patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention - collaborative learning tables

by:ITATOUCH     2020-03-23
patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention  -  collaborative learning tables
Despite growing interest in attracting patients and families (P/F)
In patient safety education, little is known about how P/F contributes most.
We evaluated the feasibility and acceptability of patient-teacher medical error disclosure and preventive training models.
Methods we developed an educational intervention that brought together professional, inter-professional clinicians from the hospital advisory committee and P/F to discuss false disclosure and prevention.
Patient focus groups and orientation sessions inform the Curriculum and Evaluation Design. A pre-
Post-survey using qualitative and quantitative questions to assess P/F and clinicians experience and attitude towards cooperative safety education, including participants' hopes, fears, perceived values and challenges of learning experience.
Open Response
Coding the end problem according to the principle of content analysis.
Results P/F and clinicians would like to know each other's views, communication skills and patient empowerment strategies.
Prior to the intervention, both groups were concerned that power dynamics would inhibit effective interaction.
Clinicians are concerned that P/F will understand their fallibility, while P/F is concerned about the clinician's terminology and defensive posture.
After the workshop, clinicians value direct feedback from patients, communication strategies for false disclosure, and a "real" learning experience.
P/F appreciates the clinician's accountability and insights into how medical errors affect clinicians.
Half of the participants did not find any challenges, and the rest of the clinicians cited the emotion and magnitude of "cultural change", while P/F commented on medical terminology and a desire for more time.
Valuable experience has been discovered by patients and clinicians.
Advice was provided on how to develop a patient teacher program in terms of patient safety.
Conclusion in terms of patient safety, the educational model of treating patients as teachers and learners working with clinicians is feasible and is valued by clinicians and P/F and is expected to be achieved
Focus on medical error disclosure and prevention training.
Background despite growing interest in attracting patients and families (P/F)
In patient safety education, little is known about how P/F contributes most.
We evaluated the feasibility and acceptability of patient-teacher medical error disclosure and preventive training models.
Methods we developed an educational intervention that brought together professional, inter-professional clinicians from the hospital advisory committee and P/F to discuss false disclosure and prevention.
Patient focus groups and orientation sessions inform the Curriculum and Evaluation Design. A pre-
Post-survey using qualitative and quantitative questions to assess P/F and clinicians experience and attitude towards cooperative safety education, including participants' hopes, fears, perceived values and challenges of learning experience.
Open Response
Coding the end problem according to the principle of content analysis.
Results P/F and clinicians would like to know each other's views, communication skills and patient empowerment strategies.
Prior to the intervention, both groups were concerned that power dynamics would inhibit effective interaction.
Clinicians are concerned that P/F will understand their fallibility, while P/F is concerned about the clinician's terminology and defensive posture.
After the workshop, clinicians value direct feedback from patients, communication strategies for false disclosure, and a "real" learning experience.
P/F appreciates the clinician's accountability and insights into how medical errors affect clinicians.
Half of the participants did not find any challenges, and the rest of the clinicians cited the emotion and magnitude of "cultural change", while P/F commented on medical terminology and a desire for more time.
Valuable experience has been discovered by patients and clinicians.
Advice was provided on how to develop a patient teacher program in terms of patient safety.
Conclusion in terms of patient safety, the educational model of treating patients as teachers and learners working with clinicians is feasible and is valued by clinicians and P/F and is expected to be achieved
Focus on medical error disclosure and prevention training.
Not just the workshop, but the whole process.
The focus group and the preparation meeting asked us questions that we had never asked before. —
Patient and Family participation (PFE)
More and more attention has been paid to safety work.
Patients are encouraged to participate in safety6-8 by 1-5 major organizations, and some patients are actively engaging with clinicians as safety partners.
9-11 although P/F members are increasingly serving as consultants to the quality improvement committee and regularly investigate the patient experience after the 13 th hospital stay, this intervention may not be able to effectively bring to patients and their families (P/F)
Voice for front-line care services.
In terms of medical error disclosure training, PFE may be particularly important, as patients are less satisfied with this conversation than doctors after a harmful event occurs.
15 ensuring that P/F voices are heard in disclosure training can help clinicians better prepare for meeting P/F needs at such fragile times.
16, 17 healthcare organizations can learn from patients' input into adverse events to gain a more comprehensive understanding of events, 18-23, and a better understanding of P/F after harmful events
4, 24, 25 effectively integrate P/F into safety work, and may also enable them to speak out the issues of concern.
In order to achieve meaningful PFE, some experts advocated the invitation of P/F as a teacher and co-designer of the education initiative.
28 training programmes on medical error disclosure are rapidly spreading in USA29-31 and other countries.
32 however, there is still a lack of opportunities for patients and providers to come together to reflect and participate in collaborative learning in patient safety communication.
33, 34 few people know the potential role of patients as teachers, helping clinicians develop relationships and communication skills when things go wrong, what risks may PFE pose to clinician's patient safety education.
Similarly, if patients observe few problems in care, train them as safety advocates, and patients rarely have the opportunity to develop and practice skills that enable them to speak for themselves or their loved ones in a healthcare environment.
27 to address these gaps, we have developed a new solution
Teacher of patient safety '(Patient TIPS)
, To participate in a collaborative learning experience with a member of the P/F.
The intervention is mainly focused on developing more patients.
Provide clinicians with communication skills centered on medical error disclosure.
It also addresses working more effectively with patients to prevent errors by supporting P/F to speak out concerns.
The aim of this study was to evaluate the feasibility and acceptability of patient cue collaborative learning patterns for P/F and clinicians.
Because we anticipate that clinicians, patients and organizations may have reservations about bringing P/F and clinicians together to talk about medical errors, we focus on understanding the potential benefits of this educational intervention
We expect that understanding of these factors can inform strategies that improve educational efficiency, mitigate any possible concerns, and thus facilitate wider programme implementation.
We address the following research questions: is it feasible to involve P/F and an inter-professional clinician in a cooperative learning program for medical error disclosure and prevention?
Specifically: Are P/F and clinicians willing to attend?
