The effects of organizational commitment and structural empowerment on patient safety culture.

Purpose The purpose of this paper is to investigate the relationship between patient safety culture and two attitudinal constructs: affective organizational commitment and structural empowerment. In doing so, the main and interaction effects of the two constructs on the perception of patient safety culture were assessed using a cohort of physicians. Design/methodology/approach Affective commitment was measured with the Organizational Commitment Questionnaire, whereas structural empowerment was assessed with the Conditions of Work Effectiveness Questionnaire-II. The abbreviated versions of these surveys were administered to a cohort of 71 post-doctoral medical residents. For the data analysis, hierarchical regression analyses were performed for the main and interaction effects of affective commitment and structural empowerment on the perception of patient safety culture. Findings A total of 63 surveys were analyzed. The results revealed that both affective commitment and structural empowerment were positively related to patient safety culture. A potential interaction effect of the two attitudinal constructs on patient safety culture was tested but no such effect was detected. Research limitations/implications This study suggests that there are potential benefits of promoting affective commitment and structural empowerment for patient safety culture in health care organizations. By identifying the positive associations between the two constructs and patient safety culture, this study provides additional empirical support for Kanter's theoretical tenet that structural and organizational support together helps to shape the perceptions of patient safety culture. Originality/value Despite the wide recognition of employee empowerment and commitment in organizational research, there has still been a paucity of empirical studies specifically assessing their effects on patient safety culture in health care organizations. To the authors' knowledge, this study is the first empirical study to examine the relationship between structural empowerment as proposed by Kanter and the culture of patient safety using physicians.

Addressing dysfunctional relations among healthcare teams: improving team cooperation through applied organizational theories.

Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health-care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health-care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health-care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health-care organizations.

Improving comprehensive surgical resident training through use of the NEO Five-Factor Personality Inventory: results from a cohort-based trial.

BACKGROUND: This study uses the NEO-Five Factor Personality Inventory (NEO) to assess its value in identifying resident educational needs. METHODS: A cohort of surgical residents (n = 65) were administered the NEO. Statistical analysis compared the results between previously determined national norms and between varying resident demographics. RESULTS: The resident scores of Extroversion, Openness, and Conscientiousness were significantly higher than those of the US population and Agreeableness was significantly lower. By gender, only Agreeableness was statistically higher for female residents. The mean Extroversion score for residents who were postgraduate years (PGYs) 3 to 5 was significantly higher than that of PGYs 1 to 2. Further subanalyses were conducted on each primary component. CONCLUSIONS: The NEO was valuable for identifying areas where training could be especially useful to augment Accreditation Council for Graduate Medical Education (ACGME) core competencies. The use of this test on resident populations could be of significant value for tailoring comprehensive surgical leadership education programs.

Transformational, transactional, and passive-avoidant leadership characteristics of a surgical resident cohort: analysis using the multifactor leadership questionnaire and implications for improving surgical education curriculums.

INTRODUCTION: The need for leadership training has become recognized as being highly important to improving medical care, and should be included in surgical resident education curriculums. MATERIALS AND METHODS: Surgical residents (n = 65) completed the 5x-short version of the Multifactor Leadership Questionnaire as a means of identifying leadership areas most in need of training among medical residents. The leadership styles of the residents were measured on 12 leadership scales. Comparisons between gender and postgraduate year (PGY) and comparisons to national norms were conducted. RESULTS: Of 12 leadership scales, the residents as a whole had significantly higher management by exception active and passive scores than those of the national norm (t = 6.6, P < 0.01, t = 2.8, P < 0.01, respectively), and significantly lower individualized consideration scores than the norm (t = 2.7, P < 0.01). Only one score, management by exception active was statistically different and higher among males than females (t = 2.12, P < 0.05). PGY3-5 had significantly lower laissez-faire scores than PGY1-2 (t = 2.20, P < 0.05). Principal component analysis revealed two leadership factors with eigenvalues over 1.0. Hierarchical regression found evidence of an augmentation effect for transformational leadership. CONCLUSION: Areas of resident leadership strengths and weaknesses were identified. The Multifactor Leadership Questionnaire was demonstrated to be a valuable tool for identifying specific areas where leadership training would be most beneficial in the educational curriculum. The future use of this instrument could prove valuable to surgical education training programs.

Assessment of communication skills of surgical residents using the Social Skills Inventory.

BACKGROUND: Interpersonal and communication skills are 1 of the 6 core competencies articulated as essential to resident education by the Accreditation Council for Graduate Medical Education. The current study assessed verbal and nonverbal communication skills among surgical residents. METHODS: The communication skills of surgical residents (n = 64) were assessed using the Social Skills Inventory. RESULTS: The majority of surgical residents demonstrated strong verbal and nonverbal skills, although the equilibrium index scores demonstrated an imbalance in the social skill profile for a minority (17.2%) of residents. Post graduate year was positively related to social expressivity (r = .31, P < .01) and social control (r = .27, P < .01) skills. In some cases, being proficient in one social skill was actually negatively related to another. CONCLUSIONS: The Social Skills Inventory was found to be a useful instrument for the multidimensional assessment of resident communication skills. Areas of strengths and weaknesses were identified and could be used for targeting areas for future educational interventions.

Surveillance and assessment of workplace assault injuries: analysis of Rhode Island workers' compensation claims 1998-2002.

OBJECTIVE: To analyze workplace assault by rate, injury severity, and trends using Rhode Island workers' compensation claim data. METHOD: A total of 6402 workers' compensation assault claims from Rhode Island for the period of 1998 through 2002 was analyzed. Data from the U.S. Department of Labor was used to derive estimates of injury rates. RESULTS: An average rate of 27.7 assaults per 10,000 workers was found and varied only marginally across years. Females filed 75% of all assault claims, though injuries to males resulted in longer periods of indemnification. The total cost of workplace assaults was 7,025,997 dollars, averaging 1097 dollars per claim, and average indemnification duration was 16.8 days per claim. While the assault rate was relatively stable, a notable decline in both cost and indemnification periods over time was discovered. CONCLUSION: The assault rate found was among the highest reported to date, demonstrating that workplace violence remains a significant threat to employee safety. While a decline in incident severity was discovered over time, many outcomes were still serious. Preventive interventions to reduce incidents of workplace assaults among groups at the highest risk should be given highest priority.