Thesis (Ph.D.)--Ohio University, June, 2008. / Title from PDF t.p. Includes bibliographical references.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2017-04-18T20:23:49Z No. of bitstreams: 2 Dissertação - Fernando Fortes Picoli - 2017.pdf: 3321173 bytes, checksum: 6f8f8cd249cf836151faa2fc3de2aafc (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-20T13:00:40Z (GMT) No. of bitstreams: 2 Dissertação - Fernando Fortes Picoli - 2017.pdf: 3321173 bytes, checksum: 6f8f8cd249cf836151faa2fc3de2aafc (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-04-20T13:00:40Z (GMT). No. of bitstreams: 2 Dissertação - Fernando Fortes Picoli - 2017.pdf: 3321173 bytes, checksum: 6f8f8cd249cf836151faa2fc3de2aafc (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-20 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Once the dentist is inserted in a social context, his professional performance is mediated by laws that may require compensation, as financial claims, for the damages caused to the patients. The literature has pointed out a significant increase in the lawsuits that dentists are involved, being orthodontics among the specialties most enrolled in these litigations. This study aimed to analyze the judicial decisions on second instance that involved Orthodontics in alleged dental error in Brazil. An online search was done on the virtual pages of the Courts of Justice of the Brazilian states and the Federal District, searching for decisions that were published until December 31st, and that had the orthodontic treatment as central focus. The following keywords were used in the search: erro AND odontológico; erro AND odontologia; ortodontia; aparelho AND dentário; dentário; ortodôntico. Data regarding the profile of the parties, monetary amounts involved, contractual obligation, type of civil liability considered and the judgments of judicial decisions were collected. A total of 319 judgments that were in line with the scope of research were found, and in 38.6% of them, the main reason for initiating the lawsuit was dissatisfaction with the orthodontic treatment. In 52.4% of the cases, there was absolution of the dentist. The conviction in the first instance and the fact that orthodontic treatment was considered as a contractual obligation of result had a statistically significant influence (p <0.05) on the conviction frequencies of the professionals in the second instance. Through this study, it can be concluded that, in Brazil, most patients who demand dentists for malpractice in orthodontic therapy claimed to be dissatisfied with the treatment outcome. The conviction on the singular jury decision and the contractual obligation of the Orthodontics influenced the frequency of second-degree convictions. / Estando o cirurgião-dentista inserido no contexto social, sua atuação profissional também é mediada por normas jurídicas que podem exigir que os danos causados aos pacientes sejam ressarcidos na forma de indenizações. A literatura tem apontado um incremento significativo nas ações judiciais que cirurgiões-dentistas são demandados, estando a Ortodontia entre as especialidades mais envolvidas nessas lides. Este trabalho teve como objetivo analisar as decisões judiciais de segunda instância que envolviam a Ortodontia em alegado erro odontológico no Brasil. Para tanto, foram feitas pesquisas nas páginas virtuais dos Tribunais de Justiça dos estados brasileiros e do Distrito Federal, com o auxílio da internet, buscando por decisões publicadas até 31 de dezembro de 2015 e que tivessem como cerne da lide o tratamento ortodôntico. Foram utilizadas as palavras chave associadas a operador booleano: erro E odontológico; erro E odontologia; ortodontia; aparelho E dentário; dentário; ortodôntico. Dados relativos ao perfil das partes, valores monetários envolvidos, obrigação contratual, tipo de responsabilidade civil considerada e as sentenças das decisões judiciais foram coletados. Encontrou-se 319 acórdãos que atendiam ao escopo do trabalho, sendo que em 38,6% deles, o motivo alegado para instauração dos processos foi a insatisfação com o tratamento. Em 52,4% dos casos, houve absolvição do cirurgião-dentista. A condenação em primeira instância e o fato do tratamento ortodôntico ter sido considerado como obrigação contratual de resultado influenciaram de forma estatisticamente significante (p<0,05) nas frequências de condenações dos profissionais em segunda instância. Por meio deste trabalho, pode-se concluir que a maior parte dos pacientes que processam os cirurgiões-dentistas por insatisfação com tratamento ortodônticos no Brasil alegaram estar insatisfeitos com o resultado do tratamento, sendo que a sentença condenatória em primeiro grau e a obrigação contratual da Ortodontia influenciaram na frequência de sentenças condenatórias em segundo grau.

