Cultures for improving patient safety through learning: the role of teamwork.

Improvements in patient safety result primarily from organisational and individual learning. This paper discusses the learning that can take place within organisations and the cultural change necessary to encourage it. It focuses on teams and team leaders as potentially powerful forces for bringing about the management of patient safety and better quality of care.

Leadership and the quality of care.

The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produced.

The effect of 1-year rotations on stress in preregistration house officers.

A comparison of stress levels in preregistration house officers demonstrated lower levels in those completing 1-year rotations compared with those completing 6-month posts in two different hospitals. One-year rotations provide a more stable environment, allow new doctors to become familiar with the workings of an organization from several viewpoints and permit a better sense of working within a multiprofessional team than the traditional arrangements.

Interventions to improve physicians' well-being and patient care.

Concerns about the quality of medical care provided by health services appear to be increasing. Deficits in care are frequently found to be associated with stress and with the apparent lack of recognition of psychological problems when they occur in doctors. This paper looks briefly at the levels and sources of stress, depression and alcoholism in doctors, and the relationship of these to the care they provide.

New stressors, new remedies.

This paper looks at the stressors prominent in the workplace at the end of the 20th century--increases in workload, falls in social support, uncertainty and violence. It considers some of the pressures that have created these stressors and some of the interventions used to combat them; for example, better teamworking, different management style, an emphasis on quality, a more accurate analysis of the burgeoning costs of stress to organizations, and an increasing appreciation that parental stress affects children negatively and so makes our future society more at risk. It considers the rising emphasis on the individual role in stress, and on the increase in counselling services.