Scholars@Duke
John Bryan Sexton

John Bryan Sexton

Medical Associate Professor in the Department of Psychiatry and Behavioral Sciences
Psychiatry & Behavioral Sciences, Adult Psychiatry & Psychology
bryan.sexton@duke.edu
Box 102506, Attn: Duke Center for the Advancement of, Durham, NC 27710
DUMC Box # 102506, Attn: Duke Center for the Advancement of, Durham, NC 27710

Selected Publications

Bite-sized self-compassion: a pilot cohort study of a well-being tool for healthcare workers.

Journal Article Scientific reports · August 2025 Healthcare worker (HCW) well-being is an urgent priority in the wake of the COVID-19 Pandemic. Poor worker well-being has been linked to greater turnover, lower quality of care, and higher patient safety risks. Brief, simple tools to increase HCW well-bein ... Full text Cite

"WISER" intervention to reduce healthcare worker burnout - 1 year follow up.

Journal Article Journal of perinatology : official journal of the California Perinatal Association · December 2024 ObjectiveTest sustainability of Web-based Implementation for the Science of Enhancing Resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) emotional exhaustion (EE), a key component of burnout.DesignOne-year follow ... Full text Cite

Well-Being Outcomes of Health Care Workers After a 5-Hour Continuing Education Intervention: The WELL-B Randomized Clinical Trial.

Journal Article JAMA network open · September 2024 ImportanceCompromised well-being in health care workers (HCWs) is detrimental to the workforce, organizations, and patients.ObjectiveTo test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based contin ... Full text Cite

Self-compassion letter tool for healthcare worker well-being: a qualitative descriptive analysis.

Journal Article BMJ open · April 2024 ObjectiveThis qualitative study aimed to identify categories within therapeutic self-compassion letters written by healthcare workers. Resulting categories were assessed for their relevance to the construct of self-compassion.DesignThis w ... Full text Open Access Cite

Characterizing burnout and resilience among nurses: A latent profile analysis of emotional exhaustion, emotional thriving and emotional recovery.

Journal Article Nursing open · November 2023 AimsTo identify subgroups of nurses with distinct profiles of burnout (emotional exhaustion) and resilience (emotional thriving and emotional recovery) and describe nurse characteristics associated with each profile.DesignCross-sectional, ... Full text Cite

Leadership Behavior Associations with Domains of Safety Culture, Engagement, and Health Care Worker Well-Being.

Journal Article Joint Commission journal on quality and patient safety · March 2023 BackgroundLeadership is a key driver of health care worker well-being and engagement, and feedback is an essential leadership behavior. Methods for evaluating interaction norms of local leaders are not well developed. Moreover, associations betwee ... Full text Cite

Assessing Leadership Behavior in Health Care: Introducing the Local Leadership Scale of the SCORE Survey.

Journal Article Joint Commission journal on quality and patient safety · March 2023 BackgroundEngaged and accessible leadership is a key component of care excellence. However, the field lacks brief, reliable, and actionable measures of feedback and coaching-related behaviors of local leaders (for example, provides frequent feedba ... Full text Cite

Teamwork Before and During COVID-19: The Good, the Same, and the Ugly….

Journal Article J Patient Saf · January 1, 2023 OBJECTIVES: The COVID 19 pandemic placed unprecedented strain on healthcare systems and workers, likely also impacting patient safety and outcomes. This study aimed to understand how teamwork climate changed during that pandemic and how these changes affec ... Full text Open Access Link to item Cite

Stressors Among Healthcare Workers: A Summative Content Analysis.

Journal Article Global qualitative nursing research · January 2023 Healthcare workers are experiencing high stress and burnout, at rates up to 70%, hindering patient care. Studies often focus on stressors in a particular setting or within the context of the pandemic which limits understanding of a more comprehensive view ... Full text Cite

Corrigendum: The language of healthcare worker emotional exhaustion: a linguistic analysis of longitudinal survey.

Journal Article Frontiers in psychiatry · January 2023 [This corrects the article DOI: 10.3389/fpsyt.2022.1044378.]. ... Full text Cite

A new look at an old well-being construct: evaluating the psychometric properties of 9, 5, and 1-item versions of emotional exhaustion metrics.

Journal Article Front Psychol · 2023 OBJECTIVE: To compare the relative strengths (psychometric and convergent validity) of four emotional exhaustion (EE) measures: 9- and 5-item scales and two 1-item metrics. PATIENTS AND METHODS: This was a national cross-sectional survey study of 1409 US p ... Full text Link to item Cite

The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings.

Journal Article J Patient Saf · September 1, 2022 OBJECTIVES: The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) ex ... Full text Open Access Link to item Cite

Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021.