Would it be comfortable for each group discussion to discuss medical errors with another group?
What are the programming features required to create a safe space for a collaborative discussion between clinicians and P/F on medical error communication?
What are the benefits and risks of this intervention?
What is the value of P/F learning found by clinicians?
What are they worried about?
What is the value of P/F for clinicians learning?
What are they worried about?
Methods in this study, a combination of qualitative and quantitative methods was used to explore participants' experiences and perspectives on educational intervention in four stages, each involving P/F directly (figure 1).
During the exploration phase, we discussed with P/F at the patient and family Advisory Board (PFAC)
Describe the program and receive feedback for the meeting.
These guided discussions serve as focus groups (FG)
Learn more about the design of the course, including the content of the course and the promotion strategy.
The preparation phase includes a briefing session (OS)
With volunteer P/F, prepare for the workshop.
During the implementation phase, we conducted practical educational interventions involving P/F.
The evaluation phase included pre-and post-intervention surveys of P/F and clinicians, as well as debriefing of the workshop.
Further details of the course design, as well as the features of the exploration, preparation and implementation phases, can be found in the online Supplementary Appendix.
Download figureOpen in the new tabDownload powerpoint Figure 1 for the patient prompt stage and the roadmap for P/F participation in each step.
P/F for patients and family members;
Patient tip, patient-
A patient and safe teacher.
Supplementary Appendix [bmjqs-2015-
Appendix 004292 p. pdf]
Educational intervention because conversations about medical errors are personal and emotional challenges involving taking risks among stakeholders across the medical level, we use two conceptual frameworks to design our education1)
Relationship learning 34, 35 (
Supplementary Appendix 1 online)and (2)
Projects to enhance relationship and communication skills (PERCS)
It has been used since 2002 to help clinicians from different professions improve their relationship and communication skills to meet the challenges of difficult conversations in a variety of healthcare settings.
Psychological safety promotes safe spaces for interpersonal adventure, 41-43, and organizational learning.
44-46 in order to further create an educational environment in which P/F feels safe to speak and take on the teaching role, we have engaged P/F as stakeholders throughout the course design, implementation and evaluation process from the start.
Between 2012 and 2013, three workshops were held in two academic medical centers in a row.
We plan to hold 3 workshops each for 20-25 learners.
We set the goal of recruiting 15 P/F members (
P/F) strive for 20%-25% participation
A precedent based on the proportion of pediatric palliative care education interventions involving parents who have lost their loved ones.
There is one at the 47, 48 4 hour seminar
Conduct in-depth simulation of medical error disclosure based on case developed by education team and invite input from P/F
Professional actors play the role of P/F members and clinicians play their own role.
49 upon each enactment, briefings were heard immediately, including actors, clinicians, P/F, and presenters.
Throughout the workshop, P/F also shared their own experiences at will.
These workshops include several other interactive sections involving P/F and clinicians (
Figure 1 and online Supplementary Appendix).
The host includes doctors, psychosocial and family faculty of practicing professionals and educators.
Participants we recruited a purposeful sample of P/F interested in patient security and clinicians to attend the workshop.
P/F of PFACs of the two hospitals presented the patient prompt plan at the PFAC meeting and volunteered to participate.
To expose clinicians to a wide range of P/F experiences when discussing error disclosure and prevention, we did not limit our sample to P/F
Report errors.
P/F participating in the workshop participated in the previous orientation session focusing on the principles of cooperative learning (
Figure 1 and online Supplementary Appendix).
In addition to workshop participants, all P/F of a PFAC were invited to complete the baseline survey to gain a broader understanding of the patient's attitude towards collaborative learning of medical errors.
Doctors, nurse managers, social workers, medical translators, and other health care personnel are invited to attend a seminar by e-mail for hospital safety and professional leadership in two academic hospitals, which provides a brief introduction to the program.
To ensure that clinicians and P/F do not have an existing relationship prior to the workshop, the list of participants was shared before training.
The survey design baseline and post-intervention surveys were designed according to the opinions of P/F participants.
We include P/F at this stage as part of our commitment to integrate P/F throughout the project, so, our measure of programme impact will also reflect P/F values and priorities.
The questionnaire was based on a previously published PERCS survey of 35 and 36 years old and adjusted according to the patient prompt format and research objectives.
The pilot version of the survey was developed by doctors.
Researchers with expertise in patient safety, patient engagement and ethics are advised by social workers and P/F delegates.
P/F and the clinician representative reviewed its content and ease of understanding and subsequently finalized after P/F feedback at the first orientation meeting.
Solving Research Problems 1 (feasibility)
, We included a project on cooperative learning attitudes and asked about the comfort of participants attending the workshop.
For research question 2, we discuss the benefits and risks of participation.
The pre-investigation questions include: "You want (
P/F or clinician)?
And "What concerns do you have about learning (
P/F or clinician)?
The problems after the investigation include: "Learning (
Patient/family member or clinician)?
And "What is the most difficult thing to learn (
P/F or clinician)?
"Quantity items include yes/no and 5-point Likert-Scale problem.
P/F and clinicians were investigated separately but in parallel.
Do a paper survey before the workshop or online through the Survey Monkey.
Questionnaires were conducted at the end of each workshop.
We use descriptive statistics to analyze quantitative data.
Four open-
To close the question, we created a database of all replies with a total of 282 words, usually one or less (
Pre-intervention quote A1-
180, quote B1-after intervention-B102).
Encode the reply according to the standard principle of content analysis.
50 data for P/F and clinicians are individually coded and divided into each open subject areaended question.
After reviewing all the data, the two research team members developed coding categories and discussed them over and over again to reach a consensus.
It was first coded by a doctor.
Researchers and educators who are familiar with the patient prompt teaching method, but do not attend the seminar, the second is a doctor
Fellows attending all seminars.
Areas of disagreement were discussed before consensus was reached.
This study was exempted by the Institutional Review Committee of our hospital.
