Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Patient Safety: Collaboration, Communication, and Physician Leadership 8 articles


Do 360-degree Feedback Survey Results Relate to Patient Satisfaction Measures?

Michiel G. J. S. Hageman MD, David C. Ring MD, PhD, Paul J. Gregory PhD, Harry E. Rubash MD, PhD, Larry Harmon PhD

There is evidence that feedback from 360-degree surveys—combined with coaching—can improve physician team performance and quality of patient care. The Physicians Universal Leadership-Teamwork Skills Education (PULSE) 360 is one such survey tool that is used to assess work colleagues’ and coworkers’ perceptions of a physician’s leadership, teamwork, and clinical practice style. The Clinician & Group-Consumer Assessment of Healthcare Providers and System (CG-CAHPS), developed by the US Department of Health and Human Services to serve as the benchmark for quality health care, is a survey tool for patients to provide feedback that is based on their recent experiences with staff and clinicians and soon will be tied to Medicare-based compensation of participating physicians. Prior research has indicated that patients and coworkers often agree in their assessment of physicians’ behavioral patterns. The goal of the current study was to determine whether 360-degree, also called multisource, feedback provided by coworkers could predict patient satisfaction/experience ratings. A significant relationship between these two forms of feedback could enable physicians to take a more proactive approach to reinforce their strengths and identify any improvement opportunities in their patient interactions by reviewing feedback from team members. An automated 360-degree software process may be a faster, simpler, and less resource-intensive approach than telephoning and interviewing patients for survey responses, and it potentially could facilitate a more rapid credentialing or quality improvement process leading to greater fiscal and professional development gains for physicians.

What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review

Joshua D. Harris MD, LT, Greg Staheli MD, MC, USN, LCDR, Lance LeClere MD, MC, USN, Diana Andersone BS, Frank McCormick MD

More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents’ duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics.

How Prevalent Are Hazardous Attitudes Among Orthopaedic Surgeons?

Wendy E. Bruinsma MD, Stéphanie J. E. Becker MD, Thierry G. Guitton MD, PhD, John Kadzielski MD, David Ring MD, PhD

So-called “hazardous attitudes” (macho, impulsive, antiauthority, resignation, invulnerable, and confident) were identified by the Federal Aviation Administration and the Canadian Air Transport Administration as contributing to road traffic incidents among college-aged drivers and felt to be useful for the prevention of aviation accidents. The concept of hazardous attitudes may also be useful in understanding adverse events in surgery, but it has not been widely studied.

Incidence of Surgical Site Infection After Spine Surgery: What Is the Impact of the Definition of Infection?

Sjoerd P. F. T. Nota MD, Yvonne Braun MD, David Ring MD, PhD, Joseph H. Schwab MD, MS

Orthopaedic surgical site infections (SSIs) can delay recovery, add impairments, and decrease quality of life, particularly in patients undergoing spine surgery, in whom SSIs may also be more common. Efforts to prevent and treat SSIs of the spine rely on the identification and registration of these adverse events in large databases. The effective use of these databases to answer clinical questions depends on how the conditions in question, such as infection, are defined in the databases queried, but the degree to which different definitions of infection might cause different risk factors to be identified by those databases has not been evaluated.

Surgeons’ Attitudes Are Associated With Reoperation and Readmission Rates

John Kadzielski MD, Frank McCormick MD, James H. Herndon MD, MBA, Harry Rubash MD, David Ring MD, PhD

Attitudes influence how people make decisions. In an effort to decrease pilot judgment-related accidents, the Federal Aviation Administration teaches new pilots about hazardous attitudes that are believed to be incompatible with safe flight: macho, impulsive, worry, resignation, self-confidence, and antiauthority. If these attitudes are hazardous for pilots and their passengers, they may also be incompatible with the reliable and safe delivery of surgical care.

Use of the National Surgical Quality Improvement Program in Orthopaedic Surgery

Cesar S. Molina MD, Rachel V. Thakore BS, Alexandra Blumer BS, William T. Obremskey MD, MPH, MMHC, Manish K. Sethi MD

The goal of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) is to improve patient safety. The database has been used by hospitals across the United States to decrease the rate of adverse events and improve surgical outcomes, including dramatic decreases in 30-day mortality, morbidity, and complication rates. However, only a few orthopaedic surgical studies have employed the ACS NSQIP database, all of which have limited their analysis to either single orthopaedic procedures or reported rates of adverse events without considering the effect of patient characteristics and comorbidities.