Journal Article JAMA Netw Open · September 1, 2022 IMPORTANCE: Extraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being. OBJECTIVE: To determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point. DESIGN, SETTING, AND ... Full text Open Access Link to item Cite

The Association between Well-being Behaviors and Resilience in Health Care Workers.

Journal Article Western journal of nursing research · August 2022 Engaging in well-being behaviors may promote resilience, which can protect against burnout. This descriptive, correlational analysis utilized baseline data from health care workers enrolled in the Web-based Implementation of the Science for Enhancing Resil ... Full text Open Access Cite

Implementation challenges to patient safety in Guatemala: a mixed methods evaluation.

Journal Article BMJ Qual Saf · May 2022 BACKGROUND: Little is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala. MET ... Full text Open Access Link to item Cite

Effectiveness of a bite-sized web-based intervention to improve healthcare worker wellbeing: A randomized clinical trial of WISER.

Journal Article Frontiers in public health · January 2022 ImportanceProblems with the wellbeing of healthcare workers (HCWs) are widespread and associated with detrimental consequences for the workforce, organizations, and patients.ObjectiveThis study tested the effectiveness of the Web-based Im ... Full text Cite

The language of healthcare worker emotional exhaustion: A linguistic analysis of longitudinal survey.

Journal Article Frontiers in psychiatry · January 2022 ImportanceEmotional exhaustion (EE) rates in healthcare workers (HCWs) have reached alarming levels and been linked to worse quality of care. Prior research has shown linguistic characteristics of writing samples can predict mental health disorder ... Full text Cite

Changes in Safety and Teamwork Climate After Adding Structured Observations to Patient Safety WalkRounds.

Journal Article Joint Commission journal on quality and patient safety · December 2021 BackgroundPatient safety is essential for the reliable delivery of health care. One way to positively influence patient safety is to improve the safety and teamwork climate of a clinical area. Research shows that patient safety WalkRounds (WRs) ar ... Full text Cite

Changing safety culture.

Journal Article Journal of perinatology : official journal of the California Perinatal Association · October 2021 Safety culture, an aspect of organizational culture, that reflects work place norms toward safety, is foundational to high-quality care. Improvements in safety culture are associated with improved operational and clinical outcomes. In the neonatal intensiv ... Full text Cite

Randomized controlled trial of the "WISER" intervention to reduce healthcare worker burnout.

Journal Article Journal of perinatology : official journal of the California Perinatal Association · September 2021 ObjectiveTest web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout.DesignRCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (pr ... Full text Open Access Cite

The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being.

Journal Article Arch Pathol Lab Med · September 1, 2021 CONTEXT.—: Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover. OBJECTIVE.—: To describe the state of the science regardin ... Full text Open Access Link to item Cite

Results from the National Taskforce for Humanity in Healthcare's Integrated, Organizational Pilot Program to Improve Well-Being.

Journal Article Joint Commission journal on quality and patient safety · September 2021 BackgroundIn health care, burnout remains a persistent and significant problem. Evidence now exists that organizational initiatives are vital to address health care worker (HCW) well-being in a sustainable way, though system-level interventions ar ... Full text Open Access Cite

Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds.

Journal Article Jt Comm J Qual Patient Saf · July 2021 BACKGROUND: Interventions to decrease burnout and increase well-being in health care workers (HCWs) and improve organizational safety culture are urgently needed. This study was conducted to determine the association between Positive Leadership WalkRounds ... Full text Open Access Link to item Cite

Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study.

Journal Article Journal of medical Internet research · July 2021 BackgroundNew technology adoption is common in health care, but it may elicit frustration if end users are not sufficiently considered in their design or trained in their use. These frustrations may contribute to burnout.ObjectiveThis stu ... Full text Open Access Cite

Perceptions of Institutional Support for "Second Victims" Are Associated with Safety Culture and Workforce Well-Being.

Journal Article Joint Commission journal on quality and patient safety · May 2021 ObjectiveThis study was performed to determine whether health care worker (HCW) assessments of good institutional support for second victims were associated with institutional safety culture and workforce well-being.MethodsHCWs' awareness ... Full text Open Access Cite

Personal and Professional Factors Associated With Work-Life Integration Among US Physicians.

Journal Article JAMA network open · May 2021 ImportancePoor work-life integration (WLI) occurs when career and personal responsibilities come in conflict and may contribute to the ongoing high rates of physician burnout. The characteristics associated with WLI are poorly understood.Objec ... Full text Open Access Cite

Clinician Burnout Associated With Sex, Clinician Type, Work Culture, and Use of Electronic Health Records.

