James W Pichert

James W Pichert
Vanderbilt University VUMC

Doctor of Philosophy

About

176
Publications
20,975
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
7,663
Citations

Publications

Publications (176)
Article
Full-text available
Background High reliability in health care requires a balance between intentionally designed systems and individual professional accountability. One element of accountability includes a process for addressing clinicians whose practices are associated with a disproportionate share of patient complaints. This study aimed to evaluate the impact of the...
Article
Context A decline in the number of physician-scientists has been identified in the United States for at least two decades. Although many mechanisms have been proposed to reverse this trend, most of these have concentrated on MD/PhD programs, research in subspecialty fellowships, and other approaches later in physician training. Few have emphasized...
Article
Objectives: In this pilot study, we developed and tested an online educational module for the purpose of teaching optimal shared decision making (SDM) behaviors for physicians in training. We hypothesized that those who received this intervention would show significant improvement in SDM behaviors afterward as compared with those who had not recei...
Article
Introduction: Patient reports of unprofessional conduct by surgeons have been linked to outcomes of care, most notably in terms of post-procedure complications and increased risk for malpractice claims.While patient complaints may focus on communication, accessibility, rudeness, and care outcomes, coworkers are also positioned to observe and repor...
Article
Introduction: Unsolicited patient complaints (UPCs) about surgeons correlate with surgical complications and malpractice claims. Analysis of UPCs in orthopedics is limited. Methods: Patient complaint reports recorded at 36 medical centers between January 1, 2015 and December 31, 2018 were coded using a previously validated coding algorithm Patie...
Article
Full-text available
BACKGROUND Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the distributions and types of UPCs associated with oncologists by specialty and assessed oncologist characteristics associated with UPCs. METHODS This retrospective study reviewe...
Article
OBJECTIVE The number of unsolicited patient complaints (UPCs) about surgeons correlates with surgical complications and malpractice claims. Using a large, national patient complaint database, the authors sought to do the following: 1) compare the rates of UPCs for neurosurgeons to those for other physicians, 2) analyze the risk of UPCs with individ...
Chapter
Committed leadership, effective planning and teamwork, and reliable implementation are essential elements of successful healthcare initiatives, clinical outcomes, and research endeavors. Lapses in professional conduct at any level may undermine the teamwork necessary to achieve goals in safety and outcomes. Therefore, Academic Medical Center (AMC)...
Article
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...
Article
Objectives: To analyze unsolicited patient complaints (UPCs) among otolaryngologists, identify risk factors for UPCs, and determine the impact of physician feedback on subsequent UPCs. Methods: This retrospective study reviewed UPCs associated with US otolaryngologists from 140 medical practices from 2014 to 2017. A subset of otolaryngologists w...
Article
Full-text available
Objectives: Determine whether words contained in unsolicited patient complaints differentiate physicians with and without neurocognitive disorders (NCD). Methods: We conducted a nested case-control study using data from 144 healthcare organizations that participate in the Patient Advocacy Reporting System program. Cases (physicians with probable...
Article
Objectives: The aims of the study were to develop a valid and reliable taxonomy of coworker reports of alleged unprofessional behavior by physicians and advanced practice professionals and determine the prevalence of reports describing particular types of unprofessional conduct. Methods: We conducted qualitative content analysis of coworker repo...
Article
Importance Understanding the distribution of patient complaints by physician age may provide insight into common patient concerns characteristic of early, middle, and late stages of careers in ophthalmology. Most previous studies of patient dissatisfaction have not addressed the association with physician age or controlled for other characteristics...
Article
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 a...
Article
Purpose Previous research shows associations between patient complaints and urologic subspecialty, but relationships between complaints and practice environments are untested. This study explored whether associations exist between the types and rates of patient complaints filed against urologic surgeons and their practice environments, defined as “...
Article
Background: Health care team members are well positioned to observe disrespectful and unsafe conduct-behaviors known to undermine team function. Based on experience in sharing patient complaints with physicians who subsequently achieved decreased complaints and malpractice risk, Vanderbilt University Medical Center developed and assessed the feasi...
Chapter
Dedicated leadership, effective planning and teamwork, and reliable implementation are essential elements of successful healthcare initiatives, clinical outcomes and research endeavors. Lapses in professional conduct at any level may undermine the teamwork necessary to achieve goals in safety and outcomes. Therefore, Academic Medical Center (AMC) l...
Article
Purpose The number of unsolicited patient complaints about a physician has been shown to correlate with increased malpractice risk. Using a large national patient complaint database, we evaluated the number and content of unsolicited patient complaints about ophthalmologists to identify significant risk factors for receiving a complaint. Design Re...
