Support for healthcare workers and patients after medical error through mutual healing: another step towards patient safety.

BACKGROUND: Medical errors, especially those resulting in patient harm, have a negative psychological impact on patients and healthcare workers (HCWs). Healing may be promoted if both parties are able to work together and explore the effect and outcome of the event from each of their perspectives. There is little existing research in this area, even though this has the potential to improve patient safety and wellness for both HCWs and patients. METHODS: Using a patient-oriented research approach with constructive grounded theory methodology, we examined the potential for patients and HCWs to heal together after harm from a medical error. Individual interviews were conducted and transcribed verbatim. We conducted concurrent data collection and analysis according to grounded theory principles. With our findings, we created a framework and visual breakdown of the communication process between patients and HCWs. RESULTS: Our findings suggest that, after a medical error causing harm, both patients and HCWs have feelings of empathy and respect towards each other that often goes unrecognised. Barriers to communication for patients were related to their perception that HCWs did not care about them, showed no remorse or did not admit to the error. For HCWs, communication barriers were related to feelings of blame or shame, and fear of professional and legal consequences. Patients reported needing open and transparent communications to help them heal, and HCWs required leadership and peer support, including training and space to talk about the event(s). DISCUSSION: Our resulting framework suggests that if there was an opportunity for an open and purposeful conversation early or before increased emotional suffering, there might be an opportunity to bridge the barriers, and help patients and HCWs heal together. This, in turn, contributes to improved health quality and patient safety.

A Promising Route Towards Improvement of Homeless Young People's Access to Mental Health Services: The Creation and Evolution of an Outreach Service Network in Montréal.

Youth homelessness is a complex phenomenon as well as an important public health issue often compounded by mental illness of varying severity, in turn creating numerous deleterious consequences. While emergency health services usage remains high, access to mental health services is arduous and conventional interventions often fall short on providing integrated care and seldom lead to sustained positive outcomes for this group. From this observation, clinicians in Montreal, Canada, initiated collaborative meetings, eventually attended by a growing number of institutional and community stakeholders working with homeless youth. Acknowledging the unique needs of this population, the Réseau d'intervention de proximité auprès des Jeunes de la Rue (RIPAJ) or Montreal Homeless Youth Network was created to engage and seamlessly connect youth with the right resources within the network including mental health services amongst others. The genesis, philosophy and unique features of RIPAJ that allow for effective and cohesive interventions as well as future directions are discussed.

Improving mental health services for homeless youth in downtown Montreal, Canada: Partnership between a local network and ACCESS Esprits ouverts (Open Minds), a National Services Transformation Research Initiative.

AIM: In many parts of the world, there is growing concern about youth homelessness. Homeless youth are particularly vulnerable to psychological distress, substance use and mental disorders, and premature mortality caused by suicide and drug overdose. However, their access to and use of mental health care is very limited. METHODS: The Réseau d'intervention de proximité auprès des jeunes (RIPAJ), a Montreal network of over 20 community stakeholders providing a wide array of cohesive services, was created to ease homeless youth's access to mental health and psychosocial services. Its philosophy is that there should be no "wrong door" or "wrong timing" for youth seeking help. In 2014, the network partnered with the pan-Canadian transformational research initiative, ACCESS Esprits ouverts. RESULTS: Created through this partnership, ACCESS Esprits ouverts RIPAJ has been promoting early identification through outreach activities targeting homeless youth and agencies that serve them. An ACCESS Clinician was hired to promote and rapidly respond to help-seeking and referrals. By strengthening connections within RIPAJ and using system navigation, the site is working to facilitate youth's access to timely appropriate care and eliminate age-based transitions between services. A notable feature of our program, that is not usually evident in homelessness services, has been the engagement of the youth in service planning and design and the encouragement of contact with families and/or friends. CONCLUSION: Challenges remain including eliminating any remaining age-related transitions of care between adolescent and adult services; and the sustainability of services transformation and network coordination. Nonetheless, this program serves as an example of an innovative, much-needed, community-oriented model for improving access to mental health care for homeless youth.

Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts).

AIM: Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. METHOD: We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post-secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. RESULTS: Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. CONCLUSIONS: Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.

The Healthcare Environment: A Perfect Ecosystem for Growing Shame.

The expression "shame and blame" has often been used to describe the culture within healthcare when a mistake is made. There has been little exploration, however, on the shame healthcare professionals experience after a mistake. Based on an original grounded theory study on the psychological impact of mistakes on health professionals, this article explores why the healthcare environment is a perfect ecosystem for growing shame, how individuals are coping or not coping with the negative effects of this powerful emotion and what might be done at the system, organizational and team level to mitigate these negative effects.

Developing a culture of safety: Exploring students' perceptions of errors in an interprofessional setting.

Healthcare has a long tradition of silence around mistakes that cause or have the potential to cause harm to a patient, and there is evidence that this culture may be present from the beginning of a health professional's training. The purpose of this pilot study was to examine a team of interprofessional students' interactions with a preceptor in a simulation environment. The debriefing explored the students' reactions and assisted them with how to manage similar situations in the future to improve patient safety. The results showed that the students felt powerless to stop the simulated preceptor from doing harm to the patient, or to even question the preceptor's unsafe actions. Recommendations for educators include incorporating discussions and interprofessional training about handling mistakes into the curriculum, in the context of patient safety.

[Taking care of outreach workers who intervene with marginal youths : Part 2]. / Des rencontres de proximité : le prendre soin de soi des intervenants au coeur de l'intervention solidaire pour joindre les jeunes en marge : Deuxième partie.

Outreach work with youths in a precarious situation raises emotions and questions in workers while confronting them with their own suffering and fragility. In order to help them help as well as counter the risk of vicarious traumatisation, spaces for talking and exchanging with a third party have been created in various intervention settings. The objective is to allow them to elaborate on what their work makes them feel and thus preserve their stability and their ability to think. Through group or individual clinical discussions, these exchanges favor distancing and allow new perspectives on their work. That is why peer support appeared as an essential element for psychologists and therapists who support not only youths but the workers who help them. The setting up of our outreach meetings-a result of our observation, allows keeping the flame alive without risking being burned. In this article, the issue of marginality in professionals working with homeless youths-as well as our own-is raised. It sometimes translates in the absence of a fixed location for a meeting symbolizing traditional stability, sometimes in the necessary flexibility of a framework to reach this population, sometimes in the openness to otherness and more precisely to a difference that disturbs when anxiety that this disaffiliated being raises, could well be our very self! Is it really marginality or a particular positioning aiming at constructive denunciation of stigmatization, unjust exclusion that youths with mental health and addiction problems sustain that place them at risk of homelessness? Neither missionaries, nor saviors are needed, but only hopeful facilitators working alongside people who want to stand up and take their place in society.

[Close team work: sharing knowledge, solidarity and hope]. / Des rencontres de proximité: apprendre de l'autre, pour tisser de la solidarité et de l'espoir. Première partie.

A proximity team was created more than eight years ago by a group of health professionals working with disaffiliated and homeless youth in the most precarious of situations. Proximity meetings have continued since that time, despite many changes within the team, including departures and new arrivals. The proximity team is a partnership project which revolves around common values and principles aimed at improving services for youth who find themselves marginalized or at risk of exclusion. Health professionals from various backgrounds explain why they believe in this approach to proximity work.