Journal Article JAMA Netw Open · April 1, 2021 IMPORTANCE: Electronic health records (EHRs) are considered a potentially significant contributor to clinician burnout. OBJECTIVE: To describe the association of EHR usage, sex, and work culture with burnout for 3 types of clinicians at an academic medical ... Full text Open Access Link to item Cite

Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study (Preprint)

Journal Article · December 28, 2020 BACKGROUNDNew technology adoption is common in health care, but it may elicit frustration if end users are not sufficiently considered in their design or trained in their use. These frust ... Full text Open Access Cite

The Correlation Between Neonatal Intensive Care Unit Safety Culture and Quality of Care.

Journal Article Journal of patient safety · December 2020 ObjectivesKey validated clinical metrics are being used individually and in aggregate (Baby-MONITOR) to monitor the performance of neonatal intensive care units (NICUs). The degree to which perceptions of key components of safety culture, safety c ... Full text Open Access Cite

Gratitude at Work: Prospective Cohort Study of a Web-Based, Single-Exposure Well-Being Intervention for Health Care Workers.

Journal Article J Med Internet Res · May 14, 2020 BACKGROUND: Emotional exhaustion (EE) in health care workers is common and consequentially linked to lower quality of care. Effective interventions to address EE are urgently needed. OBJECTIVE: This randomized single-exposure trial examined the efficacy of ... Full text Open Access Link to item Cite

Associations Between a New Disruptive Behaviors Scale and Teamwork, Patient Safety, Work-Life Balance, Burnout, and Depression.

Journal Article Jt Comm J Qual Patient Saf · January 2020 BACKGROUND: Disruptive and unprofessional behaviors occur frequently in health care and adversely affect patient care and health care worker job satisfaction. These behaviors have rarely been evaluated at a work setting level, nor do we fully understand ho ... Full text Open Access Link to item Cite

Three Good Tools: Positively reflecting backwards and forwards is associated with robust improvements in well-being across three distinct interventions.

Journal Article The journal of positive psychology · January 2020 Burnout in healthcare workers (HCWs) is costly, consequential, and alarmingly high. Many HCWs report not having enough time or opportunities to engage in self-care. Brief, engaging, evidence-based tools have unique potential to alleviate burnout and improv ... Full text Open Access Cite

Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis.

Journal Article Annals of internal medicine · October 2019 BackgroundWhether health care provider burnout contributes to lower quality of patient care is unclear.PurposeTo estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exagg ... Full text Cite

Safety climate, safety climate strength, and length of stay in the NICU.

Journal Article BMC health services research · October 2019 BackgroundSafety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to e ... Full text Open Access Cite

Gratitude at Work: Prospective Cohort Study of a Web-Based, Single-Exposure Well-Being Intervention for Health Care Workers (Preprint)

Journal Article · July 19, 2019 BACKGROUNDEmotional exhaustion (EE) in health care workers is common and consequentially linked to lower quality of care. Effective interventions to address EE are urgently needed. ... Full text Open Access Cite

Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness.

Journal Article BMJ open · March 2019 ObjectivesHigh rates of healthcare worker (HCW) burn-out have led many to label it an 'epidemic' urgently requiring interventions. This prospective pilot study examined the efficacy, feasibility and evaluation of the 'Three Good Things' (3GT) inte ... Full text Open Access Cite

Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis.

Journal Article BMJ Qual Saf · February 2019 BACKGROUND: Healthcare is approaching a tipping point as burnout and dissatisfaction with work-life integration (WLI) in healthcare workers continue to increase. A scale evaluating common behaviours as actionable examples of WLI was introduced to measure w ... Full text Open Access Link to item Cite

Teaching patient safety in global health: lessons from the Duke Global Health Patient Safety Fellowship.

Journal Article BMJ Glob Health · 2019 Health systems in low-income and middle-income countries (LMICs) have a high burden of medical errors and complications, and the training of local experts in patient safety is critical to improve the quality of global healthcare. This analysis explores our ... Full text Link to item Cite

The Improvement Readiness scale of the SCORE survey: a metric to assess capacity for quality improvement in healthcare.

Journal Article BMC Health Serv Res · December 17, 2018 BACKGROUND: Quality improvement efforts are inextricably linked to the readiness of healthcare workers to take them on. The current study aims to clarify the nature and measurement of Improvement Readiness (IR) by 1) examining the psychometric properties o ... Full text Open Access Link to item Cite

Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout.

Journal Article BMJ quality & safety · April 2018 BackgroundThere is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance.MethodsThis cross-sectional survey study evaluated associations ... Full text Open Access Cite

Building a safety culture in global health: lessons from Guatemala.

Journal Article BMJ Glob Health · 2018 Programmes to modify the safety culture have led to lasting improvements in patient safety and quality of care in high-income settings around the world, although their use in low-income and middle-income countries (LMICs) has been limited. This analysis ex ... Full text Open Access Link to item Cite

Context in Quality of Care: Improving Teamwork and Resilience.

