An integrative review of research evaluating organisational culture in residential aged care facilities.

BACKGROUND: Evidence suggests that the culture of healthcare organisations, including residential aged care facilities (RACFs), is linked to the quality of care offered. The number of people living in RACFs has increased globally, and in turn, attention has been placed on care quality. This review aimed to identify how organisational culture is studied, sought to elucidate the results of previous studies, and aimed to establish what interventions are being used to improve organisational culture in RACFs. METHODS: We employed an integrative review design to provide a comprehensive understanding of organisational culture. Five academic data bases were searched (Ovid Medline, Scopus, PsycInfo, CINAHL, Embase). Articles were included if they were empirical studies, published in peer reviewed journals in English, conducted in a RACF setting, and were focused on organisational culture/climate. RESULTS: Ninety-two articles were included. Fifty-nine studies (64.1%) utilised a quantitative approach, while 24 (26.0%) were qualitative, and nine used mixed methods (9.8%). Twenty-two (23.9%) aimed to describe the culture within RACFs, while 65 (70.7%) attempted to understand the relationship between culture and other variables, demonstrating mixed and indeterminate associations. Only five (5.4%) evaluated an intervention. CONCLUSIONS: This review highlights the heterogenous nature of this research area, whereby differences in how culture is demarcated, conceptualised, and operationalised, has likely contributed to mixed findings. Future research which is underpinned by a sound theoretical basis is needed to increase the availability of empirical evidence on which culture change interventions can be based.

Issues and complexities in safety culture assessment in healthcare.

The concept of safety culture in healthcare-a culture that enables staff and patients to be free from harm-is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to "survey fatigue," with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.

Explaining emergency physicians' capacity to recover from interruptions.

OBJECTIVE: To assess whether the capacity to utilize cues amongst emergency physicians is associated with differences in the capacity to recover performance following an interruption. BACKGROUND: Interruptions are implicated in errors in emergency medicine due to the cognitive load that they impose on working memory, resulting in a loss of performance on the primary task. The utilization of cues is associated with a reduction in cognitive load during the performance of a task, thereby enabling the allocation of residual resources that mitigates the loss of performance following interruptions. METHOD: Thirty-nine emergency physicians, recruited at a medical conference, completed an assessment of cue utilization (EXPERTise 2.0) and an online simulation (Septris) that involved the management of patients presenting with sepsis. During the simulation, physicians were interrupted and asked to check a medication order. Task performance was assessed using scores on Septris, with points awarded for the accurate management of patients. RESULTS: Emergency physicians with higher cue utilization recorded significantly higher scores on the simulation task following the interruption, compared to physicians with lower cue utilization (p = .028). CONCLUSION: The results confirm a relationship between cue utilization and the recovery of performance following an interruption. This is likely due to the advantages afforded by associated reductions in cognitive load. APPLICATION: Assessments of cue utilization may assist in the development of interventions to support clinicians in interruptive environments.

Cue Utilization Differentiates Performance in the Management of Interruptions.

OBJECTIVE: To examine the role of cue utilization in the management of interruptions during a high workload, rail control simulation. BACKGROUND: High-risk, high-consequence environments are characterized by cognitively demanding, time-critical activities, in which operators are required to manage frequent interruptions under conditions of high workload. Interruptions are deleterious to performance as they impose excessive cognitive demand on limited working memory resources, thereby depleting residual resources for the primary task. Cue utilization may enable superior performance in managing interruptions through efficiencies gained by the application of implicit patterns stored in long-term memory. METHOD: Two experiments were conducted. In Experiment 1, 46 university students undertook an assessment of cue utilization and subsequently engaged in a high workload, simulated rail control task while managing multiple interruptive tasks. Experiment 2 replicated and extended Experiment 1, wherein 52 university students completed a measure of cue utilization and engaged in a high workload, simulated rail control task while managing multiple interruptions and breaks. RESULTS: The analyses revealed that participants who demonstrated a greater capacity for cue utilization also demonstrated a reduced loss of performance following interruptions. CONCLUSION: The outcomes suggest a relationship between a greater capacity for cue utilization and superior performance in the management of interruptions in high workload conditions. APPLICATION: Assessments of cue utilization may assist in the selection and training of operators in high-consequence, high-risk environments, to ensure efficient and accurate performance during the management of interruptions.

Cross-task cue utilisation and situational awareness in simulated air traffic control.

OBJECTIVE: To examine the role of cross-task cue utilisation in the acquisition of situational awareness during the initial stages of learning to operate an air traffic control simulation. BACKGROUND: Cue-based associations are an important component of situational awareness, a construct that is necessary for skilled process control, where the location, movement, and direction of multiple targets needs to be managed. However, the potential for high levels of situational awareness is difficult to assess in the absence of exposure. Previous research suggests that cross-task cue utilisation predicts the acquisition of feature-event associations that form the basis of situational awareness METHOD: Sixty university students undertook an assessment of cue utilisation in the context of motor vehicle driving and subsequently engaged in an air traffic control simulation task. During the air traffic control simulation task, situational awareness queries were introduced based on the Situation Awareness Global Assessment Test (SAGAT). RESULTS: The analyses revealed that participants who demonstrated relatively higher levels of cross-task cue utilisation also demonstrated greater performance on the SAGAT and achieved greater performance during the simulated air traffic control task. CONCLUSION: The outcomes suggest a relationship between cross-task cue utilisation and situational awareness, particularly at the initial stages of skill acquisition. APPLICATION: Assessments of cross-task cue utilisation may be used to distinguish the propensity for prospective trainees to acquire the situational awareness necessary for complex, process control tasks such as air traffic control.