Article
Full-text available
When patients and families observe and report their healthcare experiences, they can play important roles in promoting safety and improving quality. This chapter begins with the case of a busy, well regarded medical professional associated with a patient complaint. The complaint is a means by which patients and families can be “safety promoters”. W...
Article
One factor that affects surgical team performance is unprofessional behavior exhibited by the surgeon, which may be observed by patients and families and reported to health care organizations in the form of spontaneous complaints. The objective of this study was to assess the relationship between patient complaints and adverse surgical outcomes. A...
Article
Unsolicited patient complaints (UPCs) serve as a powerful predictor of increased risk of malpractice claims, and reductions in UPCs, through targeted physician interventions, lower incidence of lawsuits and decrease cost of risk management. We analyzed UPCs, verified by trained counselors in patient relations, to determine the malpractice risk of p...
Article
Patients and their families are well positioned to partner with health care organizations to help identify unsafe and dissatisfying behaviors and performance. A peer messenger process was designed by the Center for Professional and Patient Advocacy at Vanderbilt University Medical Center (Nashville, Tennessee) to address "high-risk" physicians iden...
Article
Background: Anesthesiology groups continually seek data sources and evaluation metrics for ongoing professional practice evaluation, credentialing, and other quality initiatives. The analysis of patient complaints associated with physicians has been previously shown to be a marker for patient dissatisfaction and a predictor of malpractice claims....
Article
Disruptive (“non-teamwork-promoting”) behavior by medical professionals undermines healthcare quality and a culture of safety, decreases staff morale, increases healthcare expense and increases litigation risk. Despite these untoward outcomes, disruptive behavior, defined as any performance that impacts the team's ability to achieve intended outcom...
Article
Effective teamwork is critical to successful outcomes in pediatric cardiac surgery. Unfortunately, lapses in professional performance and conduct by those who treat pediatric cardiac patients pose threats to quality and safety. One hallmark of a profession is self regulation. Therefore, healthcare leaders need specific means for identifying and add...
Article
Background: Nursing professionals are confronted with situations where adverse events (AEs) or errors occur, and communication and disclosure principles are required to manage these challenging situations ethically and effectively. We adapted and taught hospital cardiovascular nurses an established program at Vanderbilt for training “the how and wh...
Article
Trauma surgery is perceived to have high malpractice risk. Unsolicited patient complaints (UPCs) can predict increased malpractice risk. An ex ante analysis of UPCs was performed to determine the risk profile for trauma surgeons compared with nontrauma surgeons. UPCs from 14 health systems over 4 years were retrospectively studied. Surgeons were di...
Article
Background: Service recovery refers to an organizations entire process for facilitating resolution of dissatisfactions, whether or not visible to patients and families. Patients are an important resource for reporting miscommunications, provider inattention, rudeness, or delays, especially if they perceive a connection to misdiagnosis or failed tr...
Article
Patient complaints are associated with physician risk management experience, including medical malpractice claims risk, and small proportions of physicians account for disproportionate shares of claims. We investigated whether patient complaint experience differs among urologists, and whether urological subspecialists generate distinct quantities a...
Chapter
Full-text available
Patients can help promote safety and reduce risk in several ways. One is to make known their concerns about their health care experiences because complaints might suggest unsafe systems and providers. Responsive health care organizations can benefit since patient complaints that are recorded, systematically analyzed, aggregated, and profiled by omb...
Article
Vanderbilt University School of Medicine (VUSM) employs several strategies for teaching professionalism. This article, however, reviews VUSM's alternative, complementary approach: identifying, measuring, and addressing unprofessional behaviors. The key to this alternative approach is a supportive infrastructure that includes VUSM leadership's commi...
Article
Disparities in depression care remain an important problem in the United States. Action inquiry technologies may assist individuals and communities in their attempts to reduce or eliminate these disparities--and the multiple factors contributing to them--through a recurring cycle of planning, action, evaluation, and new actions based on reflections...
Article
Full-text available
We report a retrospective analysis of 84 consecutive pediatrics-related internal review files opened by a medical center's risk managers between 1996 and 2001. The aims were to identify common causative factors associated with adverse events/adverse outcomes (AEs) in a Pediatrics Department, then suggest ways to improve care. The main outcome was i...
Article
Nurses increasingly use telephonic assessment and counseling to manage clients with a variety of chronic illnesses. This article describes a study designed to assess a group of telephonic nurse disease managers' teaching and adherence promotion skills during actual patient interactions. Nurse care managers showed improvements after training in four...
Article
To study the association between physicians' complaint records and their risk management experiences in a regional healthcare center. Patient complaints about physicians in a large border state medical center's hospital and outpatient clinics were recorded and coded. The study period was from January 2001 through December 2003. These records were l...