Educational intervention because conversations about medical errors are personal and emotional challenges involving taking risks among stakeholders across the medical level, we use two conceptual frameworks to design our education1)
Relationship learning 34, 35 (
Supplementary Appendix 1 online)and (2)
Projects to enhance relationship and communication skills (PERCS)
It has been used since 2002 to help clinicians from different professions improve their relationship and communication skills to meet the challenges of difficult conversations in a variety of healthcare settings.
Psychological safety promotes safe spaces for interpersonal adventure, 41-43, and organizational learning.
44-46 in order to further create an educational environment in which P/F feels safe to speak and take on the teaching role, we have engaged P/F as stakeholders throughout the course design, implementation and evaluation process from the start.
Between 2012 and 2013, three workshops were held in two academic medical centers in a row.
We plan to hold 3 workshops each for 20-25 learners.
We set the goal of recruiting 15 P/F members (
P/F) strive for 20%-25% participation
A precedent based on the proportion of pediatric palliative care education interventions involving parents who have lost their loved ones.
There is one at the 47, 48 4 hour seminar
Conduct in-depth simulation of medical error disclosure based on case developed by education team and invite input from P/F
Professional actors play the role of P/F members and clinicians play their own role.
49 upon each enactment, briefings were heard immediately, including actors, clinicians, P/F, and presenters.
Throughout the workshop, P/F also shared their own experiences at will.
These workshops include several other interactive sections involving P/F and clinicians (
Figure 1 and online Supplementary Appendix).
The host includes doctors, psychosocial and family faculty of practicing professionals and educators.
Participants we recruited a purposeful sample of P/F interested in patient security and clinicians to attend the workshop.
P/F of PFACs of the two hospitals presented the patient prompt plan at the PFAC meeting and volunteered to participate.
To expose clinicians to a wide range of P/F experiences when discussing error disclosure and prevention, we did not limit our sample to P/F
Report errors.
P/F participating in the workshop participated in the previous orientation session focusing on the principles of cooperative learning (
Figure 1 and online Supplementary Appendix).
In addition to workshop participants, all P/F of a PFAC were invited to complete the baseline survey to gain a broader understanding of the patient's attitude towards collaborative learning of medical errors.
Doctors, nurse managers, social workers, medical translators, and other health care personnel are invited to attend a seminar by e-mail for hospital safety and professional leadership in two academic hospitals, which provides a brief introduction to the program.
To ensure that clinicians and P/F do not have an existing relationship prior to the workshop, the list of participants was shared before training.
The survey design baseline and post-intervention surveys were designed according to the opinions of P/F participants.
We include P/F at this stage as part of our commitment to integrate P/F throughout the project, so, our measure of programme impact will also reflect P/F values and priorities.
The questionnaire was based on a previously published PERCS survey of 35 and 36 years old and adjusted according to the patient prompt format and research objectives.
The pilot version of the survey was developed by doctors.
Researchers with expertise in patient safety, patient engagement and ethics are advised by social workers and P/F delegates.
P/F and the clinician representative reviewed its content and ease of understanding and subsequently finalized after P/F feedback at the first orientation meeting.
Solving Research Problems 1 (feasibility)
, We included a project on cooperative learning attitudes and asked about the comfort of participants attending the workshop.
For research question 2, we discuss the benefits and risks of participation.
The pre-investigation questions include: "You want (
P/F or clinician)?
And "What concerns do you have about learning (
P/F or clinician)?
The problems after the investigation include: "Learning (
Patient/family member or clinician)?
And "What is the most difficult thing to learn (
P/F or clinician)?
"Quantity items include yes/no and 5-point Likert-Scale problem.
P/F and clinicians were investigated separately but in parallel.
Do a paper survey before the workshop or online through the Survey Monkey.
Questionnaires were conducted at the end of each workshop.
We use descriptive statistics to analyze quantitative data.
Four open-
To close the question, we created a database of all replies with a total of 282 words, usually one or less (
Pre-intervention quote A1-
180, quote B1-after intervention-B102).
Encode the reply according to the standard principle of content analysis.
50 data for P/F and clinicians are individually coded and divided into each open subject areaended question.
After reviewing all the data, the two research team members developed coding categories and discussed them over and over again to reach a consensus.
It was first coded by a doctor.
Researchers and educators who are familiar with the patient prompt teaching method, but do not attend the seminar, the second is a doctor
Fellows attending all seminars.
Areas of disagreement were discussed before consensus was reached.
This study was exempted by the Institutional Review Committee of our hospital.
Patient tips for resultshypothesis and acceptability collaborative learning modelBaseline data collected 53/55 (96%)
Clinicians and 71/88 involved (81%)of P/F (
Including PFAC members who continue to participate in the workshop and those who do not voluntarily participate in the programme).
The experience of clinicians ranges from 1 to 42 years.
Of all P/F members, 36% reported that they had experienced medical errors in the past.
48% of them said medical errors were disclosed to them.
A total of 18 PFAC members and 55 clinicians moved forward as volunteers for the program.
All 55 clinicians and 9 P/F personnel completed the workshop, and about 15%-20% of learners at each meeting were composed of P/F, close to our goal.
Due to scheduling conflicts or diseases, we ended up with fewer patients attending the workshop than expected;
Several patients were canceled just before the seminar.
The features of clinicians and P/F involved in baseline and post-workshop surveys are shown in Table 1.
View this table: View the inline View pop-up table 1 features of clinicians participating in baseline and baseline post-seminar surveys and P/F, almost all responding clinicians (98%, 52/53)and P/F (94%, 61/65)
I think it is a good idea to cooperate with the learning model.
84% after the workshop (42/50)
It is reported that they feel comfortable discussing mistakes with patients.
Again, 100% (9/9)
The P/F that completed the training reported discussing the wrong comfort with the clinician.
The program features required to create a safe space for cooperative learning are used in the program design, including course content and promotion strategies (table 2).
For example, based on the discussion of FG and OS, P/F gives priority to understanding why clinicians want to attend the workshop, which allows us to include a discussion and survey assessment of what individuals want to learn.
They also highlighted concerns about seating arrangements and power dynamics that echo the qualitative thematic analysis of survey data.
