150: Social Impediments to Implementation of Structured Handoff in a Professional Context: A Qualitative Study of I-Pass Implementation
Notice bibliographique
Résumé
Literature on high reliability organizations suggests that structured communication can reduce errors. The I-PASS Handoff Bundle aims to improve resident handoff and consists of teamwork training, structured verbal communication using a mnemonic, and an electronic written handoff tool. The program was implemented as part of a nine-site study. This qualitative study examines the implementation of structured handoff in the context of residency training programmes. This study examined to what extent I-PASS was adopted amongst residents, what factors facilitate and impede adoption, and in particular the impact of social factors. Focus groups were conducted with residents (n=54) at eight of nine IPASS sites. The data were analysed using grounded theory techniques to generate insight into how adoption of structured communication could be facilitated in health care. The results were very consistent across sites, and resident perspectives fell into four main themes. Residents expect communication to be efficient. Time is universally regarded as a scarce resource and it is expected that communication should cover only the information necessary for on-going quality patient care. The perception that the I-PASS mnemonic requires that the same information be covered regardless of the professional's level or knowledge of the patient and for all patients regardless of complexity was seen as violating this norm. Residents expect communication to respect professional competence. The standardized nature of the information communicated to colleagues can be seen as insensitive to the requirements of residents at different stages of professional competence. Junior residents were more receptive to comprehensive information while the same information was felt redundant by senior residents. Residents expect allowance for professional judgment and autonomy. The standardized format of IPASS communication, particularly the Synthesis by Receiver step (read back) was seen as limiting professionals' right to exercise judgment in communication. Residents expect informal communication among peers: The standardized format of IPASS was seen as more suited to demonstrating skill to a superior rather than for use among colleagues of the same hierarchical level. These data must be interpreted in the context of residency training. Residents who have varying levels of professional identity formation may vary in their ability to adopt new structured communication practices. Acknowledgement of these norms in the training and ongoing reinforcement phases could lead to more positive attitudes and greater receptivity to ongoing efforts to improve communication, which will be required to bring about transformative change.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,022 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,008 | 0,009 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».