Publications by authors named "Annegret Hannawa"

24 Publications

  • Page 1 of 1

Testing the Integrative Quality Care Assessment Tool (INQUAT).

Int J Health Care Qual Assur 2019 Dec;33(1):120-144

Faculty of Communication Sciences, Università della Svizzera Italiana, Lugano, Switzerland.

Purpose: Identifying the factors that contribute or hinder the provision of good quality care within healthcare institutions, from the managers' perspective, is important for the success of quality improvement initiatives. The purpose of this paper is to test the Integrative Quality Care Assessment Tool (INQUAT) that was previously developed with a sample of healthcare managers in the USA.

Design/methodology/approach: Written narratives of 69 good and poor quality care episodes were collected from 37 managers in Italy. A quantitative content analysis was conducted using the INQUAT coding scheme, to compare the results of the US-based study to the new Italian sample.

Findings: The core frame of the INQUAT was replicated and the meta-categories showed similar distributions compared to the US data. Structure (i.e. organizational, staff and facility resources) covered 8 percent of all the coded units related to quality aspects; context (i.e. clinical factors and patient factors) 10 percent; process (i.e. communication, professional diligence, timeliness, errors and continuity of care) 49 percent; and outcome (i.e. process- and short-term outcomes) 32 percent. However, compared to the US results, Italian managers attributed more importance to different categories' subcomponents, possibly due to the specificity of each sample. For example, professional diligence, errors and continuity of care acquired more weight, to the detriment of communication. Furthermore, the data showed that process subcomponents were associated to perceived quality more than outcomes.

Research Limitations/implications: The major limitation of this investigation was the small sample size. Further studies are needed to test the reliability and validity of the INQUAT.

Originality/value: The INQUAT is proposed as a tool to systematically conduct in depth analyses of successful and unsuccessful healthcare events, allowing to better understand the factors that contribute to good quality and to identify specific areas that may need to be targeted in quality improvement initiatives.
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http://dx.doi.org/10.1108/IJHCQA-03-2018-0065DOI Listing
December 2019

Communication and patient safety in gynecology and obstetrics - study protocol of an intervention study.

BMC Health Serv Res 2019 Nov 28;19(1):908. Epub 2019 Nov 28.

Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of CommunicationSciences, Università della Svizzera Italiana, Lugano, Switzerland.

Background: Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction.

Methods: The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes).

Discussion: This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments.

Trial Registration: ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019.
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http://dx.doi.org/10.1186/s12913-019-4579-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883614PMC
November 2019

When facing our fallibility constitutes "safe practice": Further evidence for the Medical Error Disclosure Competence (MEDC) guidelines.

Patient Educ Couns 2019 10 30;102(10):1840-1846. Epub 2019 Apr 30.

Università della Svizzera Italiana (USI), Switzerland. Electronic address:

Objective: This study pursues further empirical validation of the "Medical Error Disclosure Competence (MEDC)" guidelines. The following research questions are addressed: (1) What communicative skills predict patients' perceived disclosure adequacy? (2) To what extent do patients' adequacy perceptions predict disclosure effectiveness? (3) Are there any significant sex differences in the MEDC constructs?

Methods: A sample of 193 respondents completed an online survey about a medical error they experienced in the past 5 years, and about the subsequent disclosure of that error to them.

Results: One in four patients had experienced a medical error, only a third of them received a disclosure. Only interpersonal adaptability influenced disclosure adequacy, with a large effect size. Adequacy, in turn, predicted both patients' relational distancing and approach behaviors. Nonverbally skillful disclosures significantly decreased the likelihood of patient trauma. Expressions of remorse significantly increased patient resilience. Nonverbal skills (-) and a full account (+) predicted patients' tendency to harm themselves. Males were more reactive to disclosures than female patients.

Conclusion: MEDC guidelines-adherent disclosure communication maintains the provider-patient relationship, increase patient resilience, and decreases patient trauma after a medical error.