View this table: View the inline View popupTable2 insights from the focus group and the impact of the potential risks of collaborative learning models on the risk and benefits of course adaptation: before the workshop, concerns and challenges from participants asked about their concerns about the educational model, and about half of clinicians were not worried.
The people in the report mentioned two issues most often.
They are concerned that power dynamics may limit effective interaction with P/F: "People don't say what they really feel based on the person in the room or [it]
In many cases of conflict, the opposite direction becomes very tense. ” (A87)
They are also worried that patients will learn about the doctor's fallibility and that P/F "will lose confidence in [their]provider [or]
Other nursing staff. ” (A92)
While clinicians usually focus on the potential hazards of P/F by understanding the defects in the medical system, some also point out that, it's easy for them themselves to "hear the way we hurt and/or let down while taking care of them ". ” (A69)
About half of the people in P/F did not report any issues.
Some P/F expressed an understanding of the medical hierarchy and were concerned that the clinician's defensive posture was an obstacle to open communication and an opportunity to learn from P/F.
I am concerned that due to the patient's involvement, health care providers are not free to speak openly with their colleagues as if they were showing and had to "perform.
While it is theoretically good to have the idea input by the patient, it may be challenging to create a judgment --
Free Zone in reality.
This requires very specific, flexible, honest, confident individuals who are clear communicators and are very strong in their roles. (A148)
Some people are concerned about the adverse effects of power dynamics, such as the P/F gap in medical knowledge, which may make P/F feel excluded or disrespectful: "I hope they won't use too many medical terms, and they won't
Participants trained in medicine” (A154)
After the training, half of clinicians reported that it was difficult to discuss communication with patients related to errors.
Other clinicians find it challenging to deal with emotions arising from the P/F experience, such as "their harm to the medical industry and potential distrust ",(B52)
"Anger and distrust
It may be worth it. ” (B70)
Several clinicians have gained insight into the shortcomings of the health care system, as well as the huge task of triggering change, believing that "there is no simple repair and a lot of culture --
Family needs to change-centered care. ” (B84)
Clinicians also acknowledge that, to some extent, meaningful changes in collaboration with P/F will require a level playing field, given, "P/F for clinicians, lack of strength or great power difference. ” (B72)
Nevertheless, when asked what is most surprising about the learning experience shared, clinicians most often say, "This can be done. ” (B85)
Like clinicians, about half of P/F reports that it is difficult to learn medical errors with clinicians.
Some commented on the challenges of medical terminology and they will benefit from longer workshops.
P/F reports some of the surprises of sharing learning experience, but it's nice to see how much clinicians are happy to work with P/F
They point out that while patients may be nervous about participation, this experience can be transformative.
Potential benefits: prior to training, the clinician's answer revealed three themes, and the value of collaborative learning specifically asked what they wanted to learn from patients.
First of all, their goal is to better understand the patient's point of view and express interest in learning "what the receiving end may look like (A61)
Wrong disclosure, and "[how]patients]
Our medical professionals. ” (A33)
Clinicians want to understand the concerns of patients, "listen to their feedback ",(A55)
Their concerns and assumptions
In a typical encounter in the office, this situation may still not be explained. ” (A18)
Second, clinicians are interested in learning how to communicate best after harmful events. “[I hope to be]
Hear from patients and family that they believe effective and compassionate communication. ” (A59)
Finally, clinicians give priority to understanding the patient authorization strategy: "[
Hope to know about it
What problems exist that prevent or restrict their active participation in care and decision-making ,"(A32)
"What can suppliers do . . . . . . [to]
Create a positive experience [for patients]. ” (A62)
Regarding what P/F would like to learn from clinicians, P/F is often interested in "how providers think. ” (A108)
They are interested in how clinicians handle medical errors at an individual and organizational level, for example, citing "what clinicians have experienced in medical errors "(A4)
What is the policy in this case.
They asked "how to follow the security agreement to prevent errors, what are the procedures disclosed to patients and family when errors occur. ” (A120)
P/F believes that a better understanding of the clinician's point of view can help better prepare P/F if things go wrong.
Second, P/F is interested in specific advice on strategies to communicate with clinicians and how they can better work with clinicians in terms of safety :[
I want to learn
To prevent/minimize medical errors, ask questions to health care professionals ,[and]
I minimize the role in the error. (A115)
Finally, they would like clinicians to hear P/F publicly and would like to know how to involve clinicians in learning from patients :[
I hope the clinician
Recognize the power of working with patients.
They are willing to be seen as people who make mistakes easily.
They believe that building an honest relationship with the patients they care about is critical to the good outcome of the patient's illness. (A105)
After the seminar, almost all (96%, 48/50)
Clinicians report that P/F participation is valuable for their learning, independent of professional or years of clinical experience (data not shown). All (100%, 9/9)
Patients agree that the participation of clinicians is valuable for their learning.
When asked what is valuable, clinicians usually emphasize three aspects.
First, they reported new insights into the patient's point of view.
They attach great importance to the opportunity to receive patient feedback, as well as a new space to listen to P/F members in ways that are more difficult to obtain in regular clinical contact.
Some clinicians have pointed out that by learning with patients, they have a greater understanding of their role as a patient.
Somehow, even though we are patients at some point, as health care workers, we often lose our ability to see things as patients in theoretical or even real situations.
It reminds us of their point of view when they are there. (B26)
Second, clinicians say patient engagement helps them better understand effective communication strategies in challenging conversations.
The importance of trust and honesty "(B7)
Stressed.
Some clinicians point out that P/F "takes time to process-we go too fast. ” (B75)
In the same way, clinicians attach importance to understanding [patients’]take-
Key points of conversation [were]” (B12)
To measure how well they communicate with P/F and understand that they think what they say is not necessarily what the patient hears.
Finally, clinicians emphasize the value of the "real" learning experience by discussing with P/F The real emotions triggered by medical errors and "discuss [ing]
Areas of mutual vulnerability. ” (B45)
They pointed out that by increasing the moral urgency of learning with patients, the power of simulation has been expanded, and the workshop has a "truly transparent atmosphere ",(B32)
Let them imagine and practice their response in an actual clinical setting.
