Communication and collaboration: it's about the pharmacists, as well as the physicians and nurses.

OBJECTIVE: Collaboration and communication as dimensions of patient safety climate have been measured in acute care hospital units, and discrepant viewpoints have been documented between different professional groups, particularly between physicians and nurses. In the ambulatory care setting, these groups often work more closely together throughout the day than in acute care settings, thereby enhancing effective collaboration and communication. This study sought to determine if the communication differences that are known to impact patient safety, which are found in acute care, also exist in ambulatory care. METHODS: The Safety Attitudes Questionnaire, a 77-item survey of collaboration, communication and safety attitudes, was administered to the primary care staff at four Midwestern military ambulatory care clinics. RESULTS: There were 107 participants consisting of nurses (n=46), nurse practitioners (n=12), pharmacists (n=10) and physicians (n=39), yielding an overall response rate of 65%. All groups rated their peer group higher than other professional groups. The ratings of nurses and physicians were very similar: 85.0% of nurses rated physicians, and 85.7% of physicians rated nurses as high or very high in communication and collaboration. Pharmacists were rated the lowest by each of the other professional groups. Only 60% of pharmacists rated physicians as high or very high. CONCLUSIONS: Collaboration and communication ratings among physicians and nurses appear to be higher in the ambulatory care setting than in the acute care. However, interactions with pharmacists are more problematic, perceived as adversarial. Teamwork training that focuses on specific interactions among professional groups should target these concerns.

Patient safety climate in primary care: age matters.

OBJECTIVE: Safety climate, as a measurement in time of safety culture using a survey instrument, has been explored in inpatient units and among hospitals. Differences have been reported among professional groups in these venues. This study sought to determine if comparable differences exist among professional groups in ambulatory care settings. SETTING: Four US Air Force ambulatory care facilities (clinics) from the Midwestern United States. METHODS: The Safety Attitudes Questionnaire was selected as the research tool because of its published utilization in inpatient venues, its sound psychometrics (Cronbach alpha, 0.74-0.93), and its ambulatory care version. RESULTS: All 328 available primary care staff from 4 clinics was surveyed yielding 213 responses for a response rate of 65%. There were no significant differences among the professional groups on the total patient safety score or on 5 of the 6 subscales. There were, however, significant differences on total safety scores based on age, not professional group, with staff members younger than 31 years scoring lower on the overall safety score (mean, 64.8; P < 0.001), as compared with the 32- to 41-year age group (mean, 74.3) and those 42- to 63-year age group (mean, 73.8). The youngest age group also had the lowest scores on the subscales of teamwork climate, safety climate, perception of management, and job satisfaction (all subscales P < 0.03). These differences persisted after controlling for professional group. CONCLUSIONS: Growing attention has been given to the demographic groups known in the popular press as Generation Xers and Nexters, but not within the context of enhancing patient safety. Efforts that address the information, training, and job satisfaction needs of these specific age groups have the potential to strengthen health care teams and contribute to a more positive safety climate.

Complex adaptive systems: concept analysis.

AIM: The aim of this paper is to explicate the concept of complex adaptive systems through an analysis that provides a description, antecedents, consequences, and a model case from the nursing and health care literature. BACKGROUND: Life is more than atoms and molecules--it is patterns of organization. Complexity science is the latest generation of systems thinking that investigates patterns and has emerged from the exploration of the subatomic world and quantum physics. A key component of complexity science is the concept of complex adaptive systems, and active research is found in many disciplines--from biology to economics to health care. However, the research and literature related to these appealing topics have generated confusion. A thorough explication of complex adaptive systems is needed. METHODS: A modified application of the methods recommended by Walker and Avant for concept analysis was used. FINDINGS: A complex adaptive system is a collection of individual agents with freedom to act in ways that are not always totally predictable and whose actions are interconnected. Examples include a colony of termites, the financial market, and a surgical team. It is often referred to as chaos theory, but the two are not the same. Chaos theory is actually a subset of complexity science. Complexity science offers a powerful new approach--beyond merely looking at clinical processes and the skills of healthcare professionals. CONCLUSION: The use of complex adaptive systems as a framework is increasing for a wide range of scientific applications, including nursing and healthcare management research. When nursing and other healthcare managers focus on increasing connections, diversity, and interactions they increase information flow and promote creative adaptation referred to as self-organization. Complexity science builds on the rich tradition in nursing that views patients and nursing care from a systems perspective.