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Article: Sensemaking in the Time of COVID-19

Christianson, Marlys K. / Barton, Michelle A.

Journal of Management Studies

Abstract: Abstract When people encounter surprising or confusing events, they engage in sensemaking to answer the questions, ?what?s the story?? and ?now what?? (Weick et al , 2005) Sensemaking is a socially constructed process in which individuals interact with ... ...

Abstract	Abstract When people encounter surprising or confusing events, they engage in sensemaking to answer the questions, ?what?s the story?? and ?now what?? (Weick et al , 2005) Sensemaking is a socially constructed process in which individuals interact with their environment and with others to create meaning and enable action The COVID-19 pandemic has created an environment that is dynamically uncertain ? routines are upended, normal interactions are disrupted, and risk must be reassessed on an ongoing basis
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #868214
Database	COVID19

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Article ; Online: End-of-round time compression in physician handoff sessions--reply.

Christianson, Marlys K / Ilan, Roy

JAMA internal medicine

2013 Volume 173, Issue 11, Page(s) 1034

MeSH term(s)	Attitude of Health Personnel ; Communication ; Continuity of Patient Care/organization & administration ; Efficiency, Organizational ; Humans ; Medical Staff, Hospital/statistics & numerical data ; Physician-Patient Relations
Language	English
Publishing date	2013-06-10
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2013.1254
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Article ; Online: Implementation of a central-line bundle: a qualitative study of three clinical units.

Goldman, Joanne / Rotteau, Leahora / Shojania, Kaveh G / Baker, G Ross / Rowland, Paula / Christianson, Marlys K / Vogus, Timothy J / Cameron, Connie / Coffey, Maitreya

Implementation science communications

2021 Volume 2, Issue 1, Page(s) 105

Abstract: Background: Evidence for the central line-associated bloodstream infection (CLABSI) bundle effectiveness remains mixed, possibly reflecting implementation challenges and persistent ambiguities in how CLABSIs are counted and bundle adherence measured. In ...

Abstract	Background: Evidence for the central line-associated bloodstream infection (CLABSI) bundle effectiveness remains mixed, possibly reflecting implementation challenges and persistent ambiguities in how CLABSIs are counted and bundle adherence measured. In the context of a tertiary pediatric hospital that had reduced CLABSI by 30% as part of an international safety program, we aimed to examine unit-based socio-cultural factors influencing bundle practices and measurement, and how they come to be recognized and attended to by safety leaders over time in an organization-wide bundle implementation effort. Methods: We used an interpretivist qualitative research approach, based on 74 interviews, approximately 50 h of observations, and documents. Data collection focused on hospital executives and safety leadership, and three clinical units: a medical specialty unit, an intensive care unit, and a surgical unit. We used thematic analysis and constant comparison methods for data analysis. Results: Participants had variable beliefs about the central-line bundle as a quality improvement priority based on their professional roles and experiences and unit setting, which influenced their responses. Nursing leaders were particularly concerned about CLABSI being one of an overwhelming number of QI targets for which they were responsible. Bundle implementation strategies were initially reliant on unit-based nurse education. Over time there was recognition of the need for centralized education and reinforcement tactics. However, these interventions achieved limited impact given the influence of competing unit workflow demands and professional roles, interactions, and routines, which were variably targeted in the safety program. The auditing process, initially a responsibility of units, was performed in different ways based on individuals' approaches to the process. Given concerns about auditing reliability, a centralized approach was implemented, which continued to have its own variability. Conclusions: Our findings report on a contextualized, dynamic implementation approach that required movement between centralized and unit-based approaches and from a focus on standardization to some recognition of a role for customization. However, some factors related to bundle compliance and measurement remain unaddressed, including harder to change socio-cultural factors likely important to sustainability of the CLABSI reductions and fostering further improvements across a broader safety agenda.
Language	English
Publishing date	2021-09-16
Publishing country	England
Document type	Journal Article
ISSN	2662-2211
ISSN (online)	2662-2211
DOI	10.1186/s43058-021-00204-y
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Article ; Online: Implementation of a central-line bundle

Joanne Goldman / Leahora Rotteau / Kaveh G. Shojania / G. Ross Baker / Paula Rowland / Marlys K. Christianson / Timothy J. Vogus / Connie Cameron / Maitreya Coffey

Implementation Science Communications, Vol 2, Iss 1, Pp 1-

a qualitative study of three clinical units

2021 Volume 11

Abstract: Abstract Background Evidence for the central line-associated bloodstream infection (CLABSI) bundle effectiveness remains mixed, possibly reflecting implementation challenges and persistent ambiguities in how CLABSIs are counted and bundle adherence ... ...

