Interdisciplinary and interprofessional communication intervention: How psychological safety fosters communication and increases patient safety.

Background: Effective teamwork and communication are imperative for patient safety and quality care. Communication errors and human failures are considered the main source of patient harm. Thus, team trainings focusing on communication and creating psychologically safe environments are required. This can facilitate challenging communication and teamwork scenarios, prevent patient safety risks, and increase team performance perception. The sparse research concerning communication interventions calls for an understanding of psychological mechanisms. Therefore, this study investigated mechanisms of an interpersonal team intervention targeting communication and the relation of psychological safety to patient safety and team performance perception based on the applied input-process-output model of team effectiveness. Methods: Before and after a 4-h communication intervention for multidisciplinary teams, a paper-pencil survey with N = 137 healthcare workers from obstetric units of two university hospitals was conducted. Changes after the intervention in perceived communication, patient safety risks, and team performance perception were analyzed via t-tests. To examine psychological mechanisms regarding psychological safety and communication behavior, mediation analyses were conducted. Results: On average, perceived patient safety risks were lower after the intervention than before the intervention (MT1 = 3.220, SDT1 = 0.735; MT2 = 2.887, SDT2 = 0.902). This change was statistically significant (t (67) = 2.760, p =.007). However, no such effect was found for interpersonal communication and team performance perception. The results illustrate the mediating role of interpersonal communication between psychological safety and safety performances operationalized as perceived patient safety risks (α1∗ß1 = -0.163, 95% CI [-0.310, -0.046]) and team performance perception (α1∗ß1 = 0.189, 95% CI [0.044, 0.370]). Discussion: This study demonstrates the psychological mechanisms of communication team training to foster safety performances and psychological safety as an important predecessor for interpersonal communication. Our results highlight the importance of teamwork for patient safety. Interpersonal and interprofessional team training represents a novel approach as it empirically brings together interpersonal communication and collaboration in the context of patient safety. Future research should work on follow-up measures in randomized-controlled trials to broaden an understanding of changes over time.

Psychosocial Processes in Healthcare Workers: How Individuals' Perceptions of Interpersonal Communication Is Related to Patient Safety Threats and Higher-Quality Care.

Interpersonal communication, as a central form of social resource derived from social relations, is crucial for individuals coping with threats in the workplace, especially for hospitals that provide high-quality care and patient safety. Using social system mentalization as a theoretical background, we applied psychosocial processes and a psychodynamic system approach to get insights on how healthcare workers interact with team members and patients. The goal was to test the following hypotheses: H1: Better communication is associated with fewer patient safety threats (H1a) and higher-quality care (H1b). H2: The associations between communication and patient safety threats (H2a) and higher-quality care (H2b) are mediated by psychological safety. In this two-studies design, we conducted a cross-sectional hospital survey (N = 129) and a survey of obstetric team members (N = 138) in Germany. Simple mediation analyses were run. Results revealed that communication is associated with safety performance. Further, the mediating effect of psychological safety between communication and safety performance was demonstrated. These findings contribute to an understanding of social relation representations, as individuals' communication interrelates with safety performance mediated by psychological safety to complement healthcare and public health strategies. With a better understanding of communication and psychological safety, tools, routines, and concrete trainings can be designed.

Behavior change training for pregnant women's communication during birth: A randomized controlled trial.

Applying health psychological theories can improve communication interventions to empower pregnant women and ensure safe births. The aim was to test a short digital communication intervention based on the health action process approach. A randomized-controlled trial was conducted with pregnant women at two German university hospitals. The intervention group (NT1 = 225; NT2 = 142) received a 2.5 h online training focusing on communication planning, self-efficacy and communicating personal needs and preferences under difficult circumstances. This group was compared with a passive control group (NT1 = 199; NT2 = 144). Data from the N = 286 women with complete datasets were used for multilevel analyses. Data from all recruited N = 424 women were used for intention-to-treat analyses with multiple imputation. Both groups improved regarding communication behavior, quality of birth, action planning, coping planning and coping self-efficacy after birth, which was more pronounced in the intervention group. The intention-to-treat analyses confirmed the higher improvement for communication behavior, perceived quality of birth and coping planning. The intervention was related to improvements in pregnant women's communication behavior and quality of birth. Hence, future research and practice should apply and evaluate health psychological theories when targeting communication and empowerment.

