“Nothing Comes to Mind…”: Challenges With Identifying One’s Own Role in Preventable Adverse Outcomes in Interprofessional Birthing Unit Teams, and the Implications for Quality Improvement Initiatives
Bibliographic record
Abstract
Introduction: Preventable adverse perinatal outcomes have a devastating impact on patients and providers and form the basis of many quality improvement (QI) and patient safety initiatives in birthing unit teams, including fetal health surveillance (FHS) training programs. Birthing unit staff attitudes regarding the role of interprofessional relationships on FHS decisions remain largely unexplored with respect to preventable adverse outcomes. Methods: In this intervention-primed, constructivist grounded theory study, members across all five professions providing intrapartum care at one academic centre attended an interprofessional workshop on improving their FHS interpretation, response, communication, and teamwork skills. Twenty-three birthing unit team members across midwifery, obstetrics, family medicine, nursing, and obstetrical trainees were purposively sampled and completed semi-structured interviews. Self-serving bias theory was used as a sensitizing concept to explore the social phenomena observed. Results: Birthing unit staff constructed a self-schema of their role in FHS management that was more flattering than the person-schema created by their colleagues about them. The schemas encoded four categories of information that included (1) Identifying the offender, (2) Assigning blame (3) Aligning with the "right" philosophy of care, and (4) Defending one's profession. Participants demonstrated distorted perceptual processes where they described errors other team members had made with ease but struggled to acknowledge their own role in poor outcomes. Discussion: Dissonant schemas can be barriers to the accurate self-assessment of one's skills and have significant implications for interprofessional team competence. QI initiatives may be of limited efficacy given these findings, but addressing these distorted perceptual processes in QI initiatives could improve team performance.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".