Practice Implications: Given the results of this study, adherence to the MEDC-guidelines must be considered "safe practice."
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http://dx.doi.org/10.1016/j.pec.2019.04.024DOI Listing
October 2019

Dispatcher-assisted cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest: A structured evaluation of communication issues using the SACCIA safe communication typology.

Resuscitation 2019 06 15;139:144-151. Epub 2019 Apr 15.

Department of Emergency Medicine, KK Women's & Children's Hospital, 100 Bukit Timah Road, 229899 Singapore. Electronic address:

Aim: To evaluate communication issues during dispatcher-assisted cardiopulmonary resuscitation (DACPR) for paediatric out-of-hospital cardiac arrest in a structured manner to facilitate recommendations for training improvement.

Methods: A retrospective observational study evaluated DACPR communication issues using the SACCIA Safe Communication typology (Sufficiency, Accuracy, Clarity, Contextualization, Interpersonal Adaptation). Telephone recordings of 31 cases were transcribed verbatim and analysed with respect to encoding, decoding and transactional communication issues.

Results: Sixty SACCIA communication issues were observed in the 31 cases, averaging 1.9 issues per case. A majority of the issues were related to sufficiency (35%) and accuracy (35%) of communication between dispatcher and caller. Situation specific guideline application was observed in CPR practice, (co)counting and methods of compressions.

Conclusion: This structured evaluation identified specific issues in paediatric DACPR communication. Our training recommendations focus on situation and language specific guideline application and moving beyond verbal communication by utilizing the smart phone's functions. Prospective efforts are necessary to follow-up its translation into better paediatric DACPR outcomes.
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http://dx.doi.org/10.1016/j.resuscitation.2019.04.009DOI Listing
June 2019

Determinants of good and poor quality as perceived by US health care managers.

J Health Organ Manag 2018 Aug 7;32(5):708-725. Epub 2018 Aug 7.

Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of Communication Sciences, Università della Svizzera Italiana , Lugano, Switzerland.

Purpose The scientific literature evidences that the quality of care must be improved. However, little research has focused on investigating how health care managers - who are responsible for the implementation of quality interventions - define good and poor quality. The purpose of this paper is to develop an empirically informed taxonomy of quality care as perceived by US managers - named the Integrative Quality Care Assessment Tool (INQUAT) - that is grounded in Donabedian's structure, process and outcome model. Design/methodology/approach A revised version of the critical incident technique was used to collect 135 written narratives of good and poor quality care from 74 health care managers in the USA. The episodes were thematically analyzed. Findings In total, 804 units were coded under the 135 written narratives of care. They were grouped under structure (9 percent, n=69), including organizational, staff and facility resources; process (52 percent, n=419), entailing communication, professional diligence, timeliness, errors, and continuity of care; outcomes (32 percent, n=257), embedding process- and short-term outcomes; and context (7 percent, n=59), involving clinical and patient factors. Process-related categories tended to be described in relation to good quality (65 percent), while structure-related categories tended to be associated with poor quality (67 percent). Furthermore, the data suggested that managers did not consider their actions as important factors influencing quality, but rather tended to attribute the responsibility for quality care to front-line practitioners. Originality/value The INQUAT provides a theoretically grounded, evidence-based framework to guide health care managers in the assessment of all the components involved with the quality of care within their institutions.
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http://dx.doi.org/10.1108/JHOM-03-2018-0075DOI Listing
August 2018

"It Matters What I Think, Not What You Say": Scientific Evidence for a Medical Error Disclosure Competence (MEDC) Model.

J Patient Saf 2018 Jul 20. Epub 2018 Jul 20.

Indiana University School of Medicine, Indianapolis, IN.

Objective: This study sought to validate the ability of a "Medical Error Disclosure Competence" (MEDC) model to predict the effects of physicians' communication skills on error disclosure outcomes in a simulated context.

