INTERMED project.

During the last 10 years the INTERMED method has been developed as a generic method for the assessment of bio-psychosocial health risks and health needs and for planning of integrated treatment. The INTERMED has been conceptualized to counteract divisions and fragmentation of medical care. Designed to enhance the communication between patients and the health providers as well as between different professions and disciplines, the INTERMED is a visualized, action-oriented decision-support tool. This article presents various aspects of the INTERMED, such as its relevance, description, scoring, the related patient interview and treatment planning, scientific evaluation, implementation, and support for the method.

Decision Support Systems, Clinical↗

[Adherence to antiretroviral therapy during HIV infection, a multidisciplinary approach].

Since HIV infection has become a chronic disease, antiretroviral therapy is now used on a long-term basis. Response to treatment is conditioned by numerous inter-dependent factors, including non-compliance, which can result in failure of the therapeutic regimen. Although compliance is crucial for long-term efficacy of the treatment, it is a dynamic factor, and therefore difficult to evaluate. This literature review proposes a multidisciplinary approach to treatment adherence during HIV infection, and deals with the following questions: how should adherence and non-adherence be defined? How are they correlated to the treatment response? How is adherence measured in trials and cohorts, as well as in clinical practice? By what factors is it influenced? What tools can be implemented to improve adherence? The interaction between adherence and response to antiretroviral therapy requires communication between clinicians, healthcare providers, patients, virologists, pharmacologists, and the companies responsible for developing drugs. The pharmaceutical industry must sustain its efforts to ensure a balance between demands for efficacy and adherence when developing new drugs. And the methods implemented by numerous healthcare teams plead in favour of a dynamic approach to adherence, with the active participation of all.

Anti-HIV Agents↗

Defining the technical skills of teamwork in surgery.

Developments in surgical technology and procedure have accelerated and altered the work carried out in the operating theatre/room, but team modelling and training have not co-evolved. Evidence suggests that team structure and role allocation are sometimes unclear and contentious, and coordination and communication are not fully effective. To improve teamwork, clinicians need models that specify team resources, structure, process and tasks. They also need measures to assess performance and methods to train teamwork strategically. An effective training strategy might be to incorporate teamwork with other technical skills training in simulation. However, the measures employed for enhancing teamwork in training and practice will need to vary in their object of analysis, level of technical specificity, and system scope.

Clinical Competence↗

The DNA damage response and patient safety: engaging our molecular biology-oriented colleagues.

The imperative to improve patient safety is clear. Biomedical scientists, who account for a large proportion of medical school faculty, and clinicians tend to speak different languages. Biological systems are remarkable for their high robustness, flexibility, and efficiency. Biomedical scientists possess a profound understanding of the complex mechanisms that govern organisms. Their insights may inform the design of safer health care systems. We propose a model to assist in bi-directional communication between these disciplines. We use the principles and mechanisms of the DNA damage response to describe the central concepts of safety science and discuss similarities and differences between the systems of DNA repair and organizational approaches to safety in health care. We suggest that such biomedical scientists can and should be engaged in the effort to bring education about patient safety management into the medical school curriculum and to make patient care safer.

Biomedical Research↗

Discharge planning for the elderly ambulatory surgical patient.

Discharge planning for the elderly ambulatory surgery patient should begin as soon as the patient's procedure is booked. Successful discharge planning relies on 1) comprehensive preoperative assessment; 2) effective communication among the surgical facility's caregivers, the physician's office, the patient, and the family; 3) consideration of the patient's preoperative status; and 4) a strong patient and family education plan. The challenges of planning the aftercare are compounded by the physical, social, financial, cognitive, and sensory changes related to the normal aging process as well as to systemic diseases, which are more prevalent in the older population than in younger patients. The elderly patient's discharge plan should identify and address age-related barriers to communication, incorporate the patient's existing physical and medical condition, diminish the negative effects of social support challenges, and address environmental issues that can be improved to support recovery. The elderly population often deals with the imperfect: isolation from family or friends, aging bodies, hearing and visual loss, financial limitations, and emotional challenges. Although the nurse cannot reverse these challenges of old age, he or she can still make a difference by providing guidance and resources to blunt the potential complications of surgery and anesthesia.

Age Factors↗