Abstract	Abstract Background Evidence for the central line-associated bloodstream infection (CLABSI) bundle effectiveness remains mixed, possibly reflecting implementation challenges and persistent ambiguities in how CLABSIs are counted and bundle adherence measured. In the context of a tertiary pediatric hospital that had reduced CLABSI by 30% as part of an international safety program, we aimed to examine unit-based socio-cultural factors influencing bundle practices and measurement, and how they come to be recognized and attended to by safety leaders over time in an organization-wide bundle implementation effort. Methods We used an interpretivist qualitative research approach, based on 74 interviews, approximately 50 h of observations, and documents. Data collection focused on hospital executives and safety leadership, and three clinical units: a medical specialty unit, an intensive care unit, and a surgical unit. We used thematic analysis and constant comparison methods for data analysis. Results Participants had variable beliefs about the central-line bundle as a quality improvement priority based on their professional roles and experiences and unit setting, which influenced their responses. Nursing leaders were particularly concerned about CLABSI being one of an overwhelming number of QI targets for which they were responsible. Bundle implementation strategies were initially reliant on unit-based nurse education. Over time there was recognition of the need for centralized education and reinforcement tactics. However, these interventions achieved limited impact given the influence of competing unit workflow demands and professional roles, interactions, and routines, which were variably targeted in the safety program. The auditing process, initially a responsibility of units, was performed in different ways based on individuals’ approaches to the process. Given concerns about auditing reliability, a centralized approach was implemented, which continued to have its own variability. Conclusions Our findings report on a ...
Keywords	Central-line bundle ; Central-line-associated bloodstream infections ; Implementation ; Qualitative research ; Patient safety ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The earlier the longer: disproportionate time allocated to patients discussed early in attending physician handoff sessions.

Cohen, Michael D / Ilan, Roy / Garrett, Lyndon / LeBaron, Curtis / Christianson, Marlys K

Archives of internal medicine

2012 Volume 172, Issue 22, Page(s) 1762–1764

MeSH term(s)	Attitude of Health Personnel ; Communication ; Continuity of Patient Care/organization & administration ; Efficiency, Organizational ; Humans ; Medical Staff, Hospital/statistics & numerical data ; Physician-Patient Relations
Language	English
Publishing date	2012-12-11
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	211575-x
ISSN	1538-3679 ; 0003-9926 ; 0888-2479 ; 0730-188X
ISSN (online)	1538-3679
ISSN	0003-9926 ; 0888-2479 ; 0730-188X
DOI	10.1001/2013.jamainternmed.65
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Article ; Online: Becoming a high reliability organization.

Christianson, Marlys K / Sutcliffe, Kathleen M / Miller, Melissa A / Iwashyna, Theodore J

Critical care (London, England)

2011 Volume 15, Issue 6, Page(s) 314

Abstract: Aircraft carriers, electrical power grids, and wildland firefighting, though seemingly different, are exemplars of high reliability organizations (HROs)--organizations that have the potential for catastrophic failure yet engage in nearly error-free ... ...

Abstract	Aircraft carriers, electrical power grids, and wildland firefighting, though seemingly different, are exemplars of high reliability organizations (HROs)--organizations that have the potential for catastrophic failure yet engage in nearly error-free performance. HROs commit to safety at the highest level and adopt a special approach to its pursuit. High reliability organizing has been studied and discussed for some time in other industries and is receiving increasing attention in health care, particularly in high-risk settings like the intensive care unit (ICU). The essence of high reliability organizing is a set of principles that enable organizations to focus attention on emergent problems and to deploy the right set of resources to address those problems. HROs behave in ways that sometimes seem counterintuitive--they do not try to hide failures but rather celebrate them as windows into the health of the system, they seek out problems, they avoid focusing on just one aspect of work and are able to see how all the parts of work fit together, they expect unexpected events and develop the capability to manage them, and they defer decision making to local frontline experts who are empowered to solve problems. Given the complexity of patient care in the ICU, the potential for medical error, and the particular sensitivity of critically ill patients to harm, high reliability organizing principles hold promise for improving ICU patient care.
MeSH term(s)	Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/standards ; Organizations/organization & administration ; Quality of Health Care/organization & administration ; Quality of Health Care/standards
Language	English
Publishing date	2011-12-08
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/cc10360
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Article ; Online: Resilience in action

Barton, Michelle A / Christianson, Marlys / Myers, Christopher G / Sutcliffe, Kathleen

BMJ Leader

leading for resilience in response to COVID-19

2020 Volume 4, Issue 3, Page(s) 117–119

Abstract: Resilience matters now more than ever in healthcare, with the COVID-19 pandemic putting healthcare providers and systems under unprecedented strain. In popular culture and everyday conversation, resilience is often framed as an individual character trait ...

