The role of psychological safety and learning behavior in the development of effective quality improvement teams in Ghana: an observational study.

BACKGROUND: As lower-income countries look to develop a mature healthcare workforce and to improve quality and reduce costs, they are increasingly turning to quality improvement (QI), a widely-used strategy in higher-income countries. Although QI is an effective strategy for promoting evidence-based practices, QI interventions often fail to deliver desired results. This failure may reflect a problem with implementation. As the key implementing unit of QI, teams are critical for the success or failure of QI efforts. Thus, we used the model of work-team learning to identify factors related to the effectiveness of newly-formed hospital-based QI teams in Ghana. METHODS: This was a cross-sectional, observational study. We used structural equation modeling to estimate relationships between coaching-oriented team leadership, perceived support for teamwork, team psychological safety, team learning behavior, and QI implementation. We used an observer-rated measure of QI implementation, our outcome of interest. Team-level factors were measured using aggregated survey data from 490 QI team members, resulting in a sample size of 122 teams. We assessed model fit and tested significance of standardized parameters, including direct and indirect effects. RESULTS: Learning behavior mediated a positive relationship between psychological safety and QI implementation (ß = 0.171, p = 0.001). Psychological safety mediated a positive relationship between team leadership and learning behavior (ß = 0.384, p = 0.068). Perceived support for teamwork did not have a significant effect on psychological safety or learning behavior. CONCLUSIONS: Psychological safety and learning behavior are key for the success of newly formed QI teams working in lower-income countries. Organizational leaders and implementation facilitators should consider these leverage points as they work to establish an environment where QI and other team-based activities are supported and encouraged.

Stress and well-being at work: A century of empirical trends reflecting theoretical and societal influences.

In various forms, research on stress and well-being has been a part of the Journal of Applied Psychology (JAP) since its inception. In this review, we examine the history of stress research in JAP by tracking word frequencies from 606 abstracts of published articles in the journal. From these abstracts, we define 3 eras: a 50 year-era from 1917 to 1966, a 30-year era from 1967 to 1996, and a 20-year era from 1997 to the present. Each era is distinct in terms of the number of articles published and the general themes of the topic areas examined. We show that advances in theory are a major impetus underlying research topics and the number of publications. Our review also suggests that articles have increasingly tended to reflect broader events occurring in society such as recessions and workforce changes. We conclude by offering ideas about the future of stress and well-being research. (PsycINFO Database Record

The value of value congruence.

Research on value congruence has attempted to explain why value congruence leads to positive outcomes, but few of these explanations have been tested empirically. In this article, the authors develop and test a theoretical model that integrates 4 key explanations of value congruence effects, which are framed in terms of communication, predictability, interpersonal attraction, and trust. These constructs are used to explain the process by which value congruence relates to job satisfaction, organizational identification, and intent to stay in the organization, after taking psychological need fulfillment into account. Data from a heterogeneous sample of employees from 4 organizations indicate that the relationships that link individual and organizational values to outcomes are explained primarily by the trust that employees place in the organization and its members, followed by communication, and, to a lesser extent, interpersonal attraction. Polynomial regression analyses reveal that the relationships emanating from individual and organizational values often deviated from the idealized value congruence relationship that underlies previous theory and research. The authors' results also show that individual and organizational values exhibited small but significant relationships with job satisfaction and organizational identification that bypassed the mediators in their model, indicating that additional explanations of value congruence effects should be pursued in future research.

Methods for integrating moderation and mediation: a general analytical framework using moderated path analysis.

Studies that combine moderation and mediation are prevalent in basic and applied psychology research. Typically, these studies are framed in terms of moderated mediation or mediated moderation, both of which involve similar analytical approaches. Unfortunately, these approaches have important shortcomings that conceal the nature of the moderated and the mediated effects under investigation. This article presents a general analytical framework for combining moderation and mediation that integrates moderated regression analysis and path analysis. This framework clarifies how moderator variables influence the paths that constitute the direct, indirect, and total effects of mediated models. The authors empirically illustrate this framework and give step-by-step instructions for estimation and interpretation. They summarize the advantages of their framework over current approaches, explain how it subsumes moderated mediation and mediated moderation, and describe how it can accommodate additional moderator and mediator variables, curvilinear relationships, and structural equation models with latent variables.

The phenomenology of fit: linking the person and environment to the subjective experience of person-environment fit.

The authors distinguished 3 approaches to the study of perceived person-environment fit (P-E fit): (a) atomistic, which examines perceptions of the person and environment as separate entities; (b) molecular, which concerns the perceived comparison between the person and environment; and (c) molar, which focuses on the perceived similarity, match, or fit between the person and environment. Distinctions among these approaches have fundamental implications for theory, measurement, and the subjective experience of P-E fit, yet research has treated these approaches as interchangeable. This study investigated the meaning and relationships among the atomistic, molecular, and molar approaches to fit and examined factors that influence the strength of these relationships. Results showed that the relationships among the approaches deviate markedly from the theoretical logic that links them together. Supplemental analyses indicated that molar fit overlaps with affect and molecular fit gives different weight to atomistic person and environment information depending on how the comparison is framed. These findings challenge fundamental assumptions underlying P-E fit theories and have important implications for future research.

