Improvement Science Publications
Research papers published by our team
2022
Authors - Helen Smith, Chloe Grindey, Isabel Hague, Louise Newbould, Lesley Brown, Andrew Clegg, Carl Thompson, Rebecca Lawton
https://onlinelibrary.wiley.com/doi/10.1111/hex.13588
Abstract
Introduction
Growing numbers of older patients occupy hospital beds despite being ‘medically fit’ for discharge. These Delayed Transfers of Care amplify inefficiencies in care and can cause harm. Delayed transfer because of family or patient choice is common; yet, research on patient and family perspectives is scarce. To identify barriers to, and facilitators of, shorter hospital stays, we sought to understand older people's and caregivers' thoughts and feelings about the benefits and harms of being in hospital and the decisions made at discharge.
Methods
A multimethod qualitative study was carried out. Content analysis was carried out of older people's experiences of health or care services submitted to the Care Opinion online website, followed by telephone and video interviews with older people and family members of older people experiencing a hospital stay in the previous 12 months.
Results
Online accounts provide insight into how care was organized for older people in the hospital, including deficiencies in care organization, the discharge process and communication, as well as how care was experienced by older people and family members. Interview-generated themes included shared meanings of hospitalization and discharge experiences and the context of discharge decisions including failure in communication systems, unwarranted variation and lack of confidence in care and lack of preparation for ongoing care.
Conclusion
Poor quality and availability of information, and poor communication, inhibit effective transfer of care. Communication is fundamental to patient-centred care and even more important in discharge models characterized by limited assessments and quicker discharge. Interventions at the service level and targeted patient information about what to expect in discharge assessments and after discharge could help to address poor communication and support for improving discharge of older people from hospital.
Patient or Public Contribution
The Frailty Oversight Group, a small group of older people providing oversight of the Community Aging Research 75+ study, provided feedback on the research topic and level of interest, the draft data collection tools and the feasibility of collecting data with older people during the COVID-19 pandemic. The group also reviewed preliminary findings and provided feedback on our interpretation.
Authors - Ruth Baxter & Rebecca Lawton
https://www.cambridge.org/core/elements/positive-deviance-approach/506CA2D446210E1FE76740B7F835D87C
Summary
Positive deviance is an asset-based improvement approach. At its core is the belief that solutions to problems already exist within communities, and that identifying, understanding, and sharing these solutions enables improvements at scale. Originating in the field of international public health in the 1960s, positive deviance is now, with some adaptations, seeing growing application in healthcare. We present examples of how positive deviance has been used to support healthcare improvement. We draw on an emerging view of safety, known as Safety II, to explain why positive deviance has drawn the interest of researchers and improvers alike. In doing so, we identify a set of fundamental values associated with the positive deviance approach and consider how far they align with current use. Throughout, we consider the untapped potential of the approach, reflect on its limitations, and offer insights into the possible challenges of using it in practice. This title is also available as Open Access on Cambridge Core.
Authors - Helen Smith, Luke Budworth, Chloe Grindey, Isabel Hague, Natalie Hamer, Roman Kislov, Peter van der Graaf & Joe Langley
https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00838-x
Abstract
Background
Interest in and use of co-production in healthcare services and research is growing. Previous reviews have summarized co-production approaches in use, collated outcomes and effects of co-production, and focused on replicability and reporting, but none have critically reflected on how co-production in applied health research might be evolving and the implications of this for future research. We conducted this scoping review to systematically map recent literature on co-production in applied health research in the United Kingdom to inform co-production practice and guide future methodological research.
Methods
This scoping review was performed using established methods. We created an evidence map to show the extent and nature of the literature on co-production and applied health research, based on which we described the characteristics of the articles and scope of the literature and summarized conceptualizations of co-production and how it was implemented. We extracted implications for co-production practice or future research and conducted a content analysis of this information to identify lessons for the practice of co-production and themes for future methodological research.
Results
Nineteen articles reporting co-produced complex interventions and 64 reporting co-production in applied health research met the inclusion criteria. Lessons for the practice of co-production and requirements for co-production to become more embedded in organizational structures included (1) the capacity to implement co-produced interventions, (2) the skill set needed for co-production, (3) multiple levels of engagement and negotiation, and (4) funding and institutional arrangements for meaningful co-production. Themes for future research on co-production included (1) who to involve in co-production and how, (2) evaluating outcomes of co-production, (3) the language and practice of co-production, (4) documenting costs and challenges, and (5) vital components or best practice for co-production.