Abstract	Resilience matters now more than ever in healthcare, with the COVID-19 pandemic putting healthcare providers and systems under unprecedented strain. In popular culture and everyday conversation, resilience is often framed as an individual character trait where some people are better able to cope with and bounce back from adversity than others. Research in the management literature highlights that resilience is more complicated than that – it’s not just something you have , it’s something you do . Drawing on research on managing unexpected events, coordinating under challenging conditions, and learning in teams, we distill some counter-intuitive findings about resilience into actionable lessons for healthcare leaders.
Keywords	covid19
Language	English
Publisher	BMJ
Publishing country	uk
Document type	Article ; Online
ISSN	2398-631X
DOI	10.1136/leader-2020-000260
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Handover patterns

Ilan Roy / LeBaron Curtis D / Christianson Marlys K / Heyland Daren K / Day Andrew / Cohen Michael D

BMC Health Services Research, Vol 12, Iss 1, p

an observational study of critical care physicians

2012 Volume 11

Abstract: Abstract Background Handover (or 'handoff') is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, ...

Abstract	Abstract Background Handover (or 'handoff') is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, have been widely promoted. However, these recommendations are based mostly on expert opinion and research on medical trainees. By examining handover communication of experienced physicians, we aim to inform future research, education and quality improvement. Thus, our objective is to describe handover communication patterns used by attending critical care physicians in an academic centre and to compare them with currently popular, standardized schemes for handover communication. Methods Prospective, observational study using video recording in an academic intensive care unit in Ontario, Canada. Forty individual patient handovers were randomly selected out of 10 end-of-week handover sessions of attending physicians. Two coders independently reviewed handover transcripts documenting elements of three communication schemes: SBAR (Situation, Background, Assessment, Recommendations); SOAP (Subjective, Objective, Assessment, Plan); and a standard medical admission note. Frequency and extent of questions asked by incoming physicians were measured as well. Analysis consisted of descriptive statistics. Results Mean (± standard deviation) duration of patient-specific handovers was 2 min 58 sec (± 57 sec). The majority of handovers' content consisted of recent and current patient status. The remainder included physicians' interpretations and advice. Questions posed by the incoming physicians accounted for 5.8% (± 3.9%) of the handovers' content. Elements of all three standardized communication schemes appeared repeatedly throughout the handover dialogs with no consistent pattern. For example, blocks of SOAP's Assessment appeared 5.2 (± 3.0) times in patient handovers; they followed Objective blocks in only 45.9% of the opportunities and preceded Plan in just 21.8%. Certain ...
Keywords	Adverse effects ; Communication ; Safety ; Standardization ; Video Recording ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2012-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Handover patterns: an observational study of critical care physicians.

Ilan, Roy / LeBaron, Curtis D / Christianson, Marlys K / Heyland, Daren K / Day, Andrew / Cohen, Michael D

BMC health services research

2012 Volume 12, Page(s) 11

Abstract: Background: Handover (or 'handoff') is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, have ... ...

Abstract	Background: Handover (or 'handoff') is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, have been widely promoted. However, these recommendations are based mostly on expert opinion and research on medical trainees. By examining handover communication of experienced physicians, we aim to inform future research, education and quality improvement. Thus, our objective is to describe handover communication patterns used by attending critical care physicians in an academic centre and to compare them with currently popular, standardized schemes for handover communication. Methods: Prospective, observational study using video recording in an academic intensive care unit in Ontario, Canada. Forty individual patient handovers were randomly selected out of 10 end-of-week handover sessions of attending physicians. Two coders independently reviewed handover transcripts documenting elements of three communication schemes: SBAR (Situation, Background, Assessment, Recommendations); SOAP (Subjective, Objective, Assessment, Plan); and a standard medical admission note. Frequency and extent of questions asked by incoming physicians were measured as well. Analysis consisted of descriptive statistics. Results: Mean (± standard deviation) duration of patient-specific handovers was 2 min 58 sec (± 57 sec). The majority of handovers' content consisted of recent and current patient status. The remainder included physicians' interpretations and advice. Questions posed by the incoming physicians accounted for 5.8% (± 3.9%) of the handovers' content. Elements of all three standardized communication schemes appeared repeatedly throughout the handover dialogs with no consistent pattern. For example, blocks of SOAP's Assessment appeared 5.2 (± 3.0) times in patient handovers; they followed Objective blocks in only 45.9% of the opportunities and preceded Plan in just 21.8%. Certain communication elements were occasionally absent. For example, SBAR's Recommendation and admission note information about the patient's Past Medical History were absent from 22 (55.0%) and 20 (50.0%), respectively, of patient handovers. Conclusions: Clinical handover practice of faculty-level critical care physicians did not conform to any of the three predefined structuring schemes. Further research is needed to examine whether alternative approaches to handover communication can be identified and to identify features of high-quality handover communication.
MeSH term(s)	Academic Medical Centers ; Communication ; Continuity of Patient Care/standards ; Critical Care ; Health Services Research ; Humans ; Intensive Care Units ; Ontario ; Patient Transfer/standards ; Practice Patterns, Physicians'/standards ; Prospective Studies ; Time Factors ; Video Recording
Language	English
Publishing date	2012-01-10
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/1472-6963-12-11
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