The effect of psychological meaningfulness and perceived organisational support on the relationship between nursing workload and job satisfaction: A prospective, cross-sectional investigation.

BACKGROUND: Evidence emphasises a strong relationship between nursing workload and job satisfaction. This study sets out to test empirically the roles of psychological meaningfulness and perceived organisational support on the nursing workload-satisfaction relationship. OBJECTIVE: To investigate empirically the role and impact of psychological meaningfulness and perceived organisational support on the relationship between nursing workload and job satisfaction. DESIGN: Prospective cross-sectional study. SETTING: A large acute care and teaching hospital in China. PARTICIPANTS: 500 nurses were asked to participate in this study and respond to a survey questionnaire. 426 nurses participated in this study, of which 395 responses (valid response 79%, 52% general nurses, 40% nurses in charge, and 9% senior nurses) were considered valid. METHODS: A multi-item questionnaire was used to assess the constructs of interest, which included demographic items; items related to nursing satisfaction, meaningfulness, and perceived organisational support; and lastly items assessing workload. Included items were a combination of previously validated scales and items co-developed between the research team and nurses of the study hospitals. Since the study relies on self-reported scales, the common latent factor technique was initially used to ensure that the common bias was not a major concern. Model fitness was tested using one-factor congeneric measurement. The research hypotheses were tested using the SPSS add-on PROCESS v3.3 model in a bootstrap approach. RESULTS: In the first part of the analysis, 43 of 51 factors survived the initial tests using common latent factor technique and model fitness measurements. We found that the direct effect of psychological meaningfulness on the workload-satisfaction relationship was significant. This suggests that psychological meaningfulness mediates the relationship. It further illustrates that perceived organisational support acts as a moderator for the relationship and accordingly it specifies conditions under which the workload can be related to job satisfaction. However, in the presence of psychological meaningfulness, the perceived organisational support moderated the workload-psychological meaningfulness relationship and its direct effect on workload-job satisfaction relationship became non-significant. CONCLUSION: Our study provides an understanding of how psychological meaningfulness and perceived organisational support may play out in the context of nursing work. To the best of our knowledge, this the first study to directly measure and explore these relationships in a quantitative manner. Our results indicate the critical role of perceived organisational support, where present, in allowing nurses to see the connection between their workload and their ultimate aspirations so that their work becomes more psychologically meaningful. TWEETABLE ABSTRACT: This study provides an understanding of how psychological meaningfulness and perceived organisational support affect nursing work.

A novel conceptual approach to lean: value, psychological conditions for engagement with work and perceived organizational support in hospital care.

BACKGROUND: Lean thinking (LT) has emerged as a promising approach for reducing waste and improving efficiency. However, its applicability to and effectiveness within healthcare, particularly within hospital-based care, remains clouded by uncertainty. This paper attempts to answer the question 'how lean thinking can best be applied to hospital-based care'. METHODS: Narrative review and conceptual synthesis. RESULTS: We first review the principles of LT and how some of them are challenging to apply within hospital-based care. We then highlight that lean is an approach that was always meant as a combination of technical expertise and a focus on people-supported by a suite of human resource management supportive practices. We proceed to introduce evidence stemming from the literature studies on perceived organizational support and the psychological conditions for successful staff engagement with their work (namely, psychological meaningfulness, availability and safety as experienced by staff) and review how they may apply to hospital-based health workers. We finally advance a set of hypotheses regarding how different facets of value in a hospital care pathway may be correlated and these relationships mediated/moderated by perceived organizational support and the psychological conditions for engagement with work. CONCLUSION: We conclude with a discussion of the limitations of our work and the aspiration that the conceptual analysis we have offered is a useful and actionable framework for hospital management to explore how best to support their staff-in a manner that ultimately achieves better quality and patient experience of care.

Barriers to reporting near misses and adverse events among professionals performing laparoscopic surgeries: a mixed methodology approach.

BACKGROUND: The literature has investigated barriers to reporting adverse events in surgery, but with less emphasis on near misses. No attempt was made to categorise near misses by type and reportability. This paper attempts to fill these two gaps in the literature. METHODS: A mixed methodology approach was adopted. A sample of 16 laparoscopic surgeries were observed followed by a questionnaire distributed among professionals dealing with laparoscopies. Non-parametric tests and mediation-moderation analysis were used to compare responses and identify causal factors. RESULTS: A total of 469 near misses were observed, and classified into two categories: reportable events and common events. Among 23 observed reportable events, only 9 events were reported. Out of 300 distributed questionnaires, we received 178 valid responses (response rate 59%). The professionals strongly disagreed that reporting near misses (Mean 4.09, STD 0.95) and adverse events (4.17, 1.02) makes little contribution to the quality of surgery. However, the results show that professionals were more willing to disclose adverse events than near misses, Heavy workload, privacy, lack of support, and fear from disciplinary actions negatively affected professionals' willingness to report near misses. DISCUSSION: Error reporting should aim to promote safety, knowledge sharing and education. It is important to differentiate near misses that should be reported from voluntary reported events. Hospital's management might award professionals who frequently report errors and provide solutions, Quality rather than quantity of reports should be emphasised with flexibility in the way near misses are reported. CONCLUSION: The outcome of this study has benefits of understanding the attitudes of surgical professionals towards error reporting. It provides healthcare management with tool for enhancing safety and providing suitable training for their professionals.

