Interprofessional Conflict and Medical Errors: Results of a National Multi-Specialty Survey of Hospital Residents in the US
Accreditation Council for Graduate Medical Education, Chicago, IL 60610, USA.Journal of Interprofessional Care (Impact Factor: 1.4). 01/2009; 22(6):573-86. DOI: 10.1080/13561820802364740
Clear communication is considered the sine qua non of effective teamwork. Breakdowns in communication resulting from interprofessional conflict are believed to potentiate errors in the care of patients, although there is little supportive empirical evidence. In 1999, we surveyed a national, multi-specialty sample of 6,106 residents (64.2% response rate). Three questions inquired about "serious conflict" with another staff member. Residents were also asked whether they had made a "significant medical error" (SME) during their current year of training, and whether this resulted in an "adverse patient outcome" (APO). Just over 20% (n = 722) reported "serious conflict" with another staff member. Ten percent involved another resident, 8.3% supervisory faculty, and 8.9% nursing staff. Of the 2,813 residents reporting no conflict with other professional colleagues, 669, or 23.8%, recorded having made an SME, with 3.4% APOs. By contrast, the 523 residents who reported conflict with at least one other professional had 36.4% SMEs and 8.3% APOs. For the 187 reporting conflict with two or more other professionals, the SME rate was 51%, with 16% APOs. The empirical association between interprofessional conflict and medical errors is both alarming and intriguing, although the exact nature of this relationship cannot currently be determined from these data. Several theoretical constructs are advanced to assist our thinking about this complex issue.
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- "This study has demonstrated that the enculturation of students—i .e. the norms, values and practices learned—makes them appreciate different aspects of the environment, which also might have consequences for interprofessional collaboration and communication. Interestingly, residents' perception of involvement in interprofessional conflicts is associated with self-reported medical errors (Baldwin and Daugherty 2008). Higher demands on collaborative and communication skills have stimulated the development of interprofessional education activities, but their effectiveness regarding patient outcomes have been difficult to demonstrate (Reeves et al. 2008). "
ABSTRACT: This paper explores and contrasts undergraduate medical and nursing students’ experiences of the clinical learning environment. Using a sociocultural perspective of learning and an interpretative approach, 15 in-depth interviews with medical and nursing students were analysed with content analysis. Students’ experiences are described using a framework of ‘before’, ‘during’ and ‘after’ clinical placements. Three major themes emerged from the analysis, contrasting the medical and nursing students’ experiences of the clinical learning environment: (1) expectations of the placement; (2) relationship with the supervisor; and (3) focus of learning. The findings offer an increased understanding of how medical and nursing students learn in the clinical setting; they also show that the clinical learning environment contributes to the socialisation process of students not only into their future profession, but also into their role as learners. Differences between the two professions should be taken into consideration when designing interprofessional learning activities. Also, the findings can be used as a tool for clinical supervisors in the reflection on how student learning in the clinical learning environment can be improved.
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- "Negative behavior such as use of sarcasm or intimidation occurs among workers in non-healthcare as well as health care industries [11,18,22,39]. Healthcare researchers identified negative behavior at work among medical residents in the United States (US)  and the United Kingdom (UK) ; nurses in Australia, New "
ABSTRACT: Objective: To test hypotheses from a horizontal violence and quality and safety of patient care model: horizontal violence (negative behavior among peers) is inversely related to peer relations, quality of care and it is positively related to errors and adverse events. Additionally, the association between horizontal violence, peer relations, quality of care, errors and adverse events, and nurse and work characteristics were determined.PARTICIPANTS: A random sample (n=175) of hospital staff Registered Nurses working in California. Methods: Nurses participated via survey. Bivariate and multivariate analyses tested the study hypotheses.RESULTS: Hypotheses were supported. Horizontal violence was inversely related to peer relations and quality of care, and positively related to errors and adverse events. Including peer relations in the analyses altered the relationship between horizontal violence and quality of care but not between horizontal violence, errors and adverse events. Nurse and hospital characteristics were not related to other variables. Clinical area contributed significantly in predicting the quality of care, errors and adverse events but not peer relationships. Conclusions: Horizontal violence affects peer relationships and the quality and safety of patient care as perceived by participating nurses. Supportive peer relationships are important to mitigate the impact of horizontal violence on quality of care.
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- "Les conflits entre soignants, souvent banalisé s, nuisent a ` la qualité des soins et au maintien d'un bien-e ˆtre durable des e ´ quipes. Les conflits sont source d'erreurs mé dicales  . Ils contribuent en grande partie a ` l'e ´ puisement professionnel  . "
ABSTRACT: In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution.
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