背景:有毒的工作文化有助于医护人员的倦怠和减员,但很少有人知道医疗保健组织如何系统地创造和促进文明和合议的文化。
目的:分析作为系统化死亡率回顾调查的一部分收集的同伴对同伴的积极反馈,以确定可以为积极的组织文化变革提供信息的主题和认可动态。
方法:融合混合方法研究设计。
方法:共有388名医生,212名注册护士,64个高级实践提供商,4家非营利性医院(2家学术和2家社区)的1名呼吸治疗师。
方法:在死亡率回顾调查中提供可选的积极反馈。
方法:从正反馈数据中出现的关键主题和次主题,关键主题与积极反馈受访者特征之间的关联,以及积极反馈受访者和接受者之间的认可动态。
结果:大约20%的医护人员提供了积极的反馈。在免费文本评论的回答中出现了三个关键主题:(1)提供非凡的患者和以家庭为中心的护理;(2)表现出自负和精通;(3)表现出同理同伴支持和有效的团队合作。与其他专业相比,来自医学的最积极反馈(70.2%),神经病学(65.2%),临终关怀及姑息治疗(64.3%),手术(58.8%)专注于提供以患者和家庭为中心的非凡护理(p=0.02),而急诊医学(59.1%)的评论主要集中在证明自我占有和掌握(p=0.06)。注册护士(40.2%)比医院中其他临床医生类型更频繁地提供多方向正反馈(p<0.001)。
结论:对来自死亡率审查调查的积极反馈的分析提供了对卫生系统团队合作文化的有意义的见解,以及在提供临终关怀时与文明和合作有关的价值观。系统收集和分享积极的反馈是可行的,并有可能促进积极的文化变革和改善医护人员的福祉。
BACKGROUND: Toxic work culture contributes to healthcare worker burnout and attrition, but little is known about how healthcare organizations can systematically create and promote a culture of civility and collegiality.
OBJECTIVE: To analyze peer-to-peer positive feedback collected as part of a systematized mortality review survey to identify themes and recognition dynamics that can inform positive organizational culture change.
METHODS: Convergent mixed-methods study design.
METHODS: A total of 388 physicians, 212 registered nurses, 64 advanced practice providers, and 1 respiratory therapist at four non-profit hospitals (2 academic and 2 community).
METHODS: Providing optional positive feedback in the mortality review survey.
METHODS: Key themes and subthemes that emerged from positive feedback data, associations between key themes and positive feedback respondent characteristics, and recognition dynamics between positive feedback respondents and recipients.
RESULTS: Approximately 20% of healthcare workers provided positive feedback. Three key themes emerged among responses with free text comments: (1) providing extraordinary patient and family-centered care; (2) demonstrating self-possession and mastery; and (3) exhibiting empathic peer support and effective team collaboration. Compared to other specialties, most positive feedback from medicine (70.2%), neurology (65.2%), hospice and palliative medicine (64.3%), and surgery (58.8%) focused on providing extraordinary patient and family-centered care (p = 0.02), whereas emergency medicine (59.1%) comments predominantly focused on demonstrating self-possession and mastery (p = 0.06). Registered nurses (40.2%) provided multidirectional positive feedback more often than other clinician types in the hospital hierarchy (p < 0.001).
CONCLUSIONS: Analysis of positive feedback from a mortality review survey provided meaningful insights into a health system\'s culture of teamwork and values related to civility and collegiality when providing end-of-life care. Systematic collection and sharing of positive feedback is feasible and has the potential to promote positive culture change and improve healthcare worker well-being.