Hierarchical task analysis for identification of interrelationships between ergonomic, external disruption, and internal disruption in complex laparoscopic procedures.

BACKGROUND: Traditionally, hierarchical task analysis (HTA) in surgery examines observable disruption in a predefined set of tasks as performed, rather than examining the ergonomics requirements, which may predispose surgical teams to act erroneously. This research aims to address this gap in the literature. It develops a HTA protocol taking into consideration surgical team actions, observable external disruption, internal disruption, and ergonomic goals required for safer conducting procedures. Laparoscopic radical prostatectomy (LRP) is selected as a case. METHODS: This research involved observations inside operating rooms (ORs) of three large teaching hospitals in Australia and China. Two rounds of observations are conducted: observations for developing HTA, and observations after presenting the developed HTA among surgical teams. The traditional HTA format is expanded to include two additional columns: technical considerations and ergonomics considerations. Two groups are formed from the observed LRPs. LRPs in the first group were conducted with no regard to the specified ergonomic goals and associated ergonomic features, and the second are conducted with the surgical teams attempting to follow specified ergonomic goals and features as prescribed in HTA. Careful attempt is required to select procedures such that the total operative times for both groups are approximately equal (± 5%). RESULTS: Between March 2016 and November 2017, a total of 29 LRPs were observed, and a HTA developed. The results reveal significant reduction (43%) in the total external disruptive events and approximately 58% reduction in the internal disruptive events in LRPs conducted with HTA requirements. CONCLUSIONS: The developed HTA appears to have some utility, but needs evaluation in larger studies. It can potentially be used as a training aid, and as a checklist for evaluating surgical performance.

Ergonomics perspective for identifying and reducing internal operative flow disruption for laparoscopic urological surgery.

BACKGROUND: The aim of this study is to examine operative flow disruption that occurs inside the surgical field, (internal operative flow disruption (OFD)), during urological laparoscopies, and to relate those events to external ergonomics environment in terms of monitor location, level of instruments' handles, and location of surgical team members. According to the our best knowledge, this is the first study of its kind. METHODS: A combination of real and video-aided observational study was conducted in the operating rooms at hospitals in Australia and China. Brain storming sessions were first conducted to identify the main internal OFD events, and the observable reasons, potential external, and latent ergonomic factors were listed. A prospective observational study was then conducted. The observer's records and the related video records of internal surgical fields were analysed. Procedures were categorised into groups based on similarity in ergonomics environment. RESULTS: The mapping process revealed 39 types of internal OFD events resulted from six reasons. A total of 24 procedures were selected and arranged into two groups, each with twelve procedures. Group A was carried out under satisfactory ergonomics environment, while Group B was conducted under unsatisfactory ergonomics environment. A total of 1178 OFD events were detected delaying the total observed operative times (2966 min) by 220 min (7.43%). Average OFD/h in group A was less than 15, while in group B about 29 OFD/h. CONCLUSION: There are two main latent ergonomics factors affecting the surgeon's performance; non-physiological posture and long-period static posture. The delays and number of internal OFD were nearly doubled where procedures were conducted under unsatisfactory external ergonomics environment. Some events such as stopping operation and irrelevant conversations during long procedures may have a positive influence on the surgeon's performance.

Impact of disruptions on anaesthetic workflow during anaesthesia induction and patient positioning: A prospective study.

BACKGROUND: Work disruption in operating rooms hinders flow of patients and increases chances of error. Previous studies have largely considered the types of disruption occurring in operating rooms, but have not analysed systematically the objective impact of disruption. OBJECTIVE: The objective was to evaluate the impact of disruption on time efficiency in preoperative anaesthetic work in the operating room and to link disruption to failures in co-ordination of care. DESIGN: Prospective, cross-sectional and observational study. SETTING: Disruptions were evaluated in operating rooms of five hospitals across three countries: Australia (one community hospital, one teaching hospital); Thailand (two community hospitals); China (one teaching hospital). PARTICIPANTS: The preoperative phase of anaesthesia induction/patient positioning of 64 surgical patients across specialities was prospectively evaluated (Australia = 33; Thailand = 12; China = 10). Further, interviews were carried out with 16 consultant anaesthetists and surgeons and 13 senior operating room nurses involved in the care of these patients. MAIN OUTCOME MEASURES: Disruptions were identified by trained observers in real time during the preoperative phase; four types of care co-ordination problems were identified from the interviews with senior anaesthetists, surgeons and nurses, and linked to the disruptions. Descriptive analyses of time efficiency were performed. RESULTS: Complete data were available from 55 cases. Good inter-observer agreement was obtained across measurements (range 74 to 92%). An average of three disruptions per case during the preoperative phase, were observed (range 2 to 9). 'Disruption types': disruptive staff activities were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 4 min 45 s per case). 'Care co-ordination problems': co-ordination lapses within the operating room team, and between them and the preoperative team were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 5 min 0 s per case). CONCLUSION: The study quantifies time inefficiencies affecting anaesthetic work during the preoperative phase. Work disruption wastes time and is preventable.