Journal Article Clinics in perinatology · September 2017 Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, ... Full text Cite

The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions.

Journal Article BMJ Qual Saf · August 2017 BACKGROUND: Improving the resiliency of healthcare workers is a national imperative, driven in part by healthcare workers having minimal exposure to the skills and culture to achieve work-life balance (WLB). Regardless of current policies, healthcare worke ... Full text Open Access Link to item Cite

Teamwork in the NICU Setting and Its Association with Health Care-Associated Infections in Very Low-Birth-Weight Infants.

Journal Article American journal of perinatology · August 2017 Background and Objective Teamwork may affect clinical care in the neonatal intensive care unit (NICU) setting. The objective of this study was to assess teamwork climate across NICUs and to test scale-level and item-level associations with health ca ... Full text Cite

The link between safety attitudes and observed performance in flight operations

Chapter · July 5, 2017 The present study explores the relationship between self reported perceptions of airline organizational culture variables, and pilot performance during regularly scheduled passenger flights. Organizational culture variables were investigated by examining t ... Full text Cite

A qualitative analysis of the Three Good Things intervention in healthcare workers.

Journal Article BMJ open · June 2017 BackgroundIntensive care unit (ICU) personnel have an elevated prevalence of job-related burn-out and post-traumatic stress disorder, which can ultimately impact patient care. To strengthen healthcare workers' skills to deal with stressful events, ... Full text Open Access Cite

Factors Associated With Provider Burnout in the NICU.

Journal Article Pediatrics · May 2017 BackgroundNICUs vary greatly in patient acuity and volume and represent a wide array of organizational structures, but the effect of these differences on NICU providers is unknown. This study sought to test the relation between provider burnout pr ... Full text Cite

Leadership and co-ordination

Chapter · March 2, 2017 Cite

Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections.

Journal Article Journal of perinatology : official journal of the California Perinatal Association · March 2017 ObjectiveTo examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates.Study designRe ... Full text Cite

Got spirit? The spiritual climate scale, psychometric properties, benchmarking data and future directions.

Journal Article BMC health services research · February 2017 BackgroundOrganizations that encourage the respectful expression of diverse spiritual views have higher productivity and performance, and support employees with greater organizational commitment and job satisfaction. Within healthcare, there is a ... Full text Open Access Cite

Managing threat and error to increase safety in medicine

Chapter · January 1, 2017 The topic of patient safety has been of great concern since the release of a report by the Institute of Medicine (IOM) concluding that as many as 98,000 patients per year may die needlessly in the United States as a result of medical error. The patient saf ... Full text Cite

Validation of the Dutch language version of the Safety Attitudes Questionnaire (SAQ-NL).

Journal Article BMC health services research · August 2016 BackgroundAs the first objective of caring for patients is to do no harm, patient safety is a priority in delivering clinical care. An essential component of safe care in a clinical department is its safety climate. Safety climate correlates with ... Full text Open Access Cite

Association of Safety Culture with Surgical Site Infection Outcomes.

Journal Article Journal of the American College of Surgeons · February 2016 BackgroundHospital workplace culture may have an impact on surgical outcomes; however, this association has not been established. We designed a study to evaluate the association between safety culture and surgical site infection (SSI).Study de ... Full text Cite

Practice and quality improvement: successful implementation of TeamSTEPPS tools into an academic interventional ultrasound practice.

Journal Article AJR Am J Roentgenol · January 2015 OBJECTIVE: The goal of this study was to implement an evidence-based teamwork system to improve communication and teamwork skills among health care professionals (TeamSTEPPS) into an academic interventional ultrasound program and to assess safety and team- ... Full text Link to item Cite

Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout.

Journal Article BMJ quality & safety · October 2014 BackgroundLeadership WalkRounds (WR) are widely used in healthcare organisations to improve patient safety. The relationship between WR and caregiver assessments of patient safety culture, and healthcare worker burnout is unknown.MethodsT ... Full text Cite

Burnout in the NICU setting and its relation to safety culture.

Journal Article BMJ quality & safety · October 2014 BackgroundBurnout is widespread among healthcare providers and is associated with adverse safety behaviours, operational and clinical outcomes. Little is known with regard to the explanatory links between burnout and these adverse outcomes.Obj ... Full text Open Access Cite

A closer look at associations between hospital leadership walkrounds and patient safety climate and risk reduction: a cross-sectional study.

Journal Article American journal of medical quality : the official journal of the American College of Medical Quality · September 2013 Leadership walkrounds (WRs) are widely used in health care organizations to improve patient safety. This retrospective, cross-sectional study evaluated the association between WRs and caregiver assessments of patient safety climate and patient safety risk ... Full text Cite

Assessing the Safety Attitudes Questionnaire (SAQ), German language version in Swiss university hospitals--a validation study.

