Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census.

OBJECTIVE: To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS: Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS: QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION: QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.

Life in an Academic Practice Versus a Solo Private Practice: How Different Are They?

Facial plastic surgery has thrived in both academic and private settings. In this article, 3 surgeons comment on a variety of selected topics that are pertinent to their lives as academic and private practice surgeons.

A Muslim Chaplaincy for Asylum Seekers? Results from an Evaluation Research Study.

Due to the high number of Muslim applicants in the Swiss asylum system, in recent years there have been calls for an introduction of a Muslim chaplaincy service into Switzerland's asylum centers. Acknowledging this need, the Swiss federal government ran a Muslim chaplaincy pilot service in Zurich's Juch Asylum Center between July 2016 and June 2017, with a view to its possible roll-out across Switzerland's federal asylum centers. This paper links methodological reflection with a presentation of key results in the evaluation of this project. Applying a mixed-method design based on the fourth-generation evaluation research, the study investigates the perspectives of the main stakeholder groups on the pilot project. The interaction with Muslim chaplains mostly led to a high degree of satisfaction among asylum seekers. The study shows there were difficulties and obstacles integrating Muslim chaplaincy into the center's inter-professional setting, although the interfaith cooperation with Christian chaplains nonetheless developed intensively. The study's methodological limitations, primarily caused by the setting of the study, are also discussed, as well as the impact the evaluation itself had on the asylum center setting.

Private rheumatology in Catalonia, Spain. / La Reumatología privada en Cataluña.

OBJECTIVE: To establish the percentage of Catalonian rheumatologists who attended to private patients, to understand the most common processes in private practice, to determine the dedication to patient care and the necessary activities to guarantee proper care, such as continuing education and office management, and to know what techniques were most widely used. MATERIAL AND METHODS: A personalized survey of Catalonian rheumatologists whose e-mail addresses were made available to us. Fifty-two responses were analyzed. RESULTS: The percentage of men (52%) and women (48%) was similar; 33% worked exclusively in private rheumatology (PR), most of them in hospitals or medical teams; 11% worked alone; 27% were in training. The disease most frequently treated was osteoarthritis; 51% were involved in studies or clinical trials in the field of RP. CONCLUSIONS: The concept of RP as a private business is changing and is progressively being transformed into working units with a structure similar to public hospitals with formal training. This report provides new data on the activities and characteristics of private rheumatologists.

[From an institution's management to the caregivers in the field: driving a change of practices]. / Du management institutionnel au terrain : impulser une dynamique pour changer les pratiques.

The managerial project of the nursing directorate set up by an adult general psychiatric unit aims first and foremost to change practices in the field. This approach firstly involves structuring the institution's management. The project's main areas of focus are then rolled out through actions prioritising the bold, innovative dimensions of caregiving. This project highlights the skills of many nurses who demonstrate high levels of creativity in their nursing practices and management of patients.

Laborist to Obstetrician/Gynecologist-Hospitalist: An Evolution or a Revolution?

The laborist model offers the best approach to standardize care and improve patient safety on the labor unit, improve physician well-being, and decrease physician dissatisfaction/burnout. The concept of the laborist was based on the hospitalist model. The laborist is free of the stresses of a private practice, works a constant and controllable schedule, and can have work shift limitations, thereby eliminating the issue of fatigue and impairment, and improving patient safety while decreasing the potential for adverse outcomes that may result in a liability action. This is what is being demanded both by patients and generation Y physicians.

Impact of organizational leadership on physician burnout and satisfaction.

OBJECTIVE: To evaluate the impact of organizational leadership on the professional satisfaction and burnout of individual physicians working for a large health care organization. PARTICIPANTS AND METHODS: We surveyed physicians and scientists working for a large health care organization in October 2013. Validated tools were used to assess burnout. Physicians also rated the leadership qualities of their immediate supervisor in 12 specific dimensions on a 5-point Likert scale. All supervisors were themselves physicians/scientists. A composite leadership score was calculated by summing scores for the 12 individual items (range, 12-60; higher scores indicate more effective leadership). RESULTS: Of the 3896 physicians surveyed, 2813 (72.2%) responded. Supervisor scores in each of the 12 leadership dimensions and composite leadership score strongly correlated with the burnout and satisfaction scores of individual physicians (all P<.001). On multivariate analysis adjusting for age, sex, duration of employment at Mayo Clinic, and specialty, each 1-point increase in composite leadership score was associated with a 3.3% decrease in the likelihood of burnout (P<.001) and a 9.0% increase in the likelihood of satisfaction (P<.001) of the physicians supervised. The mean composite leadership rating of each division/department chair (n=128) also correlated with the prevalence of burnout (correlation=-0.330; r(2)=0.11; P<.001) and satisfaction (correlation=0.684; r(2)=0.47; P<.001) at the division/department level. CONCLUSION: The leadership qualities of physician supervisors appear to impact the well-being and satisfaction of individual physicians working in health care organizations. These findings have important implications for the selection and training of physician leaders and provide new insights into organizational factors that affect physician well-being.

