Got spirit? The spiritual climate scale, psychometric properties, benchmarking data and future directions.

BACKGROUND: Organizations that encourage the respectful expression of diverse spiritual views have higher productivity and performance, and support employees with greater organizational commitment and job satisfaction. Within healthcare, there is a paucity of studies which define or intervene on the spiritual needs of healthcare workers, or examine the effects of a pro-spirituality environment on teamwork and patient safety. Our objective was to describe a novel survey scale for evaluating spiritual climate in healthcare workers, evaluate its psychometric properties, provide benchmarking data from a large faith-based healthcare system, and investigate relationships between spiritual climate and other predictors of patient safety and job satisfaction. METHODS: Cross-sectional survey study of US healthcare workers within a large, faith-based health system. RESULTS: Seven thousand nine hundred twenty three of 9199 eligible healthcare workers across 325 clinical areas within 16 hospitals completed our survey in 2009 (86% response rate). The spiritual climate scale exhibited good psychometric properties (internal consistency: Cronbach α = .863). On average 68% (SD 17.7) of respondents of a given clinical area expressed good spiritual climate, although assessments varied widely (14 to 100%). Spiritual climate correlated positively with teamwork climate (r = .434, p < .001) and safety climate (r = .489, p < .001). Healthcare workers reporting good spiritual climate were less likely to have intentions to leave, to be burned out, or to experience disruptive behaviors in their unit and more likely to have participated in executive rounding (p < .001 for each variable). CONCLUSIONS: The spiritual climate scale exhibits good psychometric properties, elicits results that vary widely by clinical area, and aligns well with other culture constructs that have been found to correlate with clinical and organizational outcomes.

Association of unconscious race and social class bias with vignette-based clinical assessments by medical students.

CONTEXT: Studies involving physicians suggest that unconscious bias may be related to clinical decision making and may predict poor patient-physician interaction. The presence of unconscious race and social class bias and its association with clinical assessments or decision making among medical students is unknown. OBJECTIVE: To estimate unconscious race and social class bias among first-year medical students and investigate its relationship with assessments made during clinical vignettes. DESIGN, SETTING, AND PARTICIPANTS: A secure Web-based survey was administered to 211 medical students entering classes at Johns Hopkins School of Medicine, Baltimore, Maryland, in August 2009 and August 2010. The survey included the Implicit Association Test (IAT) to assess unconscious preferences, direct questions regarding students' explicit race and social class preferences, and 8 clinical assessment vignettes focused on pain assessment, informed consent, patient reliability, and patient trust. Adjusting for student demographics, multiple logistic regression was used to determine whether responses to the vignettes were associated with unconscious race or social class preferences. MAIN OUTCOME MEASURES: Association of scores on an established IAT for race and a novel IAT for social class with vignette responses. RESULTS: Among the 202 students who completed the survey, IAT responses were consistent with an implicit preference toward white persons among 140 students (69%, 95% CI, 61%-75%). Responses were consistent with a preference toward those in the upper class among 174 students (86%, 95% CI, 80%-90%). Assessments generally did not vary by patient race or occupation, and multivariable analyses for all vignettes found no significant relationship between implicit biases and clinical assessments. Regression coefficient for the association between pain assessment and race IAT scores was -0.49 (95% CI, -1.00 to 0.03) and for social class, the coefficient was -0.04 (95% CI, -0.50 to 0.41). Adjusted odds ratios for other vignettes ranged from 0.69 to 3.03 per unit change in IAT score, but none were statistically significant. Analysis stratified by vignette patient race or class status yielded similarly negative results. Tests for interactions between patient race or class status and student IAT D scores in predicting clinical assessments were not statistically significant. CONCLUSIONS: The majority of first-year medical students at a single school had IAT scores consistent with implicit preference for white persons and possibly for those in the upper class. However, overall vignette-based clinical assessments were not associated with patient race or occupation, and no association existed between implicit preferences and the assessments.

From empire to democracy: effects of social progress on Turkish writers.

What is the effect of a society's culture on the creative writers living there? Few cultures have had such a event as Ataturk's 1920 revolution that changed Turkey from a monarchy ruled by sultans into a republic. How would such a dramatic shift in a country's history be reflected in the accomplishments and characteristics of its writers? In this study, the authors investigated 948 eminent Turkish writers. Variables of gender, era, type of writing, education level, profession, and winning an award were all analyzed. The type of writing (fiction, poetry, plays, or nonfiction) and the era in which the writing was produced were both predictive of whether an author won a literary award. Before 1920, fiction writers received more awards than poets; after 1920, poets received more awards. In addition, professional writers were more likely to win awards than were professional politicians. Reasons for these findings are discussed with an emphasis on cultural and historical influences.