Involvement in a patient safety event can result in serious psychological consequences for healthcare workers. This article describes the importance of proactive organizational planning to protect and support healthcare workers after involvement in a patient safety event and provides several examples of successful peer-support programs, such as the Resilience in Stressful Events (RISE) program or the Center for Professionalism and Peer Support.

Unprofessional and disruptive behavior can erode patient safety and safety culture. The Co-Worker Observation System (CORS), a peer-to-peer feedback program previously used with physicians and advance practice providers, was implemented for use with nurses in three hospitals. Reports of unprofessional behavior submitted to the internal reporting system were evaluated by the CORS team, and peer-to-peer feedback was given to the recipient. This pilot study demonstrated that the implementation bundle can be successful with nursing staff.

The effectiveness of incident reporting systems is hindered by underreporting. This cohort study describes the characteristics of incident reports submitted by trainees in a large academic medical center. From October 2019 through December 2021, trainees submitted nearly 200 incident reports, primarily describing unprofessional interactions. Findings suggest that awareness and support for the online incident reporting system among trainees was high.

This three-part series offers an in-depth look into the core values of honesty, transparency, and trust. Part 1, Promoting Professionalism, introduces interventions to increase provider professionalism. Part 2, Communication and Transparency, describes the commitment to honesty and transparency across the continuum of the patient-provider relationship. Part 3, Health Professional Wellness, describes the impact of harm on providers and offers recommendations for restoring wellness and joy in work.

This article reports findings from a survey of pediatric trainees at two large children’s hospitals on attitudes and behaviors in regard to speaking up about traditional safety threats and unprofessional behavior. While trainees more commonly observed unprofessional behavior than safety threats, they are less likely to speak up when presented with unprofessional behavior.

Physicians who behave unprofessionally toward other health care workers compromise both safety culture and patient health. Hostile behavior among surgeons is particularly harmful because surgical care is both teamwork-dependent and has high stakes. Although many have reported anecdotally that disrespectful surgeon behavior has led to patient harm, it is challenging to study systematically. Investigators sought to determine whether patients whose surgeons had coworker reports of unprofessional behavior experienced more harm. Surgeons at two academic medical centers who had coworker reports of unprofessional behavior in the 3 years before a surgery were more likely to have patients experience both medical and surgical complications after the surgery. These findings highlight the importance of empowering team members to report unprofessional behavior so that it can be remediated. Two WebM&M commentaries describe different approaches to addressing unprofessional physician behavior.

The Toyota manufacturing model "stop the line" encourages workers to stop the production line if they notice something is wrong. This commentary discusses how this philosophy can enable patients to speak up for safety both during care interactions or after events to incorporate their knowledge into improvement efforts.

Reducing the incidence of opioid overdoses and overdose deaths is an essential patient safety priority. In the last decade, children have experienced a dramatic rise in hospitalizations and intensive care unit stays for opioid poisoning. Researchers examined outpatient opioid prescriptions to children who did not have serious illnesses like cancer or sickle cell disease in Tennessee between 1999 and 2014. Dentists prescribed the largest share of more than 1 million opioid prescriptions, followed by surgeons. The authors conclude that 1 in every 2611 prescriptions resulted in an emergency department visit or hospitalization. An accompanying editorial contextualizes the study findings and offers suggestions, such as relying on less toxic analgesics for dental procedures and choosing alternatives to codeine for children who need opioids. A past PSNet perspective examined the patient safety implications of the opioid epidemic.

… Journal of patient safety … J Patient Saf … When physicians and advanced practice …

Patient complaints are associated with increased malpractice risk. This retrospective cohort study of more than 1300 ophthalmologists sought to determine whether ophthalmologist age was linked to likelihood of receiving unsolicited patient complaints. The authors found that unsolicited patient complaints occur less frequently among older ophthalmologists.

… Journal of patient safety … J Patient Saf … Including members of a patient and family …

Health care provider comfort with raising patient safety concerns is a critical aspect of safety culture. This survey of resident physicians at six academic medical centers demonstrated that trainees remain reluctant to speak up. Nearly half reported observing a patient safety threat. The majority spoke up about patient safety concerns, but a significant proportion did not. Although unprofessional behavior was more frequently observed, fewer trainees raised concerns about lack of professionalism than about patient safety. Even when respondents perceived the unprofessional behavior as having high potential for adverse patient consequences, they were not as likely to speak up about this compared to a traditional patient safety threat such as inadequate hand hygiene. The authors recommend specifically measuring tolerance for unprofessional behaviors as a part of safety culture assessment.

Most patient safety problems can be ascribed to underlying systems failures, but issues with individual clinicians play a role as well. Prior studies have shown that a small proportion of physicians account for a disproportionate share of patient complaints and malpractice lawsuits. This retrospective cohort study used data from the Patient Advocacy Reporting System (which collects unsolicited patient concerns) and the National Surgical Quality Improvement Program to examine the association between patient complaints and surgical adverse events. The investigators found that patients of surgeons who had received unsolicited patient concerns via the reporting system were at increased risk of postoperative complications and hospital readmission after surgery. Although the absolute increase in complication rates was relatively small across all surgeons, surgeons in the highest quartile of unsolicited observations had an approximately 14% higher risk of complications compared to surgeons in the lowest quartile. This study extends upon prior research by demonstrating an association between patient concerns about individual clinicians and clinical adverse events, and it strengthens the argument for using data on patient concerns to identify and address problem clinicians before patients are harmed.

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … This survey of operational leaders at a …

Health systems struggle with how to effectively involve patients in safety efforts without placing undue responsibility or blame on them. Greater patient–clinician collaboration is particularly important for error disclosure because of the well-documented gaps in clinician and patient perspectives. In this study, investigators developed an intervention to have patients or family members teach error disclosure and prevention to interprofessional clinician learners, including physicians, nurses, and social workers. Their pre–post evaluation showed that the majority of patient and clinician participants reported improved communication and found the intervention valuable. Patient and clinician participation was voluntary. Although these results show promise for involving patients and families as teachers for error disclosure and prevention training, further work is needed to determine whether this approach will be effective among broader health care teams, as opposed to interested clinicians who volunteer. A related editorial discusses the challenges of including patients in safety efforts.

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … Disrespectful behavior and lack of …

This study validated two new surveys (Speaking Up Climate-Safety and Speaking Up Climate- Professionalism) for measuring aspects of safety culture that are associated with resident physicians' likelihood of speaking up about patient safety concerns and unprofessional behavior. Both scales performed well on psychometric testing. These surveys may fill current gaps in widely used assessment tools.

Although physicians generally support disclosing adverse events, they often choose their words carefully when discussing errors with patients. Since few training programs include formal curricula in error disclosure, most residents and medical students learn these skills through direct observation of senior clinicians. This survey of trainees evaluated the effects of negative and positive role models on their attitudes and behaviors regarding error disclosure. Most trainees had observed a harmful medical error, and the majority reported exposure to positive role models. Poor role models were associated with negative trainee attitudes about disclosure and an increased likelihood of trying to evade responsibility for harmful errors. More than one-third of trainees reported nontransparent behavior in response to a harmful medical error they had made. Addressing the importance of role models in shaping clinicians' future behaviors will be important to advancing full disclosure efforts. An AHRQ WebM&M perspective by Dr. Albert Wu discusses the importance of disclosing adverse events.

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … A recent Australian study showed that a …