TY - JOUR
T1 - Investigating physicians' views on soft signals in the context of their peers' performance
AU - van den Goor, Myra
AU - Silkens, Milou
AU - Heineman, Maas Jan
AU - Lombarts, Kiki
PY - 2018/9
Y1 - 2018/9
N2 - Background: Physicians are responsible for delivering high quality of care. In cases of underperformance, hindsight knowledge indicates forewarning being potentially available in terms of concerns, signs, or signals. It is not known how the physicians involved perceive such signals. Purpose: To openly explore how physicians perceive soft signals and react on them. Methods: In-depth interviews with 12 hospital-based physicians from various specialties and institutions following the interpretative phenomenological analysis approach. Results: Physicians perceive soft signals as an observable deviation from a colleague's normal behavior, appearance, or communication. Once observed, they evaluate the signal by reflecting on it personally and/or by consulting others, resulting in either an active (i.e., speaking up) or passive (i.e., avoidance) reaction. Observer sensitivity, closeness to the peer, and cohesion of the physician group influence this observation-evaluation-reaction process. Conclusions and Implications: Physicians perceive soft signals as indicators of well-being and collegiality, not as concerns about performance or patient safety. They feel it is their responsibility to be sensitive to and deal with expressed signals. Creating a psychological safe culture could foster such an environment. Because a threat to physicians' well-being may indirectly affect their professional performance, soft signals require serious follow-up.
AB - Background: Physicians are responsible for delivering high quality of care. In cases of underperformance, hindsight knowledge indicates forewarning being potentially available in terms of concerns, signs, or signals. It is not known how the physicians involved perceive such signals. Purpose: To openly explore how physicians perceive soft signals and react on them. Methods: In-depth interviews with 12 hospital-based physicians from various specialties and institutions following the interpretative phenomenological analysis approach. Results: Physicians perceive soft signals as an observable deviation from a colleague's normal behavior, appearance, or communication. Once observed, they evaluate the signal by reflecting on it personally and/or by consulting others, resulting in either an active (i.e., speaking up) or passive (i.e., avoidance) reaction. Observer sensitivity, closeness to the peer, and cohesion of the physician group influence this observation-evaluation-reaction process. Conclusions and Implications: Physicians perceive soft signals as indicators of well-being and collegiality, not as concerns about performance or patient safety. They feel it is their responsibility to be sensitive to and deal with expressed signals. Creating a psychological safe culture could foster such an environment. Because a threat to physicians' well-being may indirectly affect their professional performance, soft signals require serious follow-up.
KW - Collegiality
KW - Patient safety
KW - Performance improvement
KW - Physician performance
KW - Physician well-being
KW - Psychological safety
KW - Quality improvement
KW - Safety culture
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UR - https://www.ncbi.nlm.nih.gov/pubmed/29189435
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U2 - https://doi.org/10.1097/JHQ.0000000000000120
DO - https://doi.org/10.1097/JHQ.0000000000000120
M3 - Article
C2 - 29189435
SN - 1062-2551
VL - 40
SP - 310
EP - 317
JO - Journal for Healthcare Quality
JF - Journal for Healthcare Quality
IS - 5
ER -