The P/F response after the workshop also highlighted three themes.
First of all, P/F values the sense of responsibility to experience clinicians after medical errors: "How do they view their responsibility and how do they view stakeholders in a different way. ” (B87)
Second, they highlighted the new understanding of the experience of medical errors by clinicians, especially the impact of medical errors on emotions; “How [clinicians]
When a medical error occurred in one of their patients, I never heard the medical staff admit the feeling. ” (B90)
Finally, patients and family members welcome "[Clinical doctor
Honesty and self
Reflection, and the sharing of the two. ” (B88)
A summary of the topics of P/F and clinicians views on potential risks and benefits is shown in Table 3.
View this table: View the potential risks and benefits of collaborative learning in inline View pop-up Table 3: clinicians and P/F topics (
Show shadow areas of exploratory data)
Feasibility and acceptability of collecting baseline data for patient cue collaborative learning models from 53/55 (96%)
Clinicians and 71/88 involved (81%)of P/F (
Including PFAC members who continue to participate in the workshop and those who do not voluntarily participate in the programme).
The experience of clinicians ranges from 1 to 42 years.
Of all P/F members, 36% reported that they had experienced medical errors in the past.
48% of them said medical errors were disclosed to them.
A total of 18 PFAC members and 55 clinicians moved forward as volunteers for the program.
All 55 clinicians and 9 P/F personnel completed the workshop, and about 15%-20% of learners at each meeting were composed of P/F, close to our goal.
Due to scheduling conflicts or diseases, we ended up with fewer patients attending the workshop than expected;
Several patients were canceled just before the seminar.
The features of clinicians and P/F involved in baseline and post-workshop surveys are shown in Table 1.
View this table: View the inline View pop-up table 1 features of clinicians participating in baseline and baseline post-seminar surveys and P/F, almost all responding clinicians (98%, 52/53)and P/F (94%, 61/65)
I think it is a good idea to cooperate with the learning model.
84% after the workshop (42/50)
It is reported that they feel comfortable discussing mistakes with patients.
Again, 100% (9/9)
The P/F that completed the training reported discussing the wrong comfort with the clinician.
The program features required to create a safe space for cooperative learning are used in the program design, including course content and promotion strategies (table 2).
For example, based on the discussion of FG and OS, P/F gives priority to understanding why clinicians want to attend the workshop, which allows us to include a discussion and survey assessment of what individuals want to learn.
They also highlighted concerns about seating arrangements and power dynamics that echo the qualitative thematic analysis of survey data.
View this table: View the inline View popupTable2 insights from the focus group and the impact of the potential risks of collaborative learning models on the risk and benefits of course adaptation: before the workshop, concerns and challenges from participants asked about their concerns about the educational model, and about half of clinicians were not worried.
The people in the report mentioned two issues most often.
They are concerned that power dynamics may limit effective interaction with P/F: "People don't say what they really feel based on the person in the room or [it]
In many cases of conflict, the opposite direction becomes very tense. ” (A87)
They are also worried that patients will learn about the doctor's fallibility and that P/F "will lose confidence in [their]provider [or]
Other nursing staff. ” (A92)
While clinicians usually focus on the potential hazards of P/F by understanding the defects in the medical system, some also point out that, it's easy for them themselves to "hear the way we hurt and/or let down while taking care of them ". ” (A69)
About half of the people in P/F did not report any issues.
Some P/F expressed an understanding of the medical hierarchy and were concerned that the clinician's defensive posture was an obstacle to open communication and an opportunity to learn from P/F.
I am concerned that due to the patient's involvement, health care providers are not free to speak openly with their colleagues as if they were showing and had to "perform.
While it is theoretically good to have the idea input by the patient, it may be challenging to create a judgment --
Free Zone in reality.
This requires very specific, flexible, honest, confident individuals who are clear communicators and are very strong in their roles. (A148)
Some people are concerned about the adverse effects of power dynamics, such as the P/F gap in medical knowledge, which may make P/F feel excluded or disrespectful: "I hope they won't use too many medical terms, and they won't
Participants trained in medicine” (A154)
After the training, half of clinicians reported that it was difficult to discuss communication with patients related to errors.
Other clinicians find it challenging to deal with emotions arising from the P/F experience, such as "their harm to the medical industry and potential distrust ",(B52)
"Anger and distrust
It may be worth it. ” (B70)
Several clinicians have gained insight into the shortcomings of the health care system, as well as the huge task of triggering change, believing that "there is no simple repair and a lot of culture --
Family needs to change-centered care. ” (B84)
Clinicians also acknowledge that, to some extent, meaningful changes in collaboration with P/F will require a level playing field, given, "P/F for clinicians, lack of strength or great power difference. ” (B72)
Nevertheless, when asked what is most surprising about the learning experience shared, clinicians most often say, "This can be done. ” (B85)
Like clinicians, about half of P/F reports that it is difficult to learn medical errors with clinicians.
Some commented on the challenges of medical terminology and they will benefit from longer workshops.
P/F reports some of the surprises of sharing learning experience, but it's nice to see how much clinicians are happy to work with P/F
They point out that while patients may be nervous about participation, this experience can be transformative.
Potential benefits: prior to training, the clinician's answer revealed three themes, and the value of collaborative learning specifically asked what they wanted to learn from patients.
First of all, their goal is to better understand the patient's point of view and express interest in learning "what the receiving end may look like (A61)
Wrong disclosure, and "[how]patients]
Our medical professionals. ” (A33)
Clinicians want to understand the concerns of patients, "listen to their feedback ",(A55)
Their concerns and assumptions
In a typical encounter in the office, this situation may still not be explained. ” (A18)
Second, clinicians are interested in learning how to communicate best after harmful events. “[I hope to be]
Hear from patients and family that they believe effective and compassionate communication. ” (A59)
Finally, clinicians give priority to understanding the patient authorization strategy: "[
Hope to know about it
What problems exist that prevent or restrict their active participation in care and decision-making ,"(A32)
"What can suppliers do . . . . . . [to]
Create a positive experience [for patients]. ” (A62)
Regarding what P/F would like to learn from clinicians, P/F is often interested in "how providers think. ” (A108)
They are interested in how clinicians handle medical errors at an individual and organizational level, for example, citing "what clinicians have experienced in medical errors "(A4)
What is the policy in this case.