Method: A random sample of 721 respondents was assigned to 16 experimental disclosure conditions that tested the MEDC model's constructs across 2 severity conditions (i.e., minor error and sentinel event).

Results: Severity did not affect survey respondents' perceptions of the physician's disclosure style. Respondents who viewed the nonverbally skilled disclosure perceived the disclosure as more adequate compared to respondents in the "low nonverbal skill" disclosure condition. Interpersonal adaptability did not affect respondents' adequacy ratings. Consistent with the MEDC model, those who viewed the physician's error disclosure as inadequate indicated that they would be more prone to engage in relational distancing behaviors, while those who rated the disclosure as adequate were more likely to reinvest into their relationship with their physician. These respondents also had higher resilience scores. In the context of a sentinel event, perceived adequacy significantly predicted endorsing legal redress or remedies (e.g., lawsuit). Verbal apology (e.g., "I'm sorry," "I apologize") did not predict any significant variance in the model beyond the physician's nonverbal skill.

Conclusion: In a simulated disclosure setting, physicians' communicative skills-particularly effective nonverbal communication during a disclosure-trigger outcomes that affect the patient, the physician, and the provider-patient relationship. Findings from this study suggest that MEDC guidelines may be helpful in reducing financial and reputational risks to individual providers and institutions, particularly in the context of a sentinel event.
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http://dx.doi.org/10.1097/PTS.0000000000000524DOI Listing
July 2018

What constitutes "competent error disclosure"? Insights from a national focus group study in Switzerland.

Swiss Med Wkly 2017 2;147:w14427. Epub 2017 May 2.

Centre for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of Communication Sciences, Università della Svizzera Italiana (USI), Switzerland.

The question is no longer whether to disclose an error to a patient. Many studies have established that medical errors are co-owned by providers and patients and thus must be disclosed. However, little evidence is available on the concrete communication skills and contextual features that contribute to patients' perceptions of "competent disclosures" as a key predictor of objective disclosure outcomes. This study operationalises a communication science model to empirically characterise what messages, behaviours and contextual factors Swiss patients commonly consider "competent" during medical error disclosures, and what symptoms and behaviours they experience in response to competent and incompetent disclosures. For this purpose, ten focus groups were conducted at five hospitals across Switzerland. Sixty-three patients participated in the meetings. Qualitative analysis of the focus group transcripts revealed concrete patient expectations regarding provider's motivations, knowledge and skills. The analysis also illuminated under what circumstances to disclose, what to disclose, how to disclose and the effects of competent and incompetent disclosures on patients' symptoms and behaviours. Patients expected that providers enter a disclosure informed and with approach-oriented motivations. In line with previous research, they preferred a remorseful declaration of responsibility and apology, a clear and honest account, and a discussion of reparation and future forbearance. Patients expected providers to display attentiveness, compo-sure, coordination, expressiveness and interpersonal adaptability as core communication skills. Furthermore, numerous functional, relational, chronological and environmental contextual considerations evolved as critical features of competent disclosures. While patients agreed on a number of preferences, there is no one-size-fits-all approach to competent disclosures. Thus, error disclosures do not lend themselves to a checklist approach. Instead, this study provides concrete evidence-based starting points for the development of a disclosure training that is grounded in a communication science model, aiming to support clinicians, institutions and patients with this challenging task.
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http://dx.doi.org/10.4414/smw.2017.14427DOI Listing
May 2018

Using and choosing digital health technologies: a communications science perspective.

J Health Organ Manag 2017 Mar;31(1):28-37

Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of Communication Sciences, Università della Svizzera italiana (USI) , Lugano, Switzerland.

