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Assessing safety climate is critical to understanding how organizational efforts can improve safety. This review identified deficiencies and inconsistencies in the way that safety climate has been conceptualized and measured. The authors underscore the importance of a consistent approach to measuring safety climate in order to evaluate its impact on patient safety outcomes.

Cognition is a recognized human factor that can contribute to medical error. This systematic review explored whether mindful practice can improve diagnosis in healthcare. Of the 33 included studies, the majority were non-empirical; however, the authors tentatively conclude that mindful practice may be a promising method to improve diagnostic accuracy and reduce error.

Safety gaps in mental health care offers a limited view if focused primarily on patient suicide. This commentary calls for Canadian psychiatric professionals to examine the safety of their patients from a system perspective to develop a research and practice improvement strategy.

Improving maternal safety is an ongoing patient safety priority. This systematic review concluded that maternal near miss events are negatively associated with various aspects of quality of life. Women exposed to maternal near miss events were more likely to have overall lower quality of life, poorer mental and social health, and suffer negative economic consequences.

Accurate measurement of patient safety culture (PSC) is essential to improving patient safety. This review summarizes the results of 66 studies on PSC in hospitals. Multiple instruments were used to assess PSC, including the Hospital Survey on Patient Safety Culture (HSPSC) and the Safety Attitudes Questionnaire (SAQ). Teamwork and organization and behavioral learning were identified as critical factors impacting PSC and should be considered in future research.

Machine learning uses data and statistical methods to enhance risk prediction models and it has been promoted as a tool to improve healthcare safety. Using Medicaid claims data for a large cohort of White and Black pregnant females, this study evaluated approaches to reduce bias in clinical prediction algorithms for postpartum depression and mental health service utilization. The researchers found that a reweighing method in machine learning models was associated with a greater reduction in bias than excluding race from the prediction models. The authors suggest further examination of potentially biased data informing clinical prediction models and consideration of other methods to mitigate bias.

Implicit bias can contribute to poor decision-making and lead to poor patient outcomes. This qualitative study found that many healthcare providers have negative implicit attitudes about American Indians, such as implicitly stereotyping American Indians as noncompliant patients. The effect of these implicit attitudes and stereotypes was moderated by self-reported cultural competency and implicit bias training.

Challenges to identifying and measuring diagnostic errors, particularly in the era of COVID-19, persist. The authors of this perspective proposed a new framework of diagnostic process safety to measure the quality and safety of diagnostic processes. The framework focuses on three measurable components – do not miss diagnoses, red flags, and diagnostic pitfalls. This framework can provide a structured approach for designing and testing specific measures of diagnostic process safety.

Learning from adverse events is a core component of patient safety improvement. These authors developed guidance for the use of peer review protected information (such as voluntary event reports and root causes analyses) in safety research. The guidance aims to ensure that data are handled safely and appropriately while supporting scientific discovery.  

Structural racism affects both population and individual health. This article proposes four key areas in which the medical and public health communities can contribute in order to change policy and social norms: documenting the impact of racism on health; improving the collection and availability of race and ethnicity data; turning the lens to themselves; and, acknowledging that structural racism has been challenged by mass social movements.

Disruptive and rude behavior can hinder teamwork and diminish patient safety. This randomized, simulation-based study including attendings, fellows, and residents explored whether rudeness during handoff affects the likelihood for challenging a diagnostic error. The authors found that rudeness may disproportionally hinder diagnostic performance among less experienced physicians.

The COVID-19 pandemic has dramatically affected the psychological and emotional well-being of health care workers. This article summarizes the COVID-19-related psychological effects on healthcare workers and the detrimental impact on team effectiveness. The authors recommended actions to mitigate the effects of stress on team performance and patient outcomes and discuss how teams can recover and learn from the current crisis to prepare for future challenges.

The ”weekend effect” refers to worse patient outcomes occurring outside of usual business hours. The authors used national data to examine in-hospital mortality differences among patients experiencing stroke admitted on the weekend versus on a weekday. After adjusting for patient and hospital characteristics, in-hospital mortality among hemorrhagic stroke patients was significantly greater among weekend compared to weekday admissions. No weekend effect was found among ischemic stroke patients. Future research should explore the influence of additional factors, such as patient-level behavioral risk factors and the availability of care providers and stroke care centers, particularly in rural regions.  

Silence in the operating room (OR) can have implications on surgical team function and patient safety. Through interviews with interprofessional surgical team members, the authors explored the influence of silence on team action in the OR and found that silence in the surgical environment – whether due to team cohesion or individual defiance – has implications for team functions.

This article discusses the threat that the “flexibilization” of science has played during the COVID-19 pandemic, defined as the loosening of methodological standards leading to low-quality studies, and resulting in unreliable data and anecdotal evidence.

This cohort explored the mental health impacts of a universal COVID-19 testing program on asymptomatic pregnant women and labor and delivery health care workers. Among multiparous women who tested negative, nearly 35% reported that COVID-19 led to additional fear or anxiety postpartum compared with previous deliveries. Labor and delivery health care workers reported that COVID-19 decreased job satisfaction and increased job-related anxiety.

This meta-analysis of the psychological and mental impacts of COVID-19 among healthcare workers, patients at increased risk for the virus, and the general public found that anxiety and depression among all individuals was common. For example, over half of patients with pre-existing conditions and COVID-19 infection reported anxiety or depression.

Unprofessional behavior can hinder patient safety and create a disruptive work environment. Encompassing both qualitative and quantitative literature, this systematic review explored predictors and triggers of incivility in medical teams (defined as disrespectful behaviors but whose intent to harm is ambiguous). The review identified a wide range of triggers of incivility. Studies generally found that incivility occurs mainly within professional disciplines rather than across disciplines (e.g., physician to nurse) and surgery was the most commonly cited uncivil specialty. Situational and cultural triggers for incivility included excessive workload, communication issues, patient safety concerns, lack or support, and poor leadership.