Complementary and supplementary fit: a theoretical and empirical integration.

Complementary and supplementary fit represent 2 distinct traditions within the person-environment fit paradigm. However, these traditions have progressed in parallel but separate streams. This article articulates the theoretical underpinnings of the 2 traditions, using psychological need fulfillment and value congruence as prototypes of each tradition. Using a sample of 963 adult employees ranging from laborers to executives, the authors test 3 alternative conceptual models that examine the complementary and supplementary traditions. Results show that an integrative model dominates the other two, such that both traditions simultaneously predict outcomes in different ways.

A comparative study of the in vitro activity of meropenem and representatives of the major classes of broad-spectrum antibiotics.

OBJECTIVE: To compare the in vitro activity of meropenem with that of other agents with a broad-spectrum of antibacterial activity, and which may therefore be candidates for empirical use. The agents tested were imipenem, third-generation and newer cephalosporins, penicillins combined with a beta-lactamase inhibitor, ciprofloxacin and amino-glycosides. METHODS: Using agar dilution methods, all agents were tested against 900 clinical isolates (many of which were multiresistant), including Gram-positive aerobes, nutritionally fastidious aerobes, Enterobacteriaceae, non-fermenters and anaerobes, collected from 17 UK hospitals during 1994. In addition, some agents were tested against strains expressing defined beta-lactamases, including extended-spectrum beta-lactamases. RESULTS: The potency and spectrum of the carbapenems, unequalled against aerobes and anaerobes, were undoubtedly influenced by their stability to serine beta-lactamases. Meropenem and imipenem exhibited essentially the same spectrum of activity but imipenem was often less potent, notably against Gram-negative aerobes, including Pseudomonas aeruginosa and Burkholderia cepacia. Conversely, the activity of the third-generation (MIC90s 0.016--64 mg/L) and, to some extent, the newer cephalosporins (MIC90s 0.06--8 mg/L) and the augmented penicillins (MIC90s 1 to >128 mg/L) was unreliable against many genera of Enterobacteriaceae because of chromosomally mediated enzymes or the, now commonplace, plasmid-mediated beta-lactamases. Ciprofloxacin had modest activity (MIC90s 1--64 mg/L) against Gram-positive aerobes, was potent against nutritionally fastidious species, had again variable activity against the Enterobacteriaceae (MIC90s 0.008--4 mg/L) and was inactive against many strains of Pseudomonas, Burkholderia and Acinetobacter, resulting in MIC90s of 4 to >128 mg/L. The aminoglycosides were impressive only against the Enterobacteriaceae, with amikacin alone active (MIC90s 2--8 mg/L) against the 11 species tested. CONCLUSIONS: This study demonstrates that it is difficult on grounds of spectrum to differentiate third-generation cephalosporins, and that neither cefepime nor cefpirome materially enhance utility. The study suggests also that, judged on activity in vitro, meropenem or imipenem are the only monotherapy options for empirical antibacterial therapy of polymicrobic infections or when local epidemiology indicates the predominance of multiresistant Enterobacteriaceae. Instability to current and emerging beta-lactamases is progressively compromising the use of all other beta-lactam compounds.

A compilation of studies assessing the in vitro activity of meropenem and comparators in 84 laboratories throughout Europe.

OBJECTIVE: To compile the results of investigations conducted in 84 centers throughout Europe of the in vitro activity of meropenem and a standard set of comparators against some 12 000 Gram-positive, Gram-negative, aerobic and anaerobic bacteria. METHODS: Recent clinical isolates from 84 European countries were tested using Mueller---Hinton broth or agar (aerobes and nutritionally fastidious species) or Wilkins---Chalgren medium (anaerobes) for susceptibility to meropenem, imipenem, cefotaxime, ceftazidime, piperacillin, ciprofloxacin and gentamicin (aerobes) or meropenem, imipenem, clindamycin and metronidazole (anaerobes). RESULTS: Whether compared across studies or across countries, meropenem and imipenem were the only compounds that produced uniform and predictable activity. The activity of ceftazidime and cefotaxime was compromized because of instability to both chromosomally mediated and new plasmid-mediated (transferable) beta-lactamases. This effect was even more pronounced with piperacillin. Resistance to gentamicin was commonplace, although variable between countries; strains resistant to ciprofloxacin occurred in many genera of Enterobacteriaceae and amongst the pseudomonads. Metronidazole was uniformly active against anaerobes but there were many clindamycin-resistant strains. Resistance, or diminished susceptibility, amongst Streptococcus pneumoniae was found frequently, but of the beta-lactams tested, only ceftazidime and piperacillin produced minimum inhibitory concentration values that could compromize therapeutic efficacy outside the central nervous system. CONCLUSIONS: These data provide further evidence of the high incidence of antibiotic resistance in Europe, notably in France, Spain and Italy. Fortunately, the carbapenems are highly stable to the enzymes that hydrolyze cephalosporins and penicillins. Hence, they retain an essentially unaltered and exceptional antimicrobial spectrum, embracing the vast majority of strains resistant to the other comparators, although meropenem was more reliable than imipenem against Pseudomonas aeruginosa.