Journal Article BMC health services research · September 2013 BackgroundImproving patient safety has become a major focus of clinical care and research over the past two decades. An institution's patient safety climate represents an essential component of ensuring a safe environment and thereby can be vital ... Full text Cite

Measuring handoff quality in labor and delivery: development, validation, and application of the Coordination of Handoff Effectiveness Questionnaire (CHEQ).

Journal Article Joint Commission journal on quality and patient safety · May 2013 BackgroundA prospective, nonblinded intervention study was conducted (1) to evaluate the psychometric properties of a new questionnaire, the CHEQ (Coordination of Handoff Effectiveness Questionnaire) for measuring the quality of handoff interactio ... Full text Cite

Safety culture and hand hygiene: linking attitudes to behavior.

Journal Article Infection control and hospital epidemiology · December 2012 Full text Cite

A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units*.

Journal Article Critical care medicine · November 2012 ObjectivesTo determine the causal effects of an intervention proven effective in pre-post studies in reducing central line-associated bloodstream infections in the intensive care unit.DesignWe conducted a multicenter, phased, cluster-rand ... Full text Cite

Predictors of likelihood of speaking up about safety concerns in labour and delivery.

Journal Article BMJ quality & safety · September 2012 BackgroundDespite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectio ... Full text Cite

Variation in safety culture dimensions within and between US and Swiss Hospital Units: an exploratory study.

Journal Article BMJ quality & safety · July 2012 BACKGROUND: The purpose of this study was to explore the variability in safety culture dimensions within and between Swiss and US clinical areas. METHODS: Cross-sectional design. The 30-item Safety Attitudes Questionnaire (SAQ) was distributed in 2009 to c ... Full text Cite

Neonatal intensive care unit safety culture varies widely.

Journal Article Archives of disease in childhood. Fetal and neonatal edition · March 2012 BackgroundVariation in healthcare delivery and outcomes in neonatal intensive care units (NICUs) may be partly explained by differences in safety culture.ObjectiveTo describe NICU care giver assessments of safety culture, explore variabil ... Full text Cite

The Safety Attitudes Questionnaire as a tool for benchmarking safety culture in the NICU.

Journal Article Archives of disease in childhood. Fetal and neonatal edition · March 2012 BackgroundNeonatal intensive care unit (NICU) safety culture, as measured by the Safety Attitudes Questionnaire (SAQ), varies widely. Associations with clinical outcomes in the adult intensive care unit setting make the SAQ an attractive tool for ... Full text Cite

Provider attitudes toward clinical protocols in obstetrics.

Journal Article Am J Med Qual · 2012 The Johns Hopkins Oxytocin Protocol (JHOP) Survey was distributed to clinical labor and delivery staff to compare obstetrical providers' attitudes toward clinical protocols and the JHOP. Agreement by registered nurses (RNs), physicians in training (PIT), a ... Full text Link to item Cite

Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-oriented plans.

Journal Article Joint Commission journal on quality and patient safety · November 2011 BackgroundThe Rhode Island (RI) Intensive Care Unit (ICU) Collaborative was designed to improve patient safety and clinical outcomes in adult ICUs through a unit-based patient safety program and evidenced-based practices. Few studies have shown ho ... Full text Cite

Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: An observational study.

Journal Article International journal of nursing studies · October 2011 BACKGROUND: Patient safety is fundamental to healthcare quality. Attention has recently focused on the patient safety culture of an organisation and its impact on patient outcomes. A strong safety climate appears to be an essential condition for safe patie ... Full text Cite

Republished paper: Assessing and improving safety culture throughout an academic medical centre: A prospective cohort study

Journal Article Postgraduate Medical Journal · June 1, 2011 Objectives: To describe the authors' hospital-wide efforts to improve safety climate at a large academic medical centre. Design and setting: A prospective cohort study used multiple interventions to improve hospital-wide safety climate. 144 clinical units ... Full text Cite

Predicting Likelihood of Speaking Up in Labor & Delivery

Conference JOGNN Journal of Obstetric Gynecologic and Neonatal Nursing · June 1, 2011 Full text Cite

Assessing and improving safety climate in a large cohort of intensive care units.

Journal Article Critical care medicine · May 2011 ObjectivesTo evaluate the impact of a comprehensive unit-based safety program on safety climate in a large cohort of intensive care units participating in the Keystone intensive care unit project.Design/settingA prospective cohort collabo ... Full text Cite

Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit.

Journal Article Infection control and hospital epidemiology · April 2011 ObjectiveTo evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.DesignCollaborative cohort before-after study.SettingIntensive care units ... Full text Cite

Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study.

