Organisational trust: the keystone to patient safety.
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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. (+info)
Older persons' evaluations of health care: the effects of medical skepticism and worry about health.
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OBJECTIVE: To describe how skepticism about medical care and other individual differences, including worry about health status, are associated with evaluations of health care among the noninstitutionalized elderly. DATA SOURCES/STUDY SETTING: Data were collected through a survey of approximately 5,000 community-dwelling elders (aged 65 and older) in a southwestern region of the United States. STUDY DESIGN: Global evaluations of health care were measured with two items from the Consumer Assessment of Health Plans Study (CAHPS) instrument, an overall care rating (OCR) and a personal doctor rating (PDR). Multivariate ordered logit regression models were tested to examine how medical skepticism and other factors were associated with ratings of 0-7, 8-9, and 10. PRINCIPAL FINDINGS: Consumers who were skeptical of prescription drugs relative to home remedies, who held attitudes that they understand their health better than most doctors, and who worried about their health had worse OCR and PDR. Those who held attitudes that individual behavior determines how soon one gets better when sick had better PDR and OCR. CONCLUSIONS: Health policymakers, managers, and providers may need to consider the degree to which they should attempt to satisfy skeptical consumers, many of whom may never rate their care highly. Alternatively, they may need to target skeptical consumers with educational efforts explaining the benefits of medical care. (+info)
Doctors' communication of trust, care, and respect in breast cancer: qualitative study.
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OBJECTIVE: To determine how patients with breast cancer want their doctors to communicate with them. DESIGN: Qualitative study. SETTING: Breast unit and patients' homes. PARTICIPANTS: 39 women with breast cancer. MAIN OUTCOME MEASURE: Patients' reports of doctors' characteristics or behaviour that they valued or deprecated. RESULTS: Patients were not primarily concerned with doctors' communication skills. Instead they emphasised doctors' enduring characteristics. Specifically, they valued doctors whom they believed were technically expert, had formed individual relationships with them, and respected them. They therefore valued forms of communication that are currently not emphasised in training and research and did not intrinsically value others that are currently thought important, including provision of information and choice. CONCLUSIONS: Women with breast cancer seek to regard their doctors as attachment figures who will care for them. They seek communication that does not compromise this view and that enhances confidence that they are cared for. Testing and elaborating our analysis will help to focus communication research and teaching on what patients need rather than on what professionals think they need. (+info)
Essential characteristics of effective Balint group leadership.
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OBJECTIVE: Balint work in the United States has suffered from a lack of written material on how Balint group leaders structure and guide group process. This study identified characteristics of effective Balint group leadership by gathering information from experienced Balint leaders. METHODS: We used evaluations of the leadership methods used by 21 Balint group leaders assembled at an American Balint Society workshop to pilot test the Society's credentialing process. Free text and rating data from leader evaluation forms were analyzed using qualitative text analysis and factor analysis. We also conducted focus groups. RESULTS: Convergence was seen on several characteristics across all sources of data. Effective Balint leaders operate to create a safe environment and move the group toward a new understanding of a specific doctor-patient relationship. Specific leader behaviors include protecting the presenter from interrogation, encouraging open speculation by group members, avoiding premature solutions, and tolerating silence and uncertainty. DISCUSSION: Although Balint group leaders rely on behaviors common to other small-group methods, they create a space and purpose markedly different from that seen in other small groups in medical education. Balint group leaders model and create a safe environment for shared, creative speculation and a more empathic experience of the doctor-patient relationship. (+info)
Public trust in health care: the system or the doctor?
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OBJECTIVES: To examine how the public assess trust in health care in England and Wales. DESIGN: Postal structured questionnaire in cross sectional survey. SETTING: Random sample of people on the electoral register in England and Wales. SUBJECTS: People aged 18 and over. MAIN OUTCOME MEASURES: General levels of trust and confidence in health care. RESULTS: The response rate was 48% (n = 1187). The mean level of confidence (trust) in the healthcare system was 6.0 out of a score of 10. Levels of distrust appeared relatively high with at least 356 (30%) respondents reporting little or very little trust for 28 of 32 specific aspects of health care. The highest levels of distrust were found in relation to how the health service was run and financed, particularly waiting times and the implication of cost cutting for patients. Statistical analysis by univariable linear regression of the specific determinants of generic assessments of public trust (confidence) suggested that the key aspects were patient centred care and levels of professional expertise. Being covered by private health insurance was also a key determinant of levels of public trust. CONCLUSION: Public assessment of trust tends to address the views of care at the micro level. Policy makers concerned with the erosion of public trust need to target aspects associated with patient centred care and professional expertise. (+info)
Re-thinking accountability: trust versus confidence in medical practice.
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In seeking to prevent a reoccurrence of scandals such as that involving cardiac surgery in Bristol, the UK government has adopted a model of regulation that uses rules and surveillance as a way of both improving the quality of care delivered and increasing confidence in healthcare institutions. However, this approach may actually act to reduce confidence and trust while also reducing the moral motivation of practitioners. Accountability in health care is discussed, and it is suggested that openness about the difficult dilemmas that arise when practitioners have a duty to be accountable to more than one audience may be an alternative means of restoring trust. A greater emphasis on the sharing of information between individual health professionals and their patients would increase trust and would allow patients to hold their doctors to account for the quality of care they receive. Concentrating more on developing trust by the sharing of information and less on the futile search for complete confidence in systems and rules may improve the quality of care delivered while also nurturing the moral motivation of professionals upon which the delivery of high quality health care depends. (+info)
A year of mentoring in academic medicine: case report and qualitative analysis of fifteen hours of meetings between a junior and senior faculty member.
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We describe a specific mentoring approach in an academic general internal medicine setting by audiotaping and transcribing all mentoring sessions in the year. In advance, the mentor recorded his model. During the year, the mentee kept a process journal. Qualitative analysis revealed development of an intimate relationship based on empathy, trust, and honesty. The mentor's model was explicitly intended to develop independence, initiative, improved thinking, skills, and self-reflection. The mentor's methods included extensive and varied use of questioning, active listening, standard setting, and frequent feedback. During the mentoring, the mentee evolved as a teacher, enhanced the creativity in his teaching, and matured as a person. Specific accomplishments included a national workshop on professional writing, an innovative approach to inpatient attending, a new teaching skills curriculum for a residency program, and this study. A mentoring model stressing safety, intimacy, honesty, setting of high standards, praxis, and detailed planning and feedback was associated with mentee excitement, personal and professional growth and development, concrete accomplishments, and a commitment to teaching. (+info)
Implications of Harold Shipman for general practice.
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Harold Shipman was an English general practitioner who murdered at least 215 of his patients between 1974 and 1998. A public inquiry is underway, but general practitioners and all doctors also need to consider the implications for their profession. The aim of this paper is to stimulate debate. Issues identified as important to consider include: trust between doctors; attitudes towards failing systems such as cremation certification; acceptance of the duty of accountability; ensuring patients can have reasonable confidence in their doctors; commitment to preventing such a case occurring again; and relationships with patients. It is argued that restricting debate to methods to detect doctors who murder would limit the opportunity to improve medical practice and would constitute a failure to fulfil the duty owed by doctors to Shipman's victims and their families. (+info)