Conclusion
Researchers are operationalizing co-production in various ways, often without the necessary financial and organizational support required and the right conditions for success. We argue for accepting the diversity in approaches to co-production, call on researchers to be clearer in their reporting of these approaches, and make suggestions for what researchers should record. To support co-production of research, changes to entrenched academic and scientific practices are needed.
2021
Authors - Tmam A. Al-Ghunaim, Judith Johnson, Chandra Shekhar Biyani, Khalid M. Alshahrani, Alice Dunning, Daryl B. O'Connor
https://www.sciencedirect.com/science/article/abs/pii/S0002961021007595?via%3Dihub
Abstract
Background
Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has investigated this association in surgeons specifically. The present study addressed this gap, by examining the association between surgeon burnout and 1) patient safety and 2) surgical professionalism.
Methods
A systematic review was performed in accordance with PRISMA guidelines. We included original empirical studies that measured burnout and patient care or professionalism in surgeons. Six databases were searched (PsycINFO, Ovid MEDLINE(R), EMBASE, Cochrane Database, CINAHL, and Web of Science) from inception to February 2021. An adapted version of the Cochrane Risk of Bias tool was used to assess study quality. Meta-analysis and narrative synthesis were utilised to synthesise results.
Results
Fourteen studies were included in the narrative review (including 27,248 participants) and nine studies were included in the meta-analysis. Burnout was associated with a 2.5-fold increased risk of involvement in medical error (OR = 2.51, 95% Cl [1.68–3.72]). The professionalism outcome variables were too diverse for meta-analysis, however, the narrative synthesis indicated a link between high burnout and a higher risk of loss of temper and malpractice suits and lower empathy. No link was found between burnout and patient satisfaction.
Conclusion
There is a significant association between higher burnout in surgeons and poorer patient safety. The delivery of interventions to reduce surgeon burnout should be prioritised; such interventions should be evaluated for their potential to produce concomitant improvements in patient safety.
Authors - Olivia Rochelle Joseph, Stuart W. Flint, Rianna Raymond-Williams, Rossby Awadzi and Judith Johnson
https://www.mdpi.com/1660-4601/18/23/12771
Abstract
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.
Authors - Judith Johnson, Tmam Abdulaziz Al-Ghunaim, Chandra Shekhar Biyani, Anthony Montgomery, Roland Morley & Daryl B. O’Connor
https://link.springer.com/article/10.1007/s12262-021-03047-y
Abstract
Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.
Authors - Alice Dunning, Gemma Louch, Angela Grange, Karen Spilsbury, Judith Johnson
https://journals.sagepub.com/doi/10.1177/1744987120976172
Abstract
Background
Values are of high importance to the nursing profession. Value congruence is the extent to which an individual’s values align with the values of their organisation. Value congruence has important implications for job satisfaction.
Aim
This study explored nurse values, value congruence and potential implications for individual nurses and organisations in terms of wellbeing and patient care and safety.
Method
Fifteen nurses who worked in acute hospital settings within the UK participated in semi-structured telephone interviews. Thematic analysis was utilised to analyse the data.
Results
Four themes were identified: organisational values incongruent with the work environment; personal and professional value alignment; nurse and supervisor values in conflict; nurses’ values at odds with the work environment. Perceived value incongruence was related to poorer wellbeing, increased burnout and poorer perceived patient care and safety. The barriers identified for nurses being able to work in line with their values are described.
Conclusions
Value congruence is important for nurse wellbeing and patient care and safety. Improving the alignment between the values that organisations state they hold, and the values implied by the work environment may help improve patient care and safety and support nurses in practice.
Authors - Raabia Sattar, Rebecca Lawton, Maria Panagioti & Judith Johnson
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-06049-w
Abstract
Background
Qualitative synthesis approaches are increasingly used in healthcare research. One of the most commonly utilised approaches is meta-ethnography. This is a systematic approach which synthesises data from multiple studies to enable new insights into patients’ and healthcare professionals’ experiences and perspectives. Meta-ethnographies can provide important theoretical and conceptual contributions and generate evidence for healthcare practice and policy. However, there is currently a lack of clarity and guidance surrounding the data synthesis stages and process.
Method
This paper aimed to outline a step-by-step method for conducting a meta-ethnography with illustrative examples.