Journal Article Quality & safety in health care · December 2010 ObjectivesTo describe the authors' hospital-wide efforts to improve safety climate at a large academic medical centre.Design and settingA prospective cohort study used multiple interventions to improve hospital-wide safety climate. 144 cl ... Full text Cite

Intensive care unit safety culture and outcomes: a US multicenter study.

Journal Article International journal for quality in health care : journal of the International Society for Quality in Health Care · June 2010 ObjectiveSafety culture may influence patient outcomes, but evidence is limited. We sought to determine if intensive care unit (ICU) safety culture is independently associated with outcomes.DesignCohort study combining safety culture surv ... Full text Cite

Job satisfaction ratings: measurement equivalence across nurses and physicians.

Journal Article Western journal of nursing research · June 2010 The measurement equivalence of job satisfaction ratings from physicians and nurses working in intensive care units was tested in the present study. Seventy-two nurses and 72 physicians completed the Safety Attitudes Questionnaire, which contains five items ... Full text Cite

Assessing safety culture in pharmacies: the psychometric validation of the Safety Attitudes Questionnaire (SAQ) in a national sample of community pharmacies in Sweden.

Journal Article BMC clinical pharmacology · April 2010 BackgroundSafety culture assessment is increasingly recognized as an important component in healthcare quality improvement, also in pharmacies. One of the most commonly used and rigorously validated tools to measure safety culture is the Safety At ... Full text Cite

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study.

Journal Article BMJ (Clinical research ed.) · February 2010 ObjectivesTo evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate ... Full text Cite

Care for the caregiver: Benefits of expressive writing for nurses in the United States

Journal Article Progress in Palliative Care · December 1, 2009 This paper introduces expressive writing as a new tool to build psychological resilience in nurses by helping themto reduce the negative impact of the primary sources of stress in their jobs.Delivering care to patients exposes nurses to intense stressors i ... Full text Cite

Reducing health care hazards: lessons from the commercial aviation safety team.

Journal Article Health affairs (Project Hope) · May 2009 The movement to improve quality of care and patient safety has grown, but examples of measurable and sustained progress are rare. The slow progress made in health care contrasts with the success of aviation safety. After a tragic 1995 plane crash, the avia ... Full text Cite

Surgical team behaviors and patient outcomes.

Journal Article American journal of surgery · May 2009 BackgroundLittle evidence exists that links teamwork to patient outcomes. We conducted this study to determine if patients of teams with good teamwork had better outcomes than those with poor teamwork.MethodsObservers used a standardized ... Full text Cite

Measurement of quality and assurance of safety in the critically ill.

Journal Article Clinics in chest medicine · March 2009 The global health care community has worked tirelessly for nearly a decade to make medical care safer for patients, but it still has limited ability to evaluate whether safety has improved. While there is a universal push to measure safety outcomes, the ma ... Full text Cite

Beyond "see one, do one, teach one": toward a different training paradigm.

Journal Article Quality & safety in health care · February 2009 In the process of acquiring new skills, physicians-in-training may expose patients to harm because they lack the required experience, knowledge and technical skills. Yet, most teaching hospitals use inexperienced residents to care for high-acuity patients ... Full text Cite

Clinical review: checklists - translating evidence into practice.

Journal Article Critical care (London, England) · January 2009 Checklists are common tools used in many industries. Unfortunately, their adoption in the field of medicine has been limited to equipment operations or part of specific algorithms. Yet they have tremendous potential to improve patient outcomes by democrati ... Full text Cite

Framework for patient safety research and improvement.

Journal Article Circulation · January 2009 Full text Cite

Revealing and resolving patient safety defects: the impact of leadership WalkRounds on frontline caregiver assessments of patient safety.

Journal Article Health services research · December 2008 ObjectiveTo evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds.Data sources/study settingPrimary outcome variables were basel ... Full text Cite

Impact of preoperative briefings on operating room delays: a preliminary report.

Journal Article Archives of surgery (Chicago, Ill. : 1960) · November 2008 HypothesisPreoperative briefings have the potential to reduce operating room (OR) delays through improved teamwork and communication.DesignPre-post study.SettingTertiary academic center.ParticipantsSurgeons, anesthesiolo ... Full text Cite

Developing process-support tools for patient safety: finding the balance between validity and feasibility.

Journal Article Joint Commission journal on quality and patient safety · October 2008 The Johns Hopkins Quality and Safety Research Group, which has developed many process-support tools--three of which are reported in this issue--describes its approach to tool development. ... Full text Cite

Improving patient safety in intensive care units in Michigan.

Journal Article Journal of critical care · June 2008 PurposeThe aim of this study was to describe the design and lessons learned from implementing a large-scale patient safety collaborative and the impact of an intervention on teamwork climate in intensive care units (ICUs) across the state of Michi ... Full text Cite

A check-up for safety culture in "my patient care area".

