An Extended Validity Argument for Assessing Feedback Culture

Measuring an Organization's Culture of Feedback: Can It Be Done?

Steven Rougas and Brian Clyne

Construct: This study sought to develop a construct for measuring formative feedback culture in an academic emergency medicine department. Four archetypes (Market, Adhocracy, Clan, Hierarchy) reflecting an organization's values with respect to focus (internal vs. external) and process (flexibility vs. stability and control) were used to characterize one department's receptiveness to formative feedback. The prevalence of residents' identification with certain archetypes served as an indicator of the department's organizational feedback culture. Background: New regulations have forced academic institutions to implement wide-ranging changes to accommodate competency-based milestones and their assessment. These changes challenge residencies that use formative feedback from faculty as a major source of data for determining training advancement. Though various approaches have been taken to improve formative feedback to residents, there currently exists no tool to objectively measure the organizational culture that surrounds this process. Assessing organizational culture, commonly used in the business sector to represent organizational health, may help residency directors gauge their program's success in fostering formative feedback. The Organizational Culture Assessment Instrument (OCAI) is widely used, extensively validated, applicable to survey research, and theoretically based and may be modifiable to assess formative feedback culture in the emergency department. Approach: Using a modified Delphi technique and several iterations of focus groups amongst educators at one institution, four of the original six OCAI domains (which each contain 4 possible responses) were modified to create a 16-item Formative Feedback Culture Tool (FFCT) that was administered to 26 residents (response rate = 55%) at a single academic emergency medicine department. The mean score of each item on the FFCT (range = 0–100) was analyzed. Convergent and divergent properties of the four archetypes were assessed using a multitrait–multimethod matrix of Pearson's coefficients. Expecting that items in one archetype would diverge from the others, whereas items within an archetype should have strong convergent properties, convergent validity was assessed by comparing items across domains that all related to the same archetype. Similarly, divergent validity was assessed by comparing the correlation of items within an archetype to the correlations of those items within a hetero-domain block (i.e., to other items within the same domain). Results: Three of the four domains of the FFCT (Overall Departmental Characteristics 35.4 ± 15.4, Departmental Foundation of Feedback 46.1 ± 16.7, and Departmental Emphasis of Feedback 30.3 ± 17.7) had the highest mean in the Market archetype (results/achievement oriented), whereas the final domain (Departmental Definition of Successful Feedback 34.8 ± 22.1) had the highest mean in the Clan archetype (personal growth/team achievement). Item responses in the Clan and Hierarchy archetypes had the strongest convergent and divergent validity, respectively. Item responses in the Adhocracy archetype had the weakest convergent and divergent validity. Conclusions: Although the sample size was small, this initial study demonstrates that a modified organizational culture assessment tool can feasibly be utilized to identify the primary formative feedback archetype of a cohort of residents. This may have future implications for measuring changes in culture after the implementation of strategic programs to address formative feedback. Future studies should examine the generalizability of the FFCT to other institutions, as well as address the weak validity evidence of the Adhocracy archetype in the FFCT.     

护士第二受害者支持现状及与医院患者安全文化的关系研究

目的 探索护士第二受害者支持现状及与医院患者安全文化的关系,为实施第二受害者干预提供参考。方法 采用方便抽样 法选取我国中西部3省6所三级甲等综合医院经历患者安全事件的执业护士2897人,采用医院患者安全文化调查问卷、第二受 害者经验及支持量表进行调查。结果 第二受害者支持总分为30.91±6.75,各维度得分由高至低分别为机构支持2.57±0.68、 同事支持2.41±0.62、非工作相关支持2.29±0.92、上级支持2.25±0.71;第二受害者支持总分及各维度得分与患者安全文化 认知总分及各维度得分呈负相关(均P< 0.01)。结论 护士作为患者安全事件的第二受害者得到的支持水平较低,并且与其对医院患者安全文化的认知有一定关系。医 院管理者应重视科室团队合作建设,鼓励不良事件上报,逐步构建基于同事-上级-机构的多层次、正式的组织支持体系,促进安 全文化建设。     

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

Scientific models are like tools, and like any tool they can be evaluated according to how well they achieve the chosen goals of the task at hand. In the science of treatment development for chronic pain, we might say that a good model ought to achieve at least 3 goals: 1) integrate current knowledge, 2) organize research and treatment development activities, and 3) create progress. In the current review, we examine models underlying current cognitive behavioral approaches to chronic pain with respect to these criteria. A relatively new model is also presented as an option, and some of its features examined. This model is called the psychological flexibility model. This model fully integrates cognitive and behavioral principles and includes a process-oriented approach of treatment development. So far it appears capable of generating treatment applications that range widely with regard to conditions targeted and modes of delivery and that are increasingly supported by evidence. It has led to the generation of innovative experiential, relationship-based, and intensive treatment methods. The scientific strategy associated with this model seeks to find limitations in current models and to update them. It is assumed within this strategy that all current treatment approaches will one day appear lacking and will change.PerspectiveThis Focus Article addresses the place of theory and models in psychological research and treatment development in chronic pain. It is argued that such models are not merely an academic issue but are highly practical. One potential model, the psychological flexibility model, is examined in further detail.     