Human error identification for laparoscopic surgery: Development of a motion economy perspective.

This study postulates that traditional human error identification techniques fail to consider motion economy principles and, accordingly, their applicability in operating theatres may be limited. This study addresses this gap in the literature with a dual aim. First, it identifies the principles of motion economy that suit the operative environment and second, it develops a new error mode taxonomy for human error identification techniques which recognises motion economy deficiencies affecting the performance of surgeons and predisposing them to errors. A total of 30 principles of motion economy were developed and categorised into five areas. A hierarchical task analysis was used to break down main tasks of a urological laparoscopic surgery (hand-assisted laparoscopic nephrectomy) to their elements and the new taxonomy was used to identify errors and their root causes resulting from violation of motion economy principles. The approach was prospectively tested in 12 observed laparoscopic surgeries performed by 5 experienced surgeons. A total of 86 errors were identified and linked to the motion economy deficiencies. Results indicate the developed methodology is promising. Our methodology allows error prevention in surgery and the developed set of motion economy principles could be useful for training surgeons on motion economy principles.

Applying hierarchical task analysis to improving the patient positioning for direct lateral interbody fusion in spinal surgery.

The present study brings together for the first time the techniques of hierarchical task analysis (HTA), human error identification (HEI), and business process management (BPM) to select practices that can eliminate or reduce potential errors in a surgical setting. We applied the above approaches to the improvement of the patient positioning process for lumbar spine surgery referred to as 'direct lateral interbody fusion' (DLIF). Observations were conducted to gain knowledge on current DLIF positioning practices, and an HTA was constructed. Potential errors associated with the practices specific to DLIF patient positioning were identified. Based on literature review and expert views alternative practices are proposed aimed at improving the DLIF patient positioning process. To our knowledge, this is the first attempt to use BPM in association with HEI/HTA for the purpose of improving the performance and safety of a surgical process - with promising results.

On the day of surgery: how long does preventable disruption prolong the patient journey?

PURPOSE: Disruption considerably prolongs session times for surgery, affects the quality of patient care, and prolongs waiting lists. In addition, there is a strong relationship between disruption and surgical error. This research aims to provide a platform for healthcare services to identify the sources of preventable disruption affecting operative time within the perioperative process and to effectively reduce it. DESIGN/METHODOLOGY/APPROACH: Events inside and outside operating rooms that disturb the operative time were recorded for 31 elective surgeries over the period of five months. Disruption events were classified according to the hospital's requirements and the findings were reviewed by the surgical teams. Lean thinking approaches were used to achieve the purpose of this study. FINDINGS: Preventable disruption caused an increase in surgical time of approximately 25 per cent. Preventable disruption consisted of poor information flow, failure to follow concepts of methods study, lack of communication and lack of coordination. Coordination failures were the main reason for disruption followed by the lack of following the principles of motion economy. ORIGINALITY/VALUE: Surgical disruption has substantial financial implications for hospitals. This research indicates that it is possible to reduce operative time considerably by eliminating preventable disruption. Such additional time could be utilised to deal with the pressure of emergency cases, reduce the waiting lists for elective surgery, increase operating room utilisation, and reduce medical errors.

The impact of preventable disruption on the operative time for minimally invasive surgery.

BACKGROUND: Current ergonomic studies show that disruption exposes surgical teams to stress and musculoskeletal disorders. This study considers minimally invasive surgery as a sociotechnical process subjected to a variety of disruption events other than those recognized by ergonomic science. The research takes into consideration the impact of preventable disruption on operating time rather than on the physical and emotional status of the surgical team. METHODS: Events inside operating rooms that disturbed operative time were recorded for 17 minimally invasive surgeries. The disruption events were classified into four main areas: prerequisite requirements, work design, communication during surgery, and other. Each area was further classified according to sources of disruption. Altogether, 11 sources of disruption were identified: patient record, protocol and policy, surgical requirements and surgeon preferences, operating table and patient positioning, arrangement of instruments, lighting, monitor, clothing, surgical teamwork, coordination, and other. RESULTS: Disruption prolonged operative time by more than 32%. Teamwork forms the main source of disruption followed by operating table and patient positioning and arrangement of instruments. These three sources represented approximately 20% of operative time. Failure to follow principles of work design had a significant negative impact, lengthening operative time by approximately 15%. Although lighting and monitors had a relatively small impact on operative time, these factors could create inconvenience and stress within the surgical teams. In addition, the effect of failure to follow surgical protocols and policies or having incomplete patient records may have a limited effect on operative time but could have serious consequences. CONCLUSION: This report demonstrates that preventable disruption caused an increase in operative time and forced surgeons and patients to endure unnecessary delay of more than 32%. Such additional time could be used to deal with the pressure of emergency cases and to reduce waiting lists for elective surgery.