Purpose The purpose of this paper is to explore a non-technical overview for leaders and researchers about how to use a communications perspective to better assess, design and use digital health technologies (DHTs) to improve healthcare performance and to encourage more research into implementation and use of these technologies. Design/methodology/approach Narrative overview, showing through examples the issues and benefits of introducing DHTs for healthcare performance and the insights that communications science brings to their design and use. Findings Communications research has revealed the many ways in which people communicate in non-verbal ways, and how this can be lost or degraded in digitally mediated forms. These losses are often not recognized, can increase risks to patients and reduce staff satisfaction. Yet digital technologies also contribute to improving healthcare performance and staff morale if skillfully designed and implemented. Research limitations/implications Researchers are provided with an introduction to the limitations of the research and to how communications science can contribute to a multidisciplinary research approach to evaluating and assisting the implementation of these technologies to improve healthcare performance. Practical implications Using this overview, managers are more able to ask questions about how the new DHTs will affect healthcare and take a stronger role in implementing these technologies to improve performance. Originality/value New insights into the use and understanding of DHTs from applying the new multidiscipline of communications science. A situated communications perspective helps to assess how a new technology can complement rather than degrade professional relationships and how safer implementation and use of these technologies can be devised.
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http://dx.doi.org/10.1108/JHOM-07-2016-0128DOI Listing
March 2017

Patient and family empowerment as agents of ambulatory care safety and quality.

BMJ Qual Saf 2017 06 24;26(6):508-512. Epub 2016 Aug 24.

Faculty of Communication Sciences, Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Università della Svizzera italiana, Switzerland.

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http://dx.doi.org/10.1136/bmjqs-2016-005489DOI Listing
June 2017

Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes.

Soc Sci Med 2016 May 19;156:29-38. Epub 2016 Mar 19.

Institute for Measurement, Methodology, Analysis and Policy (IMMAP), Texas Tech University, Lubbock, TX 79409-2051, USA. Electronic address:

Rationale: This study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error.

Objective: This study aims to examine what antecedents are most predictive of patient forgiveness and non-forgiveness, and the extent to which social-cognitive factors (i.e., fault attributions, empathy, rumination) influence the forgiveness process. Furthermore, the study evaluates the role of different disclosure styles in two different forgiveness models, and measures their respective causal outcomes.

Methods: In January 2011, 318 outpatients at Wake Forest Baptist Medical Center in the United States were randomly assigned to three hypothetical error disclosure vignettes that operationalized verbally effective disclosures with different nonverbal disclosure styles (i.e., high nonverbal involvement, low nonverbal involvement, written disclosure vignette without nonverbal information). All patients responded to the same forgiveness-related self-report measures after having been exposed to one of the vignettes.

Results: The results favored the proximity model of interpersonal forgiveness, which implies that factors more proximal in time to the act of forgiving (i.e., patient rumination and empathy for the offender) are more predictive of forgiveness and non-forgiveness than less proximal factors (e.g., relationship variables and offense-related factors such as the presence or absence of an apology). Patients' fault attributions had no effect on their forgiveness across conditions. The results evidenced sizeable effects of physician nonverbal involvement-patients in the low nonverbal involvement condition perceived the error as more severe, experienced the physician's apology as less sincere, were more likely to blame the physician, felt less empathy, ruminated more about the error, were less likely to forgive and more likely to avoid the physician, reported less closeness, trust, and satisfaction but higher distress, were more likely to change doctors, less compliant, and more likely to seek legal advice.

Conclusion: The findings of this study imply that physician nonverbal involvement during error disclosures stimulates a healing mechanism for patients and the physician-patient relationship. Physicians who disclose a medical error in a nonverbally uninvolved way, on the other hand, carry a higher malpractice risk and are less likely to promote healthy, reconciliatory outcomes.
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http://dx.doi.org/10.1016/j.socscimed.2016.03.026DOI Listing
May 2016

Identifying the field of health communication.

J Health Commun 2015 20;20(5):521-30. Epub 2015 Mar 20.

a Faculty of Communication Sciences , Università della Svizzera italiana , Lugano , Switzerland.