Journal Article Joint Commission journal on quality and patient safety · November 2007 The two-page Culture Check-Up Tool, which takes 30 to 60 minutes to complete as a group exercise, can help clinicians recognize and fix culture problems. ... Full text Cite

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial.

Journal Article Journal of perinatology : official journal of the California Perinatal Association · July 2007 ObjectiveTo add a team training and human error curriculum to the Neonatal Resuscitation Program (NRP) and measure its effect on teamwork. We hypothesized that teams that received the new course would exhibit more teamwork behaviors than those in ... Full text Cite

Needlestick injuries among surgeons in training.

Journal Article The New England journal of medicine · June 2007 BackgroundSurgeons in training are at high risk for needlestick injuries. The reporting of such injuries is a critical step in initiating early prophylaxis or treatment.MethodsWe surveyed surgeons in training at 17 medical centers about p ... Full text Cite

Partnership With Patients: Response

Journal Article Chest · April 2007 Full text Cite

Operating room briefings and wrong-site surgery.

Journal Article Journal of the American College of Surgeons · February 2007 BackgroundWrong-site surgery can be a catastrophic event for a patient, caregiver, and institution. Although communication breakdowns have been identified as the leading cause of wrong-site surgery, the efficacy of preventive strategies remains un ... Full text Cite

Measuring safety culture in the ambulatory setting: the safety attitudes questionnaire--ambulatory version.

Journal Article Journal of general internal medicine · January 2007 BackgroundProvider attitudes about issues pertinent to patient safety may be related to errors and adverse events. We know of no instruments that measure safety-related attitudes in the outpatient setting.ObjectiveTo adapt the safety atti ... Full text Cite

Perceptions of safety culture vary across the intensive care units of a single institution.

Journal Article Critical care medicine · January 2007 ObjectiveTo determine whether safety culture factors varied across the intensive care units (ICUs) of a single hospital, between nurses and physicians, and to explore ICU nursing directors' perceptions of their personnel's attitudes.Design Full text Cite

Response [6]

Journal Article Chest · January 1, 2007 Full text Cite

An intervention to decrease catheter-related bloodstream infections in the ICU.

Journal Article The New England journal of medicine · December 2006 BackgroundCatheter-related bloodstream infections occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.MethodsWe conducted a collaborative cohort study predominantly in ICUs in Michigan. An evidence-based ... Full text Cite

Toward learning from patient safety reporting systems.

Journal Article Journal of critical care · December 2006 PurposeTo evaluate the frequency and type of factors involved in incidents reported to a patient safety reporting system and answer specific questions to enhance the value of PSRS data to improve patient safety.Materials and methodsProspe ... Full text Cite

Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel.

Journal Article Anesthesiology · November 2006 BackgroundThe Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007. However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently ... Full text Cite

A leadership framework for culture change in health care.

Journal Article Joint Commission journal on quality and patient safety · August 2006 BackgroundIn 2005, Ascension Health's strategic direction sharpened the focus of its 2002 Call to Action to provide "Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind, for Life," Ascension Health has used a f ... Full text Cite

Creating high reliability in health care organizations.

Journal Article Health services research · August 2006 ObjectiveThe objective of this paper was to present a comprehensive approach to help health care organizations reliably deliver effective interventions.ContextReliability in healthcare translates into using valid rate-based measures. Yet ... Full text Cite

Variation in caregiver perceptions of teamwork climate in labor and delivery units.

Journal Article Journal of perinatology : official journal of the California Perinatal Association · August 2006 ObjectiveTo test the psychometric soundness of a teamwork climate survey in labor and delivery, examine differences in perceptions of teamwork, and provide benchmarking data.DesignCross-sectional survey of labor and delivery caregivers in ... Full text Cite

How will we know patients are safer? An organization-wide approach to measuring and improving safety.

Journal Article Critical care medicine · July 2006 ObjectiveOur institution, like many, is struggling to develop measures that answer the question, How do we know we are safer? Our objectives are to present a framework to evaluate performance in patient safety and describe how we applied this mode ... Full text Cite

Operating room debriefings.

Journal Article Joint Commission journal on quality and patient safety · July 2006 This tool helps assess factors that positively and negatively contributed to an adverse event, near miss, or inefficiency during an operation-or any procedure. ... Full text Cite

Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder.

Journal Article Journal of the American College of Surgeons · May 2006 BackgroundTeamwork is an important component of patient safety. In fact, communication errors are the most common cause of sentinel events and wrong-site operations in the US. Although efforts to improve patient safety through improving teamwork a ... Full text Cite

Patient safety in surgery.

Journal Article Annals of surgery · May 2006 BackgroundImproving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) c ... Full text Cite

The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research.