Article
The Nashville REACH 2010 project is funded by the Centers for Disease Control and Prevention to reduce health disparities in diabetes and heart disease among African Americans in Nashville, Tenn. While Tennessee has the third highest smoking rate (26.1%) in the United States, there are few appropriate local data useful for planning and evaluating l...
Article
Research supports the potential effectiveness of health programs offered through African American churches, but pastors are often unprepared to assess the value of and help their congregations adopt such programs. This article summarizes how Nashville REACH 2010 addressed these issues via a "Faith and Health" course offered by the American Baptist...
Article
Full-text available
Patient complaints are associated with increased malpractice risk but it is unclear if complaints might be associated with medical complications. The purpose of this study was to determine whether an association exists between patient complaints and surgical complications. A retrospective analysis of 16,713 surgical admissions was conducted over a...
Article
Full-text available
Diabetes is a common disease with self-management a key aspect of care. Large prospective trials have shown that maintaining glycated hemoglobin less than 7% greatly reduces complications but translating this level of control into everyday clinical practice can be difficult. Intensive improvement programs are successful in attaining control in pati...
Article
Full-text available
Identifying the etiologies of real or perceived adverse clinical events and undesired outcomes is an important step in improving patient safety and reducing malpractice risks. Systematic analysis of obstetrics and gynecology-related risk management files allows a more complete examination of ways that human and systems factors may contribute to adv...
Article
Objectives: Identifying the etiologies of adverse outcomes is an important first step in improving patient safety and reducing malpractice risks. However, relatively little is known about the causes of emergency department-related adverse outcomes. The objective was to describe a method for identification of common causes of adverse outcomes in an...
Article
This pilot study's purpose was to evaluate behavioral changes among medical directors and physicians following CME on risk management in long-term care (LTC) facilities. The setting was a satellite conference at the AGS Meeting Symposium 2000. CME participants included 51 medical directors, attending physicians, and nurses. Evaluations were based o...
Article
Full-text available
In order to gain a better understanding of diabetes-related health disparities, Nashville REACH 2010 conducted a community baseline survey on health status. A total of 3204 randomly selected African-American (AA) and Caucasian (C) residents of North Nashville, and a comparison sample of residents living in Nashville/Davidson County were interviewed...
Article
Diabetes education has largely been accepted in diabetes care. The effect of diabetes education on glycemic control and the components of education responsible for such an effect are uncertain. We performed a meta-analysis of randomized controlled trials of diabetes patient education published between 1990 and December 2000 to quantitatively assess...
Article
To systematically identify and describe common obstacles to medication adherence (i.e., compliance) for patients with glaucoma. A prospective case series of structured interviews were conducted with 48 patients with glaucoma. The subjects' responses were recorded verbatim on interview forms as well as recorded on audiotapes. Situational obstacles t...
Article
To review all admissions (age > 13) to three surgical patient care centers at a single academic medical center between January 1, 1995, and December 6, 1999, for significant surgical adverse events. Little data exist on the interrelationships between surgical adverse events, risk management, malpractice claims, and resulting indemnity payments to p...
Article
A decline in the number of physician-scientists has been identified in the United States for at least two decades. Although many mechanisms have been proposed to reverse this trend, most of these have concentrated on MD/PhD programs, research in sub-specialty fellowships, and other approaches later in physician training. Few have emphasized early m...
Article
Context A decline in the number of physician-scientists has been identified in the United States for at least two decades. Although many mechanisms have been proposed to reverse this trend, most of these have concentrated on MD/PhD programs, research in subspecialty fellowships, and other approaches later in physician training. Few have emphasized...
Article
Dietitians who work with hospitalized elderly persons need specialized training to assess nutritional needs and develop appropriate, cost-effective interventions for their patients. We evaluated “Nutrition and Aging: Implications for Hospital-Based Care,” a five-contact-hour continuing education program designed to help participants make plans to i...
Article
Full-text available
A small number of physicians experience a disproportionate share of malpractice claims and expenses. If malpractice risk is related in large measure to factors such as patient dissatisfaction with interpersonal behaviors, care and treatment, and access, it might be possible to monitor physicians' risk of being sued. To examine the association betwe...
Article
Full-text available
In Brief Among the many efforts to reduce the burden of diabetes in the United States, one involves focusing on communities. Evidence from cardiovascular disease and cancer-related community intervention projects indicate that such efforts show promise in reducing behavioral risk factors, many of which are the same for diabetes. Such projects, th...
Article
Despite instruction, many patients do not employ diabetes-related self-management skills recommended by health professionals. One problem suggested by research is that many health professionals do not often use teaching and counseling skills widely considered to be effective. Among these are specific skills that help health professionals conduct ad...
