Feedback for General Practitioners in Training: Quality, Styles, and Preferences

A General Practitioner (GP) is no longer a loner, but a team player in either a group practice or a care centre. This change has led to a concomitant growth in curricular interest in skills essential for successful collaboration and for enhancing critical reflection towards colleagues’ performance. Giving and receiving constructive feedback are examples of these skills. The aim of this study was to gain insight in the style and quality of feedback reports on consultation skills written by GPs-in-Training (GPiTs) and by their GP-trainers. Furthermore, the preferences of the GPiTs concerning feedback style were examined. Results show significant differences between GP-trainers and GPiTs in feedback style and quality. A ranking task indicated that GPiTs have a preference for reports characterised by a large number of reflective remarks. Questionnaire results indicate the added value of the use of peer feedback. Implications for the integration of peer feedback activities in the curriculum of GPiTs are discussed.     

Training a Patient Safety Work Force: The Patient Safety Improvement Corps

Objective. Evaluate short-term effects of the Patient Safety Improvement Corps (PSIC), an Agency for Healthcare Research and Quality–sponsored program to train state teams in patient safety skills/tools, to assess its contribution to building a national infrastructure supporting effective patient safety practices.
Data Source. Self-reported information gathered from (1) group interviews at the end of each year; (2) individual telephone interviews 1 year later; (3) faxed information forms 2 years later.
Study Design. Program evaluation of immediate and short-term process and impact (use of skills/tools, information sharing, changes in practice).
Data Collection. Semistructured interviews; faxed forms.
Principal Findings. One year after training, approximately half of Year 1 and 2 state agency representatives reported they had initiated or modified legislation to strengthen safe practices, and modified adverse event oversight procedures. Approximately three-quarters of hospital representatives said training contributed to modifications to adverse event oversight procedures and promotion of patient safety culture. Two years posttraining, approximately three-quarters of Year 1 trainees said they continued to use many skills/tools.
Conclusions. The PSIC contributed to building a national infrastructure supporting effective patient safety practices. Expanded training is needed to reach a larger fraction of the population for which this training is important.     

Enhancing Patient Safety through Organizational Learning: Are Patient Safety Indicators a Step in the Right Direction?

Objective. To assess the potential contribution of the Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) to organizational learning for patient safety improvement.
Principal Findings. Patient safety improvement requires organizational learning at the system level, which entails changes in organizational routines that cut across divisions, professions, and levels of hierarchy. This learning depends on data that are varied along a number of dimensions, including structure-process-outcome and from granular to high-level; and it depends on integration of those varied data. PSIs are inexpensive, easy to use, less subject to bias than some other sources of patient safety data, and they provide reliable estimates of rates of preventable adverse events.
Conclusions. From an organizational learning perspective, PSIs have both limitations and potential contributions as sources of patient safety data. While they are not detailed or timely enough when used alone, their simplicity and reliability make them valuable as a higher-level safety performance measure. They offer one means for coordination and integration of patient safety data and activity within and across organizations.     

PDCA内训师在促进医院质量持续改进中的探索与实践

为了更好地促进医院医疗质量持续改进,提高员工发现、分析和解决问题的能力,南方医科大学珠江医院采取组建内训师团队、制定内训师培养方案、开发培训课程体系、内训师牵头开展及辅导质量持续改进项目等系列措施,逐步搭建了PDCA内训师体系,员工持续改进能力有效提升,推动了医院质量持续改进。     

加强病案全程质控提高病案质量

通过建立健全病案全程质控体系;对运行病案、出院病案、终末病案等病案形成全过程进行质控;落实奖惩,持续改进等措施,实现了病案质控由“终末质量监控”向“病案全过程、各环节、多层次的动态质控”的转变,持续提高了病案质量,确保了医疗质量和安全.     

Relationship Between Clinical Quality and Patient Experience: Analysis of Data From the English Quality and Outcomes Framework and the National GP Patient Survey

PURPOSE

Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England.

METHODS

Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman’s rank correlation and multiple linear regression were used on practice-level estimates.

RESULTS

Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15).

CONCLUSION

Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.     

Education for Consumer Health: A Train the Trainer Collaboration

ABSTRACT

This project featured collaboration between a large public library system and an academic institution to address training needs related to the rise in the demand for quality consumer health information. A train the trainer program featuring hands-on training and Web-based support was designed and implemented. Public reference librarians received customized education and support to facilitate their efforts to train library users of consumer health information. The results of the collaborative effort included an increased awareness of cultural, linguistic, and literacy issues for effective provision of public library consumer health reference service along with a reaffirmation of the need for strategic community collaborations for health education.