心理资本对护士组织公民行为影响的结构方程模型

目的探讨护士心理资本对组织公民行为的影响,并阐释其作用机制。方法方便抽样法选取哈尔滨市5所三级甲等医院284名护士,采用心理资本量表和组织公民行为量表进行横断面调查,应用结构方程模型对变量的关系进行验证。结果护士心理资本均分5．00±0．81、组织公民行为均分5．97±0．72;护士心理资本对其组织公民行为具有显著的正向影响（β=0．40,P〈0．01）。结论提升护士的心理资本将会促进护理组织内的组织公民行为表现,进而提升护理组织绩效和护理工作质量。     

温州市3所三甲医院低年资护士感情承诺对反馈寻求行为的影响

目的调查温州市3所三甲医院低年资护士感情承诺和反馈寻求行为现状,探讨低年资护士感情承诺对反馈寻求行为的影响。方法采用便利抽样法,于2019年10—12月抽取浙江省温州市3所三级甲等医院400名低年资护士为研究对象,采用一般资料调查表、感情承诺量表、反馈寻求行为量表进行调查,分析感情承诺对低年资护士反馈寻求行为的影响。本次研究共发放问卷400份,回收有效问卷372份,问卷有效回收率为93%。结果372名低年资护士感情承诺量表总分为(29.07±4.86)分,反馈寻求行为量表总分为(40.47±6.47)分。单因素分析结果显示,低年资护士反馈寻求行为得分在职称、学历、科室、聘用方式方面的差异具有统计学意义(P<0.05)。Pearson相关性分析结果显示,低年资护士感情承诺量表总分与反馈寻求行为量表总分呈正相关(P<0.05)。分层回归分析结果显示,感情承诺对低年资护士反馈寻求行为具有预测作用(P<0.05)。结论低年资护士感情承诺和反馈寻求行为现状均处于中等水平,有待进一步加强,感情承诺正向影响反馈寻求行为,护理管理者可通过加强低年资护士的感情承诺水平进而提升其反馈寻求行为水平。     

A Trial of a Brief Group-Based Form of Acceptance and Commitment Therapy (ACT) for Chronic Pain in General Practice: Pilot Outcome and Process Results

Acceptance and commitment therapy (ACT) is a developing approach for chronic pain. The current study was designed to pilot test a brief, widely inclusive, local access format of ACT in a UK primary care setting. Seventy-three participants (68.5% women) were randomized to either ACT or treatment as usual (TAU). Many of the participants were aged 65 years or older (27.6%), were diagnosed with fibromyalgia (30.2%) and depression (40.3%), and had longstanding pain (median = 10 years). Standard clinical outcome measures included disability, depression, physical functioning, emotional functioning, and rated improvement. Process measures included pain-related and general psychological acceptance. The recruitment target was met within 6 months, and 72.9% of those allocated to ACT completed treatment. Immediately post treatment, relative to TAU, participants in ACT demonstrated lower depression and higher ratings of overall improvement. At a 3-month follow-up, again relative to TAU, those in ACT demonstrated lower disability, less depression, and significantly higher pain acceptance; d = .58, .59, and .64, respectively. Analyses based on intention-to-treat and on treatment “completers,” perhaps predictably, revealed more sobering and more encouraging results, respectively. A larger trial of ACT delivered in primary care, in the format employed here, appears feasible with some recommended adjustments in the methods used here (Trial registration: ISRCTN49827391).     

Leadership training to improve nurse retention

wallis a. & kennedy k.i. (2013) Journal of Nursing Management  21 , 624–632 Leadership training to improve nurse retention Aim This paper discusses findings from an evaluation of a training programme designed to promote collaborative, team-based approaches to improve nurse retention within health care organizations. Background A year-long leadership training programme was designed and implemented to develop effective teams that could address retention challenges in a diverse set of organizations in Colorado ranging from public, private to non-profit. Evaluation An evaluation, based on a combination of participant observation, group interviews, and the use of standardized tests measuring individual emotional intelligence and team dynamics was conducted to assess the effectiveness of the training programme. Key issues What role do the emotional intelligence of individual members and organizational culture play in team effectiveness? Conclusions Out of five teams participating in the training programme, two performed exceptionally well, one experienced moderate success and two encountered significant problems. Team dynamics were significantly affected by the emotional intelligence of key members holding supervisory positions and by the existing culture and structure of the participating organizations. Implications for nursing management Team approaches to retention hold promise but require careful development and are most likely to work where organizations have a collaborative problem-solving environment.