This empirical investigation addresses four paradigmatically framed research questions to illuminate the epistemological status of the field of health communication, systematically addressing the limitations of existing disciplinary introspections. A content analysis of published health communication research indicated that the millennium marked a new stage of health communication research with a visible shift onto macro-level communication of health information among nonhealth professionals. The analysis also revealed the emergence of a paradigm around this particular topic area, with its contributing scholars predominantly sharing postpositivistic thought traditions and cross-sectional survey-analytic methodologies. More interdisciplinary collaborations and meta-theoretical assessments are needed to facilitate a continued growth of this evolving paradigm, which may advance health communication scholars in their search for a disciplinary identity.
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http://dx.doi.org/10.1080/10810730.2014.999891DOI Listing
July 2015

Heuristic thinking: interdisciplinary perspectives on medical error.

J Public Health Res 2013 Dec 1;2(3):e22. Epub 2013 Dec 1.

Faculty of Communication Sciences, Institute of Communication and Health, University of Lugano , Switzerland.

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http://dx.doi.org/10.4081/jphr.2013.e22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147747PMC
December 2013

Physician-perceived contradictions in end-of-life communication: toward a self-report measurement scale.

Health Commun 2015 9;30(3):241-50. Epub 2014 Jun 9.

a Institute of Communication and Health , University of Lugano.

Communication is undoubtedly a critical element of competent end-of-life care. However, physicians commonly lack communication skills in this particular care context. Theoretically grounded, evidence-based guidelines are needed to enhance physicians' communication with patients and their families in this important time of their lives. To address this need, this study tests and validates a Contradictions in End-of-Life Communication (CEOLC) scale, which disentangles the relational contradictions physicians commonly experience when communicating with end-of-life patients. Exploratory factors analysis confirmed the presence of eight physician-perceived dialectical tensions, reflecting three latent factors of (1) integration, (2) expression, and (3) dominance. Furthermore, a number of significant intercultural differences were found in cross-cultural comparisons of the scale in U.S., Swiss, and Italian physician samples. Thus, this investigation introduces a heuristic assessment tool that aids a better understanding of the dialectical contradictions physicians experience in their interactions with end-of-life patients. The CEOLC scale can be used to gather empirical evidence that may eventually support the development of evidence-based guidelines and skills training toward improved end-of-life care.
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http://dx.doi.org/10.1080/10410236.2013.841532DOI Listing
October 2016

Emerging issues and future directions of the field of health communication.

Health Commun 2014 17;29(10):955-61. Epub 2013 Dec 17.

a Institute of Communication and Health (ICH), Faculty of Communication Sciences , University of Lugano.

The interdisciplinary intersections between communication science and health-related fields are pervasive, with numerous differences in regard to epistemology, career planning, funding perspectives, educational goals, and cultural orientations. This article identifies and elaborates on these challenges with illustrative examples. Furthermore, concrete suggestions for future scholarship are recommended to facilitate compatible, coherent, and interdisciplinary health communication inquiry. The authors hope that this article helps current and future generations of health communication scholars to make more informed decisions when facing some of the challenges discussed in this article so that they will be able to seize the interdisciplinary and international potential of this unique and important field of study.
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http://dx.doi.org/10.1080/10410236.2013.814959DOI Listing
September 2015

Relational dialectics theory: Disentangling physician-perceived tensions of end-of-life communication.

Health Commun 2014 17;29(10):962-73. Epub 2013 Dec 17.

a Institute of Communication and Health (ICH), Faculty of Communication Sciences , University of Lugano.

