Supporting the pursuit of professionalism during a crisis.

Background: Crisis plans for healthcare organisations most often focus on operational needs including staffing, supplies and physical plant needs. Less attention is focused on how leaders can support and encourage individual clinical team members to conduct themselves as professionals during a crisis.

Methods: This qualitative study analysed observations from 79 leaders at 160 hospitals that participate in two national professionalism programmes who shared their observations in focus group discussions about what they believed were the essential elements of leading and addressing professional accountability during a crisis.

Professionalism of Admitting and Consulting Services and Trauma Patient Outcomes.

Objective: To determine whether trauma patients managed by an admitting or consulting service with a high proportion of physicians exhibiting patterns of unprofessional behaviors are at greater risk of complications or death.

Summary Background Data: Trauma care requires high-functioning interdisciplinary teams where professionalism, particularly modeling respect and communicating effectively, is essential.

Methods: This retrospective cohort study used data from 9 level I trauma centers that participated in a national trauma registry linked with data from a national database of unsolicited patient complaints.

Initiative for Prevention and Early Identification of Delirium in Medical-Surgical Units: Lessons Learned in the Past Five Years.

Background: Delirium is an acute change in mental status affecting 10%-64% of hospitalized patients, and may be preventable in 30%-40% of cases. In October 2013, a task force for delirium prevention and early identification in medical-surgical units was formed at our hospital. We studied whether our standardized protocol prevented delirium among high-risk patients.

Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients.

Importance: For surgical teams, high reliability and optimal performance depend on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may undermine a culture of safety, threaten teamwork, and thereby increase the risk for medical errors and surgical complications.

Objective: To test the hypothesis that patients of surgeons with higher numbers of reports from coworkers about unprofessional behaviors are at greater risk for postoperative complications than patients whose surgeons generate fewer coworker reports.

Patient vs provider perspectives of 30-day hospital readmissions.

Objective: To compare patients' and providers' views on contributors to 30-day hospital readmissions.

Design: Analysis of a qualitative interview survey between 18 May-30 June 2015.

Setting: Interviews were conducted during the 30-day readmission hospitalisation at a single tertiary care academic hospital.

A long-term follow-up of a physician leadership program.

Purpose Physician leadership programs serve to develop individual capabilities and to affect organizational outcomes. Evaluations of such programs often focus solely on short-term increases in individual capabilities. The purpose of this paper is to assess long-term individual and organizational outcomes of the Stanford Leadership Development Program.

Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training, Prevention, and Remediation.

Purpose: Physician disrespectful behavior affects quality of care, patient safety, and collaborative clinical team function. Evidence defining the demographics, ethnography, and epidemiology of disrespectful behavior is lacking.

Method: The authors conducted a retrospective analysis of reports of disrespectful physician behavior at Stanford Hospital and Clinics from March 2011 through February 2015.

Use of Unsolicited Patient Observations to Identify Surgeons With Increased Risk for Postoperative Complications.

Importance: Unsolicited patient observations are associated with risk of medical malpractice claims. Because lawsuits may be triggered by an unexpected adverse outcome superimposed on a strained patient-physician relationship, a question remains as to whether behaviors that generate patient dissatisfaction might also contribute to the genesis of adverse outcomes themselves.

Objective: To examine whether patients of surgeons with a history of higher numbers of unsolicited patient observations are at greater risk for postoperative complications than patients whose surgeons generate fewer such unsolicited patient observations.

Designing a physician leadership development program based on effective models of physician education.

Background: Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management.

Purpose: The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance.

Surgical Comanagement by Hospitalists Improves Patient Outcomes: A Propensity Score Analysis.

Objective: The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution.

Background: Prior studies may have underestimated the impact of SCM due to methodological shortcomings.

Methods: This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695).

Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach.

Background: The Agency for Healthcare Research and Quality has adopted iatrogenic pneumothorax (IAP) as a Patient Safety Indicator. In 2006, in response to a low performance ranking for IAP rate from the University Healthsystem Consortium (UHC), the authors established a multidisciplinary team to reduce our institution's IAP rate. Root-cause analysis found that subclavian insertion of central venous catheterization (CVC) was the most common procedure associated with IAP OBJECTIVE: Our short-term goal was a 50% reduction of both CVC-associated and all-cause IAP rates within 18 months, with long-term goals of sustained reduction.

Assigning a team-based pager for on-call physicians reduces paging errors in a large academic hospital.

As complexity of care of hospitalized patients has increased, the need for communication and collaboration among members of the team caring for the patient has become increasingly important. This often takes the form of a nurse's need to contact a patient's physician to discuss some aspect of care and modify treatment plans. Errors in communication delay care and can pose risk to patients.

Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient-Centered Representation.

Background: A growing body of evidence suggests that patient (including family) feedback can provide compelling opportunities for developing risk management and quality improvement strategies, as well as improving customer satisfaction. The Patient Representative Department (PRD) at Stanford Health Care (SHC) (Stanford, California) created a streamlined patient complaint capture and resolution process to improve the capture of patient complaints and grievances from multiple parts of the organization and manage them in a centralized database.

Methods: In March 2008 the PRD rolled out a data management system for tracking patient complaints and generating reports to SHC leadership, and SHC needed to modify and address its data input procedures.

Improving and sustaining core measure performance through effective accountability of clinical microsystems in an academic medical center.

Background: Evidence-based performance measures, known as core measures, have been established by The Joint Commission to improve the quality of care for patient populations, such as those with acute myocardial infarction (AMI), heart failure, and community-acquired pneumonia (CAP), as well as to improve the quality of surgical care--the Surgical Care Improvement Project (SCIP) measures. Hospital administrators have traditionally held academic and community physicians and hospital clinicians accountable for integrating the core measures into daily practice. Such efforts have often led to suboptimal results because of the belief that the "organization" (macrosystem) is the appropriate level at which to work to improve quality.

A new instrument to measure appropriateness of services in primary care.

Objective: To develop a new instrument for judging the appropriateness of three key services (new prescription, diagnostic test, and referral) as delivered in primary care outpatient visits.

Design: Candidate items were generated by a seven-member expert panel, using a five-step nominal technique, for each of three service categories in primary care: new prescriptions, diagnostic tests, and referrals. Expert panelists and a convenience sample of 95 community-based primary care physicians ranked items for (i) importance and (ii) feasibility of ascertaining from a typical office chart record.

The Midpeninsula Health Service: action research using small primary care groups to provide evidence-based medicine that empowers patients while continuously improving quality and lowering costs.

Objectives: A Joint Planning Committee Report was issued in 1974 exploring how Stanford University might itself provide primary care to students, faculty, employees and their dependents at low cost. The report called for the creation of a health maintenance organization owned by its subscribers in affiliation with Stanford Medical Center. However, because the report was dismissed by the dean of the School of Medicine as being unworkable, the Midpeninsula Health Service (MHS) began operating as an unaffiliated, nonprofit health plan in downtown Palo Alto in January 1976.