Journal Article BMC health services research · April 2006 BackgroundThere is widespread interest in measuring healthcare provider attitudes about issues relevant to patient safety (often called safety climate or safety culture). Here we report the psychometric properties, establish benchmarking data, and ... Full text Cite

Teamwork and quality during neonatal care in the delivery room.

Journal Article Journal of perinatology : official journal of the California Perinatal Association · March 2006 ObjectiveExperts believe good teamwork among health care providers may improve quality. We sought to measure the frequency of team behaviors during delivery room care and to explore how these behaviors relate to the quality of care.Study desig ... Full text Cite

A morning briefing: setting the stage for a clinically and operationally good day.

Journal Article Joint Commission journal on quality and patient safety · August 2005 This tool can be used in any setting where physicians, nurses, and other disciplines work as a team to manage patients and admission-to-discharge flow. ... Full text Cite

Assessing safety culture: guidelines and recommendations.

Journal Article Quality & safety in health care · August 2005 Full text Cite

The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units

Journal Article BMC Health Services Research · April 11, 2005 Background: Executive walk rounds (EWRs) are a widely used but unstudied activity designed to improve safety culture in hospitals. Therefore, we measured the impact of EWRs on one important part of safety culture - provider attitudes about the safety clima ... Full text Cite

The effect of executive walk rounds on nurse safety climate attitudes: a randomized trial of clinical units[ISRCTN85147255] [corrected].

Journal Article BMC health services research · April 2005 BackgroundExecutive walk rounds (EWRs) are a widely used but unstudied activity designed to improve safety culture in hospitals. Therefore, we measured the impact of EWRs on one important part of safety culture -- provider attitudes about the safe ... Full text Cite

Five years after to err is human

Journal Article Journal of Critical Care · January 1, 2005 Full text Cite

Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation.

Journal Article Quality & safety in health care · October 2004 Improving teamwork in healthcare may help reduce and manage errors. This paper takes a step toward that goal by (1) proposing a set of teamwork behaviours, or behavioural markers, for neonatal resuscitation; (2) presenting a data form for recording observa ... Full text Cite

Working together in the neonatal intensive care unit: provider perspectives.

Journal Article Journal of perinatology : official journal of the California Perinatal Association · September 2004 ObjectivesTo elicit healthcare provider perceptions of working together in a neonatal intensive care unit (NICU).Study designWe conducted focus groups to elicit descriptions of how providers work together. The groups included one each of ... Full text Cite

Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit.

Journal Article Annals of internal medicine · June 2004 Intensive care is one of the largest, most expensive, and complex components of U.S. health care. Errors and the resulting adverse events are, however, common in intensive care units (ICUs). Theories about errors in high-risk environments, developed by avi ... Full text Cite

The effect of executive walk rounds on safety climate.

Conference JOURNAL OF GENERAL INTERNAL MEDICINE · 2004 Cite

Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center.

Journal Article Quality & safety in health care · December 2003 BackgroundDespite the emphasis on patient safety in health care, few organizations have evaluated the extent to which safety is a strategic priority or their culture supports patient safety. In response to the Institute of Medicine's report and to ... Full text Cite

Discrepant attitudes about teamwork among critical care nurses and physicians.

Journal Article Critical care medicine · March 2003 ObjectiveTo measure and compare critical care physicians' and nurses' attitudes about teamwork.DesignCross-sectional surveys.SettingEight nonsurgical intensive care units in two teaching and four nonteaching hospitals in the Hous ... Full text Cite

Safety attitudes vary across ICUs of a single hospital

Conference CRITICAL CARE MEDICINE · 2003 Cite

Engaging nurses in patient safety.

Journal Article Critical care nursing clinics of North America · December 2002 Critical care nurses can be instrumental in developing and implementing changes to improve patient safety. Targeted interventions, based on nurse-identified issues, can yield measurable results. There were several keys to engaging and sustaining nurses in ... Full text Cite

Analyzing cockpit communications: the links between language, performance, error, and workload.

Journal Article Human performance in extreme environments : the journal of the Society for Human Performance in Extreme Environments · October 2000 The importance of communication on the flightdeck is discussed and the application of a new computer-based linguistic method of text analysis is introduced. Preliminary results from a NASA B727 simulator study indicate that specific language variables are ... Full text Cite

Error, stress, and teamwork in medicine and aviation: cross sectional surveys.

Journal Article BMJ (Clinical research ed.) · March 2000 ObjectivesTo survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew.Design: Cross sectional surveys.Setting: ... Full text Cite

Error, stress, and teamwork in medicine and aviation: Cross sectional surveys

Journal Article Ugeskrift for Laeger · 2000 Objectives: To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew, Design: Cross sectional surveys. Setting: Urban teaching and non ... Cite