Existing literature evidences the centrality of interpersonal communication during end-of-life care, but several barriers currently compromise its effectiveness. One of them is a common lack of communication skills among physicians in this challenging context. Several strategies have been suggested to enhance end-of-life interactions; however, a solid theoretical framework is needed for the development of effective systematic guidelines and interventions that can facilitate this goal. The present research study addresses this gap, choosing to focus particularly on the physician's perspective. It relies on Baxter and Montgomery's (1996) Relational Dialectics Theory to illuminate the complexity of reality doctors commonly face in interactions with their patients during end-of-life care. Semistructured interviews were conducted with 11 physicians in a southern canton of Switzerland who had experienced at least one end-of-life encounter with a patient. The interviews probed whether and under what conditions Baxter and Montgomery's theoretical contradictions translate to physicians' end-of-life communication with their patients and the patients' family members. The results replicated and extended the original theoretical contradictions, evidencing that Relational Dialectics Theory is very applicable to end-of-life conversations. Thus, this study adds a theoretically framed, empirically grounded contribution to the current literature on the communicative challenges physicians commonly face during end-of-life interactions with their patients and their patients' family members.
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http://dx.doi.org/10.1080/10410236.2013.815533DOI Listing
September 2015

Disclosing medical errors to patients: effects of nonverbal involvement.

Patient Educ Couns 2014 Mar 28;94(3):310-3. Epub 2013 Nov 28.

Institute of Communication and Health (ICH), Faculty of Communication Sciences, University of Lugano, Lugano, Switzerland. Electronic address:

Objective: The purpose of this study was to test causal effects of physicians' nonverbal involvement on medical error disclosure outcomes.

Methods: 216 hospital outpatients were randomly assigned to two experimental treatment groups. The first group watched a video vignette of a verbally effective and nonverbally involved error disclosure. The second group was exposed to a verbally effective but nonverbally uninvolved error disclosure. All patients responded to seven outcome measures.

Results: Patients in the nonverbally uninvolved error disclosure treatment group perceived the physician's apology as less sincere and remorseful compared to patients in the involved disclosure group. They also rated the implications of the error as more severe, were more likely to ascribe fault to the physician, and indicated a higher intent to change doctors after the disclosure.

Conclusion: The results of this study imply that nonverbal involvement during medical error disclosures facilitates more accurate patient understanding and assessment of the medical error and its consequences on their health and quality of life.

Practice Implications: In the context of disclosing medical errors, nonverbal involvement increases the likelihood that physicians will be able to continue caring for their patient. Thus, providers are advised to consider adopting this communication skill into their medical practice.
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http://dx.doi.org/10.1016/j.pec.2013.11.007DOI Listing
March 2014

TRACEing the roots: a diagnostic "Tool for Retrospective Analysis of Critical Events".

Patient Educ Couns 2013 Nov 23;93(2):230-8. Epub 2013 Jul 23.

Faculty of Communication Sciences, University of Lugano, Lugano, Switzerland. Electronic address:

Objective: The lack of interdisciplinary clarity in the conceptualization of medical errors discourages effective incident analysis, particularly in the event of harmless outcomes. This manuscript integrates communication competence theory, the criterion of reasonability, and a typology of human error into a theoretically grounded Tool for Retrospective Analysis of Critical Events (TRACE) to overcome this limitation.

Methods: A conceptual matrix synthesizing foundational elements pertinent to critical incident analysis from the medical, legal, bioethical and communication literature was developed. Vetting of the TRACE through focus groups and interviews was conducted to assure utility.

Results: The interviews revealed that TRACE may be useful in clinical settings, contributing uniquely to the current literature by framing critical incidents in regard to theory and the primary clinical contexts within which errors may occur.

Conclusion: TRACE facilitates a comprehensive, theoretically grounded analysis of clinical performance, and identifies the intrapersonal and interpersonal factors that contribute to critical events.

Practice Implications: The TRACE may be used as (1) the means for a comprehensive, detailed analysis of human performance across five clinical practice contexts, (2) an objective "fact-check" after a critical event, (3) a heuristic tool to prevent critical incidents, and (4) a data-keeping system for quality improvement.
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http://dx.doi.org/10.1016/j.pec.2013.06.019DOI Listing
November 2013

Building bridges: future directions for medical error disclosure research.

Patient Educ Couns 2013 Sep 21;92(3):319-27. Epub 2013 Jun 21.

Institute of Communication and Health (ICH), Faculty of Communication Sciences, University of Lugano, Lugano, Switzerland.