They asked "how to follow the security agreement to prevent errors, what are the procedures disclosed to patients and family when errors occur. ” (A120)
P/F believes that a better understanding of the clinician's point of view can help better prepare P/F if things go wrong.
Second, P/F is interested in specific advice on strategies to communicate with clinicians and how they can better work with clinicians in terms of safety :[
I want to learn
To prevent/minimize medical errors, ask questions to health care professionals ,[and]
I minimize the role in the error. (A115)
Finally, they would like clinicians to hear P/F publicly and would like to know how to involve clinicians in learning from patients :[
I hope the clinician
Recognize the power of working with patients.
They are willing to be seen as people who make mistakes easily.
They believe that building an honest relationship with the patients they care about is critical to the good outcome of the patient's illness. (A105)
After the seminar, almost all (96%, 48/50)
Clinicians report that P/F participation is valuable for their learning, independent of professional or years of clinical experience (data not shown). All (100%, 9/9)
Patients agree that the participation of clinicians is valuable for their learning.
When asked what is valuable, clinicians usually emphasize three aspects.
First, they reported new insights into the patient's point of view.
They attach great importance to the opportunity to receive patient feedback, as well as a new space to listen to P/F members in ways that are more difficult to obtain in regular clinical contact.
Some clinicians have pointed out that by learning with patients, they have a greater understanding of their role as a patient.
Somehow, even though we are patients at some point, as health care workers, we often lose our ability to see things as patients in theoretical or even real situations.
It reminds us of their point of view when they are there. (B26)
Second, clinicians say patient engagement helps them better understand effective communication strategies in challenging conversations.
The importance of trust and honesty "(B7)
Stressed.
Some clinicians point out that P/F "takes time to process-we go too fast. ” (B75)
In the same way, clinicians attach importance to understanding [patients’]take-
Key points of conversation [were]” (B12)
To measure how well they communicate with P/F and understand that they think what they say is not necessarily what the patient hears.
Finally, clinicians emphasize the value of the "real" learning experience by discussing with P/F The real emotions triggered by medical errors and "discuss [ing]
Areas of mutual vulnerability. ” (B45)
They pointed out that by increasing the moral urgency of learning with patients, the power of simulation has been expanded, and the workshop has a "truly transparent atmosphere ",(B32)
Let them imagine and practice their response in an actual clinical setting.
The P/F response after the workshop also highlighted three themes.
First of all, P/F values the sense of responsibility to experience clinicians after medical errors: "How do they view their responsibility and how do they view stakeholders in a different way. ” (B87)
Second, they highlighted the new understanding of the experience of medical errors by clinicians, especially the impact of medical errors on emotions; “How [clinicians]
When a medical error occurred in one of their patients, I never heard the medical staff admit the feeling. ” (B90)
Finally, patients and family members welcome "[Clinical doctor
Honesty and self
Reflection, and the sharing of the two. ” (B88)
A summary of the topics of P/F and clinicians views on potential risks and benefits is shown in Table 3.
View this table: View the potential risks and benefits of collaborative learning in inline View pop-up Table 3: clinicians and P/F topics (
Show shadow areas of exploratory data)
Potential risks: prior to the workshop, concerns and challenges from participants asked about their concerns about the educational model, with about half of clinicians not worried.
The people in the report mentioned two issues most often.
They are concerned that power dynamics may limit effective interaction with P/F: "People don't say what they really feel based on the person in the room or [it]
In many cases of conflict, the opposite direction becomes very tense. ” (A87)
They are also worried that patients will learn about the doctor's fallibility and that P/F "will lose confidence in [their]provider [or]
Other nursing staff. ” (A92)
While clinicians usually focus on the potential hazards of P/F by understanding the defects in the medical system, some also point out that, it's easy for them themselves to "hear the way we hurt and/or let down while taking care of them ". ” (A69)
About half of the people in P/F did not report any issues.
Some P/F expressed an understanding of the medical hierarchy and were concerned that the clinician's defensive posture was an obstacle to open communication and an opportunity to learn from P/F.
I am concerned that due to the patient's involvement, health care providers are not free to speak openly with their colleagues as if they were showing and had to "perform.
While it is theoretically good to have the idea input by the patient, it may be challenging to create a judgment --
Free Zone in reality.
This requires very specific, flexible, honest, confident individuals who are clear communicators and are very strong in their roles. (A148)
Some people are concerned about the adverse effects of power dynamics, such as the P/F gap in medical knowledge, which may make P/F feel excluded or disrespectful: "I hope they won't use too many medical terms, and they won't
Participants trained in medicine” (A154)
After the training, half of clinicians reported that it was difficult to discuss communication with patients related to errors.
Other clinicians find it challenging to deal with emotions arising from the P/F experience, such as "their harm to the medical industry and potential distrust ",(B52)
"Anger and distrust
It may be worth it. ” (B70)
Several clinicians have gained insight into the shortcomings of the health care system, as well as the huge task of triggering change, believing that "there is no simple repair and a lot of culture --
Family needs to change-centered care. ” (B84)
Clinicians also acknowledge that, to some extent, meaningful changes in collaboration with P/F will require a level playing field, given, "P/F for clinicians, lack of strength or great power difference. ” (B72)
Nevertheless, when asked what is most surprising about the learning experience shared, clinicians most often say, "This can be done. ” (B85)
Like clinicians, about half of P/F reports that it is difficult to learn medical errors with clinicians.
Some commented on the challenges of medical terminology and they will benefit from longer workshops.
P/F reports some of the surprises of sharing learning experience, but it's nice to see how much clinicians are happy to work with P/F
They point out that while patients may be nervous about participation, this experience can be transformative.
Potential benefits: prior to training, the clinician's answer revealed three themes, and the value of collaborative learning specifically asked what they wanted to learn from patients.