Article
Full-text available
Millions of Americans depend on the national nightly network news programs for current events information (1). Previous studies showed that nightly network news coverage about diabetes paled in comparison with that given to cancer and heart disease during the 1970s and 1980s (2,3). We evaluated whether the amount of national news coverage given to...
Article
Physicians must understand regulatory changes in long-term care (LTC) and adhere to prospective payment system (PPS) guidelines for minimum data set (MDS), resource utilization groups (RUG) and resident assessment instrument (RAI) processes, documentation, and evaluation. We pilot-tested "Prospective Payment System in LTC," a 7.5 hour continuing me...
Article
Diabetes education is a cornerstone of diabetes self-care management. Despite terrific progress in refining educational interventions, the diabetes literature continues to contain substantial inconsistencies in reporting the elements of educational interventions. This unnecessary variation in the quality of reporting has led to difficulties in unde...
Article
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs for patients 65 years of age or older, primarily for musculoskeletal symptoms of osteoarthritis. Because NSAIDs frequently cause serious gastrointestinal (GI) and other complications among elderly patients, expert guidelines for osteoarthritis recommend ace...
Article
The risk for serious gastrointestinal complications due to nonsteroidal anti-inflammatory drugs (NSAIDs) is high in the elderly. Acetaminophen-based regimens are safer and may be as effective as NSAIDs for the treatment of osteoarthritis in many patients. To determine the effects of an educational program on NSAID use and clinical outcomes in nursi...
Article
This article reports the results of a symposium in which diabetes educators considered and discussed issues that are likely to arise when continuous glucose monitoring (CGM) becomes available and readily accessible. Fifteen certified diabetes educators and 5 others with complementary expertise participated in a discussion based on their responses t...
Article
Some African Americans with (or at risk for) diabetes underutilize health care services. We report short-term results of a "training of trainers" workshop designed to address this problem. The training program includes culturally sensitive educational materials, including materials developed for the ADA's African American Program (AAP). Workshops w...
Article
A pilot study was conducted to learn whether an academic medical center's database of patient complaints would reveal particular service units (or clinics) with disproportionate shares of patient complaints, the types of complaints patients have about those units, and the types of personnel about whom the complaints were made. During the seven-year...
Article
Nutrition therapy is essential to the management of several chronic diseases affecting adolescents. Unfortunately, dietary impositions may evoke pathological eating-related cognitions. This pilot study examined eating- and weight-related cognitions of 55 adolescents attending a summer camp for youngsters with a heterogeneous variety of chronic dise...
Article
In the 1980s, Tennessee ranked among the top 10 states in per capita consumption of several controlled substances. We describe efforts designed to reduce non-criminally motivated misprescribing in Tennessee, present Tennessee's recent Drug Enforcement Administration (DEA) rankings, and suggest how physicians may reduce misprescribing. Tennessee's B...
Article
A 2-week summer school program, combining problem-based learning with behavior therapy, was developed to help adolescents with insulin-dependent diabetes improve their ability to cope with obstacles to dietary management. Ten students participated in a first session, and 9 participated in a second session, serving as a waiting list control group. O...
Article
Background: Patient satisfaction affects consistency of self-care, health outcomes, level of service utilization, choice of health professionals, and decisions to sue in the face of adverse outcomes. Understanding patients' specific dissatisfactions may help health professionals and administrators identify and rectify organizational deficiencies b...
Article
To examine the relationship between admitting children to a neonatal intensive care unit (NICU) and mothers' satisfaction with obstetric care. Mothers of live-born infants who are now normal were interviewed about their perceptions of the interpersonal, organizational, and technical care they and their babies received during pregnancy, delivery, an...
Article
Background. Medical students have not always had access to information and behavior skills training related to malpractice, and communication skills for difficult situations. Perhaps as a result, some pediatricians become involved in lawsuits that might have been avoided by using interpersonal skills known to enhance doctor-patient relationships. R...
Article
To develop and evaluate a tool for assessing selected aspects of dietary adherence in adolescents with diabetes mellitus (IDDM). The Situational Obstacles to Dietary Adherence Questionnaire (SODA) is a 30-item inventory that yields a total self-efficacy score and scales that measure cognitive and behavioral coping strategies. Alternative forms of t...
Article
Effective Patient Teaching (EPT), a course designed to improve health professionals' and health professions students' teaching skills, reliably produces gains in participants' skills when presented by its developers. The objective of this dissemination research study was to investigate whether, using a 'training of trainers' approach, seven nurses...
Article
Physician concern is protective against claiming while rudeness and communication failures when coupled with adverse events, promote decisions to sue. But what about factors out of a physician's control, subsequent care and outcome? To assess these influences on patient satisfaction, we sought to answer two questions: Do mothers whose babies requir...