Objective: The disclosure of medical errors has attracted considerable research interest in recent years. However, the research to date has lacked interdisciplinary dialog, making translation of findings into medical practice challenging. This article lays out the disciplinary perspectives of the fields of medicine, ethics, law and communication on medical error disclosure and identifies gaps and tensions that occur at these interdisciplinary boundaries.

Methods: This article summarizes the discussion of an interdisciplinary error disclosure panel at the 2012 EACH Conference in St. Andrews, Scotland, in light of the current literature across four academic disciplines.

Results: Current medical, ethical, legal and communication perspectives on medical error disclosure are presented and discussed with particular emphasis on the interdisciplinary gaps and tensions.

Conclusion: The authors encourage interdisciplinary collaborations that strive for a functional approach to understanding and improving the disclosure of medical errors with the ultimate goal to improve quality and promote safer medical care.

Practice Implications: Interdisciplinary collaborations are needed to reconcile the needs of the stakeholders involved in medical error disclosure. A particular challenge is the effective translation of error disclosure research into practice. Concrete research questions are provided throughout the manuscript to facilitate a resolution of the tensions that currently impede interdisciplinary progress.
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http://dx.doi.org/10.1016/j.pec.2013.05.017DOI Listing
September 2013

Medical error disclosure: a pressing agenda for public health researchers.

J Public Health Res 2012 Dec 31;1(3):214-5. Epub 2012 Oct 31.

Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano , Switzerland.

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http://dx.doi.org/10.4081/jphr.2012.e33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140373PMC
December 2012

"Explicitly implicit": examining the importance of physician nonverbal involvement during error disclosures.

Swiss Med Wkly 2012 9;142:w13576. Epub 2012 May 9.

Institute of Communication and Health (ICH), Faculty of Communication Sciences, University of Lugano, Switzerland.

Questions Under Study/principles: Medical errors are prevalent, but physicians commonly lack the training and skills to disclose them to their patients. Existing research has yielded a set of verbal messages physicians should communicate during error disclosures. However, considering the emotional message contents, patients likely derive much of the meaning from physicians' nonverbal behaviours. The purpose of this study was to test the causal effects of physicians' nonverbal communication on error disclosure outcomes.

Methods: At a university hospital in the Southeastern United States, 318 patients were randomly assigned to three treatment groups. The first group watched a video vignette of a verbally and nonverbally competent error disclosure by a person acting as a physician. The second group was exposed to a verbally competent but nonverbally incompetent error disclosure. The third group read an error disclosure transcript. Then, all patients responded to measures of closeness, trust, forgiveness, satisfaction, distress, empathy, and avoidance.

Results: The results evidenced that holding the verbal message content constant, physician nonverbal involvement was significantly associated with higher patient ratings of closeness, trust, empathy, satisfaction, and forgiveness, and with lower ratings of patient emotional distress and avoidance. These associations were not affected by patient predispositions such as sex, ethnicity, religion and previous experiences with medical errors.

Conclusion: The findings of this study imply that nonverbal communication has a significant impact on error disclosure outcomes and thus should be considered as an important component of future research and disclosure training efforts.
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http://dx.doi.org/10.4414/smw.2012.13576DOI Listing
August 2012

The good funeral: toward an understanding of funeral participation and satisfaction.

Death Stud 2011 Sep;35(8):729-50

Department of Communication, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.

This study posits a model of funeral satisfaction in which religiosity predicts general funeral attitudes, which predict levels and types of funeral participation, mediating the relationship between attitudes and satisfaction in a particular bereavement context. Over a thousand respondents rated their attitudes toward funerals in general and evaluated the most recent funeral they had actually attended. The resulting model indicated that religiosity and favorable attitudes, when enacted through participation and involvement, tend to predict funeral satisfaction, in combination with favorable comparisons, and when the deceased was close and the death unexpected or tragic. Evaluations of the funeral, in turn, independently influence a person's general attitudes about funerals. Theoretical and practical implications for understanding funerals and bereavement are explored.
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http://dx.doi.org/10.1080/07481187.2011.553309DOI Listing
September 2011

Shedding light on the dark side of doctor-patient interactions: verbal and nonverbal messages physicians communicate during error disclosures.