Este trabalho tenta colocar em evidência dois pontos dos mais atuais, tanto na área da Medicina como no Direito: a falha técnica e a correspondente reparação do dano por ela causado. Para o desenvolvimento deste trabalho, foram utilizados processos judiciais de primeira instância no período de 1995 a 2003 correlacionados às cirurgias do aparelho digestivo. Buscou-se definir os perfis dos médicos mais processados, que pagam maiores valores indenizatórios, bem como de outro lado os pacientes que mais processam e mais recebem valores indenizatórios, nos processos analisados. Os parâmetros, principais de análise foram as sentenças proferidas em primeira instância, em casos de condenação do médico e os respectivos valores envolvidos. Finalmente concluímos que: O perfil do paciente que mais processa médico: 41 a 60 anos, branco, feminino, católico com nível superior e detentor de justiça gratuita. O perfil do paciente recebe maiores valores médios indenizatórios: 41 a 60 anos, negro, feminino, católico, ensino fundamental e detentor de justiça gratuita. O perfil do médico que é mais processado por erro médico em Cirurgia do Aparelho Digestivo: 41 a 60 anos, branco, masculino, com título de especialista, formado entre 21 a 30 anos, no atendimento de convênio de plano de saúde, não possuindo seguro profissional, em atendimento de urgência/emergência e em equipe multidisciplinar. O perfil do médico que paga maiores valores indenizatórios em processos por erro médico em Cirurgia do Aparelho Digestivo: 21 a 40 anos, branco, masculino, residente, em atendimento em hospital público, não possuindo seguro profissional, em atendimento de urgência/emergência e em equipe multidisciplinar. / This works attempts to highlight two of the most current points, both in the fields of Medicine and Law: technical failure and the corresponding repair of the damage caused by it. For the development of this work, trial-court level proceedings in the period from 1995 to 2003 related to digestive system surgeries were used. The intention was to define the profile of the most prosecuted physicians, who pay the highest indemnification amounts, as well as, on the other hand, the patients that prosecute them most and receive indemnification amounts the most, in the reviewed proceedings. The main parameters for analysis were the judgments issued at trial-court level, in cases of conviction of the physician and the corresponding amounts involved. Finally, we concluded that: The profile of the patient who prosecutes the physician the most: 41 to 60 years old, Caucasian, female, catholic with higher education and entitled to free-of-charge justice. The profile of the patient who receives the highest average indemnity amount: 41 to 60 years old, black, female, catholic with primary education and entitled to free-of-charge justice. The profile of the physician who is prosecuted the most for medical error in a Surgery of the Digestive System: 41 to 60 years old, Caucasian, male, with a specialist degree, graduated between 21 and 30 years old, operating with health care insurance, and not holding professional insurance, in cases of urgency/emergency and in a multi-disciplinary team. The profile of the physician who pays the highest indemnity amounts in cases of medical error in a Surgery of the Digestive System: 21 to 40 years old, Caucasian, male, resident, working at a public hospital, not holding professional insurance, in cases of urgency/emergency and in a multi-disciplinary team.

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on:1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13192号 / 論医博第2156号 / 新制||医||1030(附属図書館) / (主査)教授 中山 健夫, 教授 松村 由美, 教授 川村 孝 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Transparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis. Three predictor variables are used to represent the various dimensions of the context just described. Perfectionism represents the intrapersonal domain, socio-organizational climate represents the interpersonal and institutional domains, and medico-legal environment represents the societal domain. Chin and Benne’s normative re-educative strategy provides theoretical support for the notion that successful organizational change hinges upon addressing the structural and cultural barriers displayed by individuals and groups. The Physician Transparency Questionnaire was completed by 270 physicians who were drawn from a multi-site healthcare organization in Central Florida. Structural equation modeling was used to determine whether perfectionism, socio-organizational climate, and medico-legal environment significantly predict two transparency outcomes, namely, error reporting transparency and provider-patient transparency. Perfectionism and socio-organizational climate were found to be statistically significant predictors. Collectively, these variables accounted for nearly half of the variance in each transparency outcome. Within socio-organizational climate, policies had the greatest influence iv on transparency, followed by immunity and professional norms. Multiple group analysis showed that the covariance model developed in this study generalizes across gender, medical specialty, and occupation. In addition, group means comparisons tests revealed a number of interesting trends in error reporting and disclosure practices that provide insights about the behavioral and cognitive psychology behind transparent communication: 1) Physicians are more inclined to engage in provider-patient transparency compared to error reporting transparency, 2) physicians are more inclined to report serious errors compared to less serious errors, and 3) physicians are more inclined to express sympathy for bad outcomes than they are to apologize for a preventable error or be honest about the details surrounding bad outcomes. These results suggest that change efforts would need to be directed at medical education curricula and health provider organizations to ensure that current and future generations of physicians replace the pursuit for perfectionism with the pursuit for excellence. Also, a number of institutional changes are recommended, such as clearly communicating transparency policies and guidelines, promoting professional norms that encourage learning from mistakes rather than an aversion to error, and reassuring physicians that reporting and disclosure activities will not compromise their reputation. From the perspective of patient safety advocates and risk managers, the results are heartening because they emphasize a key principle in quality improvement - i.e., small changes can yield big results. From an ethical standpoint, this research suggests that healthcare organizations can inhibit (or facilitate) the emergence of professional virtues. Thus, although organizations cannot make a physician become virtuous, it is within their power to create conditions that encourage the physician to practice certain virtues. With respect to leadership styles, this research finds that v bottom-up, grassroots change efforts can elicit professional virtues, and that culture change in healthcare lies beyond the scope of the medico-legal system

No description available.