The Impact of a Communication Training on the Birth Experience: Qualitative Interviews with Mothers after Giving Birth at Obstetric University Departments in Germany.

(1) Background: Patient safety is a pressing issue in healthcare. Besides economical and organizational issues, human factors play a crucial role in providing safe care. Safe and clear communication on both the healthcare workers' and patients' sides contribute to the avoidance of medical errors and increase patients' and healthcare workers' satisfaction. Globally, the incidence of experiencing at least one adverse event in obstetrics is about 10%, of which half are classified as preventable. According to international research, improving communication skills may decrease preventable adverse events. The research question was to what extent communication training for pregnant women impacts the quality of communication and mutual understanding during birth. (2) Methods: Communication interventions with pregnant women were conducted in two German university obstetric departments in a mixed methods research design, based on the Health Action Process Approach. The online classes covered the awareness of personal wishes, the understanding and usage of communication strategies, self-efficacy and empathy. This study presents the qualitative results. Out of 142 mothers who answered two questionnaires before the communication training and after the birth, 24 in-depth semistructured interviews were conducted to explore the subjective impact of the communication training. The results were analyzed with qualitative content analysis. (3) Results: The majority of participants felt incentivized to be aware of their personal wishes for birth and to express them. Perceived positive experiences with sufficient competency in communication, empathy and mutual understanding outweighed negative treatments and experiences in the hospital, some of which could be attributed to structural problems. (4) Discussion: The reported positive effects of the communication training underline the need but also the potential for communication lessons to reflect and improve communication skills in obstetrics. However, negative experiences due to structural problems in the healthcare system may be buffered by communication skills but not solved.

Birthing under the Condition of the COVID-19 Pandemic in Germany: Interviews with Mothers, Partners, and Obstetric Health Care Workers.

BACKGROUND: The COVID-19 pandemic and the necessary containment measures challenge obstetric care. Support persons were excluded while protection measures burdened and disrupted the professionals' ability to care and communicate. The objective of this study was to explore the first-hand experience of the impact of the COVID-19 pandemic on mothers, their partners, and obstetric professionals regarding birth and obstetric care in a university hospital. METHODS: To answer the descriptive research questions, we conducted a qualitative content analysis using a data triangulation approach. We carried out 35 semi-structured interviews with two stratified purposive samples. Sample one consisted of 25 mothers who had given birth during the pandemic and five partners. Sample two included 10 obstetric professionals whose insights complemented the research findings and contributed to data validation. Participants were recruited from the study sample of a larger project on patient safety from two German university hospitals from February to August 2021. The study was approved by two ethics committees and informed consent was obtained. RESULTS: Mothers complied with the rules, but felt socially isolated and insecure, especially before transfer to the delivery room. The staff equally reported burdens from their professional perspective: They tried to make up for the lack of partner and social contacts but could not live up to their usual professional standards. The exclusion of partners was seen critically, but necessary to contain the pandemic. The undisturbed time for bonding in the maternity ward was considered positive by both mothers and professionals. CONCLUSION: The negative effects of risk mitigation measures on childbirth are to be considered carefully when containment measures are applied.

Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses.

Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mistakes, mutual understanding, and debriefings of conflict situations are reported to improve collaboration. Additionally, emergency trainings, trainings in precise communication, and handovers are proposed to reduce risks for pAEs. Furthermore, the participants reported time-constraints and understaffing as a huge burden that hinders safe communication. Concluding, safety culture and organizational management are closely entwined and strategies should address various levels of which communication trainings are promising.