Patient Educ Couns 2011 Sep 2;84(3):344-51. Epub 2011 Jun 2.

Institute of Communication and Health, University of Lugano, Switzerland.

Objective: Existing investigations on medical error disclosures have neglected the fact that a disproportionately large amount of the meaning in messages is derived from nonverbal cues. This study provides an empirical assessment of the verbal and nonverbal messages physicians communicate when disclosing medical errors to standardized patients.

Methods: Sixty hypothetical error disclosures by a volunteer sample of attending physicians were videotaped, coded, and statistically analyzed.

Results: Physicians used friendly, smooth, approaching and invested nonverbal styles as they disclosed medical errors to standardized patients. Female physicians smiled more and were more attentive to patients than male physicians, and physicians tended to exhibit more positive affect in the form of facial pleasantness toward angry female patients than toward angry male patients. Furthermore, physicians touched and smiled at patients more frequently at the beginning and at the end of their error disclosures, and displayed decreased attentiveness and interactional fluency.

Conclusion: Future research needs to examine which disclosure styles patients perceive as competent, and to assess their causal impacts on objective and relational disclosure outcomes.

Practice Implications: This study provides an important baseline understanding of medical error disclosures that is essential for the successful implementation of empirically based training programs.
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http://dx.doi.org/10.1016/j.pec.2011.04.030DOI Listing
September 2011

Negotiating medical virtues: toward the development of a physician mistake disclosure model.

Health Commun 2009 Jul;24(5):391-9

Communication Department, Wake Forest University, Winston-Salem, NC 27109, USA.

Statistics show that nearly 98,000 patients die each year because of preventable medical mistakes. Despite legal obligations, a majority of physicians either fail to disclose a mistake or disclose it in an incompetent manner, causing detrimental outcomes. This article is the first to synthesize existing research on medical mistakes into an integrative physician mistake disclosure model. The proposed model theorizes that physicians conduct a cost-benefit analysis prior to deciding whether or not to disclose a medical mistake. In the event of disclosure, informational and relational disclosure competence is hypothesized to mediate the inherent detrimental effects of physician defensiveness on immediate and long-term outcomes. The article provides detailed directions for future research and discusses practical implications of the physician mistake disclosure model for physicians and health-care institutions. Most important, the model implies that a supportive organizational climate is needed to curb destructive physician defensiveness, optimize disclosure competence, and minimize detrimental outcomes. Physicians and health-care institutions are advised to collaborate in their attempts to enhance long-term error management and reduce the current number of fatal medical mistakes. The physician mistake disclosure model adds to our current understanding of medical mistake disclosure, and represents a heuristic research and training tool that has the potential to save lives.
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http://dx.doi.org/10.1080/10410230903023279DOI Listing
July 2009

"If I can't have you, no one can": development of a Relational Entitlement and Proprietariness Scale (REPS).

Violence Vict 2006 Oct;21(5):539-60

San Diego State University San Diego, CA 92182-4561, USA.

Relational proprietariness and entitlement have been theoretically related to partner violence following the threat of relationship dissolution. To date, however, no measure has been employed to verify such accounts. A multistage item pool development and refinement strategy was employed, resulting in a 32-item measure with strong construct validity. An online survey administered to 279 students resulted in an interpretable factor structure of sexual proprietariness and entitlement, consisting of social, behavioral, and information control, and a potential factor of face threat reactivity. These factors added unique variance to the prediction of instrumental and expressive aggression, were related to self-esteem and attachment, and were not contaminated by social desirability. Recommendations for bolstering the face threat reactivity factor and future studies are suggested. This measure provides a new tool that contributes to the prediction of intimate partner violence.
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October 2006
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