Results
A practical step-by-step guide for conducting meta-ethnography based on the original seven steps as developed by Noblit & Hare (Meta-ethnography: Synthesizing qualitative studies.,1998) is presented. The stages include getting started, deciding what is relevant to the initial interest, reading the studies, determining how the studies are related, translating the studies into one another, synthesising the translations and expressing the synthesis.
We have incorporated adaptations and developments from recent publications. Annotations based on a previous meta-ethnography are provided. These are particularly detailed for stages 4–6, as these are often described as being the most challenging to conduct, but with the most limited amount of guidance available.
Conclusion
Meta-ethnographic synthesis is an important and increasingly used tool in healthcare research, which can be used to inform policy and practice. The guide presented clarifies how the stages and processes involved in conducting a meta-synthesis can be operationalised.
2020
Authors - Claire Marsh, Rosemary Peacock, Laura Sheard, Rebecca Lawton
Abstract
Listening and responding to patients is essential but healthcare organisations struggle to do this effectively. This article describes a project to create the six-step Yorkshire Patient Experience Toolkit, which supports teams to collect and use patients’ feedback to improve care. Six wards trialled the toolkit and found that, while it addressed complex patient needs, the teams needed skilled support and collaborative processes.
Citation: Marsh C et al (2021) Testing a toolkit that uses patient experience feedback to improve care. Nursing Times [online]; 117: 1, 39-43.
Authors: Claire Marsh is senior research fellow, Bradford Institute for Health Research; Rosemary Peacock is research fellow, School of Medicine, University of Leeds; Laura Sheard is associate professor, York Trials Unit; Rebecca Lawton is professor, Bradford Institute for Health Research; at the time of the research, all were at Bradford Institute for Health Research.
Authors - Judith Johnson, Ruth Simms-Ellis, Gillian Janes, Thomas Mills, Luke Budworth, Lauren Atkinson & Reema Harrison
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05948-2
Abstract
Background
Healthcare professionals are experiencing unprecedented levels of occupational stress and burnout. Higher stress and burnout in health professionals is linked with the delivery of poorer quality, less safe patient care across healthcare settings. In order to understand how we can better support healthcare professionals in the workplace, this study evaluated a tailored resilience coaching intervention comprising a workshop and one-to-one coaching session addressing the intrinsic challenges of healthcare work in health professionals and students.
Methods
The evaluation used an uncontrolled before-and-after design with four data-collection time points: baseline (T1); after the workshop (T2); after the coaching session (T3) and four-to-six weeks post-baseline (T4). Quantitative outcome measures were Confidence in Coping with Adverse Events (‘Confidence’), a Knowledge assessment (‘Knowledge’) and Resilience. At T4, qualitative interviews were also conducted with a subset of participants exploring participant experiences and perceptions of the intervention.
Results
We recruited 66 participants, retaining 62 (93.9%) at T2, 47 (71.2%) at T3, and 33 (50%) at T4. Compared with baseline, Confidence was significantly higher post-intervention: T2 (unadj. β = 2.43, 95% CI 2.08–2.79, d = 1.55, p < .001), T3 (unadj. β = 2.81, 95% CI 2.42–3.21, d = 1.71, p < .001) and T4 (unadj. β = 2.75, 95% CI 2.31–3.19, d = 1.52, p < .001). Knowledge increased significantly post-intervention (T2 unadj. β = 1.14, 95% CI 0.82–1.46, d = 0.86, p < .001). Compared with baseline, resilience was also higher post-intervention (T3 unadj. β = 2.77, 95% CI 1.82–3.73, d = 0.90, p < .001 and T4 unadj. β = 2.54, 95% CI 1.45–3.62, d = 0.65, p < .001). The qualitative findings identified four themes. The first addressed the ‘tension between mandatory and voluntary delivery’, suggesting that resilience is a mandatory skillset but it may not be effective to make the training a mandatory requirement. The second, the ‘importance of experience and reference points for learning’, suggested the intervention was more appropriate for qualified staff than students. The third suggested participants valued the ‘peer learning and engagement’ they gained in the interactive group workshop. The fourth, ‘opportunities to tailor learning’, suggested the coaching session was an opportunity to personalise the workshop material.