How we provide transfusion support for neonatal and pediatric patients on extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) provides lifesaving hemodynamic and respiratory support to neonatal and pediatric patients with a variety of congenital or acquired cardiopulmonary defects. Successful ECMO support requires close collaboration among multiple services, including critical care medicine, perfusion, and transfusion medicine services. Neonatal and pediatric ECMO patients require significant transfusion support, both at the time of cannulation and after the ECMO circuit has been established, often with little advance notice. Thus a number of communication and logistic issues must be addressed through a multidisciplinary approach to ensure both good patient outcome and judicious use of resources. In this article, we describe our protocol for transfusion support for ECMO and potential ECMO patients, which was developed to address a number of issues, including identifying and stratifiying ECMO candidate patients, streamlining the ordering and communication processes, and improving blood product turnaround times and availability. Additional measures of quality improvement are also discussed. As the number of centers performing ECMO procedures remains high, we believe that our experience may be of interest to our colleagues in transfusion medicine and critical care.

Obstetrician/gynecologist hospitalists: can we improve safety and outcomes for patients and hospitals and improve lifestyle for physicians?

Over the last 5 years, a new obstetric-gynecologic hospitalist model has emerged rapidly, the primary focus of which is the care and safety of the laboring patient. The need for this type of practitioner has been driven by a number of factors: various types of patient safety programs that require a champion and organizer; the realization that bad outcomes and malpractice lawsuits often result from the lack of immediate availability of a physician in the labor and delivery suite; the desire for many younger practicing physicians to seek a balance between their personal and professional lives; the appeal of shift work as opposed to running a busy private practice; the waning amount of training that new residency graduates receive in critical skills that are needed on labor and delivery; the void in critical care of the laboring patient that is created by the outpatient focus of many physicians in maternal-fetal medicine; the need for hospitals to have a group of physicians to implement protocols and policies on the unit, and the need for teaching in all hospitals, not just academic centers. By having a dedicated group of physicians whose practice is limited mostly to the care of the labor and delivery aspects of patient care, there is great potential to address many of these needs. There are currently 164 known obstetrician/gynecologist hospitalist programs across the United States, with 2 more coming on each month; the newly formed Society of Obstetrician/Gynecologist Hospitalists currently has >80 individual members. This article addresses the advantages, challenges, and variety of Hospitalist models and will suggest that what may be considered an emerging trend is actually a sustainable model for improved patient care and safety.

End-of-life care in an acute care hospital: linking policy and practice.

The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be effective, health care professionals who provide hospital care will need to respond to its patient-centered purpose. Health services will also be called upon to train health care professionals to work with dying people in a more participatory way and to assist them to develop the clinical processes that support shared decision making. Health professionals who manage clinical workplaces become central in reshaping this practice environment by promoting patient-centered care policy objectives and restructuring health service systems to routinely incorporate patient and family preferences about care at key points in the patient's care episode.

Exploring sustainable urban water governance: a case study of institutional capacity.

The sustainable urban water management system is likely to be characterised by complex and flexible governance arrangements, increased inter-organisational interaction and wide stakeholder participation, which contrasts significantly with the traditional approach. Recently there has been significant financial investment in urban water reform, however the reforms have not been as successful as anticipated and numerous institutional barriers remain. Understanding and assessing institutional capacity is central to addressing institutional impediments. Institutional capacity comprises individual, intra- and inter-organisational and external rules and incentives capacities. This paper reports on the first case study of a social research project that aims to develop an institutional capacity assessment framework. Empirical data from semi-structured interviews with 59 water industry experts in Sydney, Australia, and a broad literature survey were used. The key capacity attributes identified could form the basis of an institutional capacity assessment tool and reveal common and differing attributes across stakeholder groups which provide insight into stakeholder relations. Synthesis of the results revealed that intra- and inter-organisational capacities were facing particular challenges and should be explicitly addressed in reform, policy and capacity development initiatives.

Investigating the effect of nurse-team communication on nurse turnover: relationships among communication processes, identification, and intent to leave.

Enhanced team communication may strengthen nurses' attachment to their organizations and teams and improve nurse retention. This study examines the relationships among nurse-team communication, identification (organizational and team), and intent to leave. Hospital nurses (N = 201) completed surveys measuring 3 nurse-team communication processes: promoting team synergy, ensuring quality decisions, and individualizing communication. Hierarchical regression analyses revealed that promoting team synergy was a significant predictor of intent to leave, whereas ensuring quality decisions and individualizing communication did not account for significant additional variance in intent to leave. Separate analyses showed that the relationship between promoting team synergy and intent to leave was partially mediated by team identification or by organizational identification. Further analyses were conducted on the 7 communication practices for promoting team synergy. Mentoring emerged as the only significant predictor of intent to leave; however, its relationship to intent to leave was fully mediated by organizational identification or partially mediated by team identification. Pragmatic suggestions are offered to improve nurse identification and reduce turnover.

Better off alone? Why physicians don't merge.

The era of the small medical practice is over. How many times have we heard that? It was widely proclaimed back in the 90s, in the wake of the Clinton administration's healthcare reform proposal. But 15 years have passed, and there are stillplenty of physicians working in solo and small group practices. Despite all the predictions that small practices could not survive in an environment of "big healthcare," they persist. A report published recently by the U.S. Centers for Disease Control and Prevention estimated that as of 2003-2004 more than 35% of office-based physicians were in solo practice, and roughly 66% practiced in groups of five or fewer. This article examines why, in spite of the challenges of being in solo and small group practices, many physicians still prefer the status quo and resist forming or joining larger groups.