Studies suggest that the majority of hospital errors go unreported. Equally disturbing is that data surrounding near miss events that could have harmed patients has been found to be even sparser. At the core of any medical error reporting effort is a desire to obtain data that can be used to reduce the frequency of errors, reveal the cause of errors, and empower those involved in the healthcare delivery system with the insight required to design methods to prevent the flaws that allow mistakes to occur. Aligned with the adage that “we can’t fix what we don’t know is broke”, the question is raised why does underreporting exist? The likelihood of reporting medical errors is explored as a manifestation of culture. Factors studied include communication and feedback, teamwork, fear of retribution, and leadership support (top management and supervisor). Data is presented using a nationally recognized instrument—the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety survey. Findings from the research are mixed with little positive relationship between the model and number of events reported although each factor is found to be positively associated with an employee’s perceived frequency by which near miss and no harm events are reported. While advances in patient safety have materialized, the act of employees’ actually reporting events still pales in comparison to the number of errors that have likely occurred, regardless of efforts to advance culture. To explore influencers beyond those found in the AHRQ Culture of Safety survey, an overlapping model is presented. This includes studying various underlying factors, such as understanding what constitutes a reportable event, ease of reporting, and knowledge of the processes supporting data submission, along with attempting to better assess the impact of the direct supervisor and incentives in influencing behavior. Findings suggest that these additional factors do contribute, albeit modestly, to the act of reporting errors. When adding tenure and patient interaction to the model, a higher percentage of the variance is explained. In terms of perceived frequency of reporting near misses and no harm events, this model yields similar results to the first, explaining approximately 28% of the variance. The two factors most positively associated with perceived frequency of reporting near miss and no harm events are communication and feedback and infrastructure —suggesting that some unexplored relationship may exist between the overlapping models. / Business Administration/Interdisciplinary

No / Describe, discuss and critically appraise human error theory and consider its relevance for nurse managers. Healthcare errors are a persistent threat to patient safety. Effective risk management and clinical governance depends on understanding the nature of error. EVALUATION: This paper draws upon a wide literature from published works, largely from the field of cognitive psychology and human factors. Although the content of this paper is pertinent to any healthcare professional; it is written primarily for nurse managers. KEY ISSUES: Error is inevitable. Causation is often attributed to individuals, yet causation in complex environments such as healthcare is predominantly multi-factorial. Individual performance is affected by the tendency to develop prepacked solutions and attention deficits, which can in turn be related to local conditions and systems or latent failures. Blame is often inappropriate. Defences should be constructed in the light of these considerations and to promote error wisdom and organizational resilience. CONCLUSION AND IMPLICATIONS: Managing and learning from error is seen as a priority in the British National Health Service (NHS), this can be better achieved with an understanding of the roots, nature and consequences of error. Such an understanding can provide a helpful framework for a range of risk management activities.

No / Patients are increasingly being thought of as central to patient safety. A small but growing body of work suggests that patients may have a role in reporting patient safety problems within a hospital setting. This review considers this disparate body of work, aiming to establish a collective view on hospital-based patient reporting. STUDY OBJECTIVES: This review asks: (a) What can patients report? (b) In what settings can they report? (c) At what times have patients been asked to report? (d) How have patients been asked to report? METHOD: 5 databases (MEDLINE, EMBASE, CINAHL, (Kings Fund) HMIC and PsycINFO) were searched for published literature on patient reporting of patient safety 'problems' (a number of search terms were utilised) within a hospital setting. In addition, reference lists of all included papers were checked for relevant literature. RESULTS: 13 papers were included within this review. All included papers were quality assessed using a framework for comparing both qualitative and quantitative designs, and reviewed in line with the study objectives. DISCUSSION: Patients are clearly in a position to report on patient safety, but included papers varied considerably in focus, design and analysis, with all papers lacking a theoretical underpinning. In all papers, reports were actively solicited from patients, with no evidence currently supporting spontaneous reporting. The impact of timing upon accuracy of information has yet to be established, and many vulnerable patients are not currently being included in patient reporting studies, potentially introducing bias and underestimating the scale of patient reporting. The future of patient reporting may well be as part of an 'error detection jigsaw' used alongside other methods as part of a quality improvement toolkit.