First of all, their goal is to better understand the patient's point of view and express interest in learning "what the receiving end may look like (A61)
Wrong disclosure, and "[how]patients]
Our medical professionals. ” (A33)
Clinicians want to understand the concerns of patients, "listen to their feedback ",(A55)
Their concerns and assumptions
In a typical encounter in the office, this situation may still not be explained. ” (A18)
Second, clinicians are interested in learning how to communicate best after harmful events. “[I hope to be]
Hear from patients and family that they believe effective and compassionate communication. ” (A59)
Finally, clinicians give priority to understanding the patient authorization strategy: "[
Hope to know about it
What problems exist that prevent or restrict their active participation in care and decision-making ,"(A32)
"What can suppliers do . . . . . . [to]
Create a positive experience [for patients]. ” (A62)
Regarding what P/F would like to learn from clinicians, P/F is often interested in "how providers think. ” (A108)
They are interested in how clinicians handle medical errors at an individual and organizational level, for example, citing "what clinicians have experienced in medical errors "(A4)
What is the policy in this case.
They asked "how to follow the security agreement to prevent errors, what are the procedures disclosed to patients and family when errors occur. ” (A120)
P/F believes that a better understanding of the clinician's point of view can help better prepare P/F if things go wrong.
Second, P/F is interested in specific advice on strategies to communicate with clinicians and how they can better work with clinicians in terms of safety :[
I want to learn
To prevent/minimize medical errors, ask questions to health care professionals ,[and]
I minimize the role in the error. (A115)
Finally, they would like clinicians to hear P/F publicly and would like to know how to involve clinicians in learning from patients :[
I hope the clinician
Recognize the power of working with patients.
They are willing to be seen as people who make mistakes easily.
They believe that building an honest relationship with the patients they care about is critical to the good outcome of the patient's illness. (A105)
After the seminar, almost all (96%, 48/50)
Clinicians report that P/F participation is valuable for their learning, independent of professional or years of clinical experience (data not shown). All (100%, 9/9)
Patients agree that the participation of clinicians is valuable for their learning.
When asked what is valuable, clinicians usually emphasize three aspects.
First, they reported new insights into the patient's point of view.
They attach great importance to the opportunity to receive patient feedback, as well as a new space to listen to P/F members in ways that are more difficult to obtain in regular clinical contact.
Some clinicians have pointed out that by learning with patients, they have a greater understanding of their role as a patient.
Somehow, even though we are patients at some point, as health care workers, we often lose our ability to see things as patients in theoretical or even real situations.
It reminds us of their point of view when they are there. (B26)
Second, clinicians say patient engagement helps them better understand effective communication strategies in challenging conversations.
The importance of trust and honesty "(B7)
Stressed.
Some clinicians point out that P/F "takes time to process-we go too fast. ” (B75)
In the same way, clinicians attach importance to understanding [patients’]take-
Key points of conversation [were]” (B12)
To measure how well they communicate with P/F and understand that they think what they say is not necessarily what the patient hears.
Finally, clinicians emphasize the value of the "real" learning experience by discussing with P/F The real emotions triggered by medical errors and "discuss [ing]
Areas of mutual vulnerability. ” (B45)
They pointed out that by increasing the moral urgency of learning with patients, the power of simulation has been expanded, and the workshop has a "truly transparent atmosphere ",(B32)
Let them imagine and practice their response in an actual clinical setting.
The P/F response after the workshop also highlighted three themes.
First of all, P/F values the sense of responsibility to experience clinicians after medical errors: "How do they view their responsibility and how do they view stakeholders in a different way. ” (B87)
Second, they highlighted the new understanding of the experience of medical errors by clinicians, especially the impact of medical errors on emotions; “How [clinicians]
When a medical error occurred in one of their patients, I never heard the medical staff admit the feeling. ” (B90)
Finally, patients and family members welcome "[Clinical doctor
Honesty and self
Reflection, and the sharing of the two. ” (B88)
A summary of the topics of P/F and clinicians views on potential risks and benefits is shown in Table 3.
View this table: View the potential risks and benefits of collaborative learning in inline View pop-up Table 3: clinicians and P/F topics (
Show shadow areas of exploratory data)
Discussion we found that it was feasible and acceptable for participants to bring P/F together with an inter-professional clinician to learn about medical error disclosure and prevention.
Almost all P/F and clinicians feel comfortable discussing mistakes with each other and find learning experience valuable, independent of professional or years of clinical experience.
Engaging P/F in programme design and evaluation strategies as early as possible in a comprehensive way can help shape the patient's expected role as a teacher and involve P/F in the programme as a stakeholder.
In the potential benefits, we are impressed by the similarity between the P/F and the clinician's "hope" learning agenda.
Prior to their involvement, both groups independently gave priority to better understanding of each other's views, understanding specific communication strategies for improving safety and misdisclosure, and empowering patients as safety advocates --
Emphasize the consistency of the course in the shared learning experience.
While clinicians are concerned about exposing their own fallibility, patients do want clinicians to be willing to be seen as "fallibility", highlighting the power of the program to challenge assumptions.
Clinicians pay special attention to direct patient feedback, which is found to be rare in routine practice.
These P/F reviews are one of the most powerful "teaching Moms" in our workshop.
At the same time, P/F finds a window into the world of clinicians to better understand how to engage with the health care system and its professionals.
Clinicians and P/F were most surprised at "what can be done", which challenged educators to integrate P/F more deeply in medical error disclosure and preventive education.
Creating opportunities for P/F and clinicians to better understand each other may be critical to improving patient safety.
Our study highlighted the activation of P/F and clinicians and suggested P/F-
As advocated by experts, education-centered 28 can have a strong impact on learners (
Watch supplementary videos online 1).
The patient cue model provides a tangible way to involve P/F in the design and delivery of safety education.
This may be a particularly useful strategy as communication and solutions are disseminated in the United States and globally, with leaders from 30-32 countries and regions seeking to clearly demonstrate partnership with P/F.
The focus of the study was on the link between collaborative learning strategies and outcomes, including changes in communication behaviour between P/F and clinicians and institutional safety culture or safety outputs.