Authors - Judith Johnson, Jane Arezina, Liz Tomlin, Siobhan Alt*, Jon Arnold, Sarah Bailey, Hannah Beety, Ruth Bender-Atik, Louise Bryant, Jen Coates, Sam Collinge, Jo Fishburn, Jane Fisher, Jan Fowler, Tracey Glanville, Julian Hallett, Ailith Harley-Roberts, Ailith Harley-Roberts, Gill Harrison, Karen Horwood, Catriona Hynes, Lindsay Kimm, Alison McGuinness, Lucy Potter, Liane Powell, Janelle Ramsay, Pieta Shakes, Roxanne Sicklen, Alexander Sims, Tomasina Stacey, Anushka Sumra, Samantha Thomas, Karen Todd, Jacquie Torrington, Rebecca Trueman, Lorraine Walsh, Katherine Watkins, Gill Yaz, Natasha K Hardicre
https://journals.sagepub.com/doi/10.1177/1742271X20935911
Abstract
Background
Studies indicate there is a need to improve the delivery of unexpected news via obstetric ultrasound, but there have been few advances in this area. One factor preventing improvement has been a lack of consensus regarding the appropriate phrases and behaviours which sonographers and ultrasound practitioners should use in these situations.
Aims
To develop consensus guidelines for unexpected news delivery in Early Pregnancy Unit and Fetal Anomaly Screening Programme NHS settings.
Methods
A workshop was conducted to identify priorities and reach consensus on areas of contention. Contributors included interdisciplinary healthcare professionals, policy experts, representatives from third-sector organisations, lay experts and academic researchers (n = 28). Written and verbal feedback was used to draft initial guidance which was then circulated amongst the wider writing group (n = 39). Revisions were undertaken until consensus was reached.
Results
Consensus guidelines were developed outlining the behaviours and phrases which should be used during scans where unexpected findings are identified. Specific recommendations included that: honest and clear communication should be prioritised, even with uncertain findings; technical terms should be used, but these should be written down together with their lay interpretations; unless expectant parents use other terminology (e.g. ‘foetus’), the term ‘baby’ should be used as a default, even in early pregnancy; at the initial news disclosure, communication should focus on information provision. Expectant parents should not be asked to make decisions during the scan.
Conclusions
These recommendations can be used to develop and improve news delivery interventions in obstetric ultrasound settings. The full guidelines can be accessed online as supplemental material and at https://doi.org/10.5518/100/24.
Authors - Kristian G. Hudson, Rebecca Lawton & Siobhan Hugh-Jones
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4942-z
Abstract
Background
Preventing the onset of poor mental health in adolescence is an international public health priority. Universal, whole school preventative approaches are valued for their reach, and anti-stigmatising and resilience building principles. Mindfulness approaches to well-being have the potential to be effective when delivered as a whole school approach for both young people and staff. However, despite growing demand, there is little understanding of possible and optimal ways to implement a mindfulness, whole school approach (M-WSA) to well-being. This study aimed to identify the determinants of early implementation success of a M-WSA. We tested the capacity of the Consolidated Framework for Implementation Research (CFIR), to capture the determinants of the implementation of a mental health intervention in a school setting.
Methods
Key members of school staff (n = 15) from five UK secondary schools attempting to implement a M-WSA were interviewed at two-time points, 6 months apart, generating a total of 30 interviews. Interviews explored participants’ attitudes, beliefs and experiences around implementing a M-WSA. Interview data were coded as CFIR constructs or other (non CFIR) factors affecting implementation. We also mapped school-reported implementation activity and perceived success over 30 months.
Results
The CFIR captured the implementation activities and challenges well, with 74% of CFIR constructs identifiable in the dataset. Of the 38 CFIR constructs, 11 appeared to distinguish between high and low implementation schools. The most essential construct was school leadership. It strongly distinguished between high and low implementation schools and appeared inter-related with many other distinguishing constructs. Other strongly distinguishing constructs included relative priority, networks and communications, formally appointed implementation leaders, knowledge and beliefs about the intervention, and executing.
Conclusions
Our findings suggest key implementation constructs that schools, commissioners and policy makers should focus on to promote successful early implementation of mental health programs. School leadership is a key construct to target at the outset. The CFIR appears useful for assessing the implementation of mental health programs in UK secondary schools.
Authors - Raabia Sattar, Judith Johnson, Clin, Rebecca Lawton PhD
https://onlinelibrary.wiley.com/doi/10.1111/hex.13029
Abstract
Objective
To synthesize the literature on the views and experiences of patients/family members and health-care professionals (HCPs) on the disclosure of adverse events.