Supplementary Video]bmjqs-2015-
004292support _ video. mp4]
Our findings extend the work of exploring patient roles before.
Educators aged 52-55 studied P/F and clinician experience in collaborative learning patterns through qualitative depth.
In a previous controlled intervention study, physicians who used patient statements to train patient safety 55 did not show obvious benefits in terms of patient safety attitudes and produced positive and negative responses from physicians.
Although P/F data are limited, previous studies on standardized patients (SP)
Some potential problems and pressures of SPs were also noted.
56. while clinicians in our study commented on possible negative emotions associated with error-prone, we were surprised to find that patients in our study paid little attention to negative emotions triggered by training, benefits were reported in both groups.
This may be due to the extensive preparation of P/F or their relative experience as a member of the PFAC, or the voluntary nature of participation.
We chose to develop teaching seminar cases and share them with P/F before the meeting in case any scenario is too close to their own experience and too emotional.
While the additional safeguards for P/F are important as they enter the conference in a traditionally more fragile role, our findings and other findings suggest that clinicians may struggle with emotions 55, it may also benefit from advanced preparation and support.
PFE in safety education: what can be learned from the patient prompt experience?
As we reflect on our experience, the success of the programme stems from the following:
In-depth preparation, serious advancement during the workshop, and strong institutional support for new approaches to patient engagement, medical error disclosure, and improved patient safety.
Integrating insights and lessons learned, we advise educators and innovators who are considering patient cue models (table 4).
Working with the institutional PFAC is a great way to identify volunteer patients who have gone through the PFAC selection process.
Despite the high motivation of P/F, we experienced more cancellations than expected due to scheduling conflicts or illness.
Planning with the back
The P/F candidate may help to offset these events.
A facilitator with strong skills to upgrade the traditional level-
It is worth noting that in our study both clinicians and patients consider this a potential barrier --
It is necessary to create a safe learning environment.
While each group regards power dynamics as an issue, none of them are described as learning challenges after course intervention, suggesting that the establishment of basic rules for shared learning plays an important role.
47 The moderator should also acknowledge the underlying emotions that arise for P/F and clinicians during the training period.
Finally, institutional support is critical, and adjusting educational content to reflect local disclosure practices and policies is a necessary condition for clinicians to purchase
Effective results.
At the same time, as we have seen in our research, participation may accelerate the drive for cultural change in suppliers, institutional leaders may seek ways to best use this potential by supporting these advocates and patients in new ways of participating in safety.
View this table: View the inline View pop-up table 4 recommended research restrictions for educators and innovators who support the development of patient tips programs include voluntary participation.
Thus, it is possible to have a selective bias towards individuals with patient safety, participation and false disclosure awareness.
Similarly, PFAC members may activate more patients than the public representative;
However, PFACs has become a clinician to develop quality improvement programs and design patients-
Take the course as the center.
Participants are recruited from two academic centres and the views that may be represented do not reflect the views of other organizations.
The small sample size of P/F that completed the training also limited the study.
However, we share these qualitative data, please note that patient and family views often echo the topic of collaborative learning by clinicians, it was also consistent with the results of baseline surveys in larger P/F groups.
PFE in safety education: what can be learned from the patient prompt experience?
As we reflect on our experience, the success of the programme stems from the following:
In-depth preparation, serious advancement during the workshop, and strong institutional support for new approaches to patient engagement, medical error disclosure, and improved patient safety.
Integrating insights and lessons learned, we advise educators and innovators who are considering patient cue models (table 4).
Working with the institutional PFAC is a great way to identify volunteer patients who have gone through the PFAC selection process.
Despite the high motivation of P/F, we experienced more cancellations than expected due to scheduling conflicts or illness.
Planning with the back
The P/F candidate may help to offset these events.
A facilitator with strong skills to upgrade the traditional level-
It is worth noting that in our study both clinicians and patients consider this a potential barrier --
It is necessary to create a safe learning environment.
While each group regards power dynamics as an issue, none of them are described as learning challenges after course intervention, suggesting that the establishment of basic rules for shared learning plays an important role.
47 The moderator should also acknowledge the underlying emotions that arise for P/F and clinicians during the training period.
Finally, institutional support is critical, and adjusting educational content to reflect local disclosure practices and policies is a necessary condition for clinicians to purchase
Effective results.
At the same time, as we have seen in our research, participation may accelerate the drive for cultural change in suppliers, institutional leaders may seek ways to best use this potential by supporting these advocates and patients in new ways of participating in safety.
View this table: View the inline View pop-up table 4 recommended research restrictions for educators and innovators who support the development of patient tips programs include voluntary participation.
Thus, it is possible to have a selective bias towards individuals with patient safety, participation and false disclosure awareness.
Similarly, PFAC members may activate more patients than the public representative;
However, PFACs has become a clinician to develop quality improvement programs and design patients-
Take the course as the center.
Participants are recruited from two academic centres and the views that may be represented do not reflect the views of other organizations.
The small sample size of P/F that completed the training also limited the study.
However, we share these qualitative data, please note that patient and family views often echo the topic of collaborative learning by clinicians, it was also consistent with the results of baseline surveys in larger P/F groups. ConclusionP/F-
Centralized communication after harmful events requires understanding of the P/F perspective.
In medical education, the participation of patients and families needs to be more strongly reflected to support clinicians who have the ability to provide care in an era of transparency.
Patients-teachers can help first-line clinicians learn "first-
From their experience, patients can also learn from clinicians how to better work together safely, which they cannot get in a regular health care setting.
Shared Learning between P/F and clinicians can enhance the safety of P/F, provide clinicians with more in-depth sensitivity and insight into the P/F perspective, and enhance P/F
The authors thank patients, family members and clinicians involved in the patient tip program for sharing their insights (
Watch supplementary videos online 1).
They also thank Beth Israel ess Medical Center and the patient and family advisory board of the Cambridge health union, the Massachusetts union for communication and resolution after medical injury, Pat Folcarelli RN, Dr. Erica Dente Irina Premack-
Sandl
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