Methods
Systematic review of qualitative studies. Searches were conducted in MEDLINE, Embase, PubMed, CINAHL and PsycINFO. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Qualitative data were analysed using a meta-ethnographic approach, comprising reciprocal syntheses of ‘patient’ and ‘health-care professional’ studies, combined to form a lines-of-argument synthesis embodying both perspectives.
Results
Fifteen studies were included in the final syntheses. The results highlighted that there is a difference in attitudes and expectations between patients and HCPs regarding the disclosure conversation. Patients/family members expressed a need for information, the importance of sincere regret and a promise of improvement. However, HCPs faced several barriers, which hindered appropriate disclosure practices. These included difficulty of disclosure in a blame culture, avoidance of litigation, lack of skills on how to conduct disclosure and inconsistent guidance. A lines-of-argument synthesis is presented that identified both the key elements of an ideal disclosure desired by patients and the facilitators for HCPs, which can increase the likelihood of this taking place.
Conclusions
Although patients/family members and HCPs both advocate disclosure, several barriers prevent HCPs from conducting disclosure effectively. Both groups have different needs for disclosure. To meet patients’ requirements, training on disclosure for HCPs and the development of an open, transparent culture within organizations are potential areas for intervention.
Authors - Siobhan Kathleen McHugh, Rebecca Lawton, Jane Kathryn O'Hara, Laura Sheard
https://qualitysafety.bmj.com/content/29/8/672
Abstract
Background Teamwork and communication are recognised as key contributors to safe and high-quality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information.
Objective
To systematically review articles that describe the use of team reflexivity in interprofessional hospital-based healthcare teams.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams.
The review
includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles’ eligibility was validated by two second reviewers (5%).
Results
Fifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone.
Conclusion
The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems.
2019
Authors - Judith Johnson, Tmam Abdulaziz Al-Ghunaim, Chandra Shekhar Biyani, Anthony Montgomery, Roland Morley & Daryl B. O’Connor
https://link.springer.com/article/10.1007/s12262-021-03047-y
Abstract
Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.
Authors - Gemma Louch, Caroline Reynolds, Sally Moore, Claire Marsh, Jane Heyhoe, Abigail Albutt, Rebecca Lawton
https://bmjopen.bmj.com/content/9/11/e031355
Abstract
Objectives There is growing evidence that patients can provide feedback on the safety of their care. The 44-item Patient Measure of Safety (PMOS) was developed for this purpose. While valid and reliable, the length of this questionnaire makes it potentially challenging for routine use. Our study aimed to produce revised, shortened versions of PMOS (PMOS-30 and PMOS-10), which retained the psychometric properties of the longer version.
Participants
To produce a shortened diagnostic measure, we analysed data from 2002 patients who completed PMOS-44, and examined the reliability of the revised measure (PMOS-30) in a sample of 751 patients. To produce a brief standalone measure, we again analysed data from 2002 patients who completed PMOS-44, and tested the reliability and validity of the brief standalone measure (PMOS-10) in a sample of 165 patients.
Methods
The process of shortening the questionnaire involved a combination of secondary data analysis (eg, Standard Deviation and inter-item correlations) and a consensus group exercise to produce PMOS-30 and examine face validity. Analysis of PMOS-30 data examined reliability (eg, Cronbach’s alpha). Further secondary data analysis (ie, corrected item-total correlations) produced PMOS-10, and primary data collection assessed its reliability and validity (eg, Cronbach’s alpha, analysis of variance).
Results
Fourteen items were removed to produce PMOS-30 and the percentage of negatively worded items was reduced from 57% to 33%. PMOS-30 demonstrated good internal reliability (α=0.89). The 10 items with the highest corrected item-total correlations across both PMOS-44 and PMOS-30 composed PMOS-10. PMOS-10 had good internal reliability (α=0.79), demonstrated convergent validity; however, discriminant validity was not established.
Conclusions
Two revised, shortened versions of the original PMOS-44 (PMOS-30 and PMOS-10) were produced to capture patient feedback about safety in hospital. The measures demonstrated good reliability and validity, and preserved the psychometric properties of the original measure.
Authors - Lesley Hughes, Laura Sheard, Lisa Pinkney, Rebecca L Lawton
https://journals.sagepub.com/doi/10.1177/1355819619867350
Abstract
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.