Abstract:
INTRODUCTION:Although patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care-related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement. HYPOTHESIS:A model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive-affective biases plus cascade could advance the understanding of cognitive-affective processes that underlie decisions and organizational cultures across the continuum of care. METHODS:Thematic analysis, qualitative information from several sources being used to support argumentation. DISCUSSION:Complex covert cognitive phenomena underlie decisions influencing health care. In the integrated model, the Swiss cheese slices represent dynamic cognitive-affective (mental) gates: Reason's successive layers of defence. Like firewalls and antivirus programs, cognitive-affective gates normally allow the passage of rational decisions but block or counter unsounds ones. Gates can be breached (ie, holes created) at one or more levels of organizations, teams, and individuals, by (1) any element of cognitive-affective biases plus (conflicts of interest and cognitive biases being the best studied) and (2) other potential error-provoking factors. Conversely, flawed decisions can be blocked and consequences minimized; for example, by addressing cognitive biases plus and error-provoking factors, and being constantly mindful. Informed shared decision making is a neglected but critical layer of defence (cognitive-affective gate). The integrated model can be custom tailored to specific situations, and the underlying principles applied to all methods for improving safety. The model may also provide a framework for developing and evaluating strategies to optimize organizational cultures and decisions. LIMITATIONS:The concept is abstract, the model is virtual, and the best supportive evidence is qualitative and indirect. CONCLUSIONS:The proposed model may help enhance rational decision making across the continuum of care, thereby improving patient safety globally.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Seshia SS,Bryan Young G,Makhinson M,Smith PA,Stobart K,Croskerry Pdoi
10.1111/jep.12847subject
Has Abstractpub_date
2018-02-01 00:00:00pages
187-197issue
1eissn
1356-1294issn
1365-2753journal_volume
24pub_type
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1046/j.1365-2753.2000.00214.x
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2007.00781.x
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journal_title:Journal of evaluation in clinical practice
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doi:10.1111/jep.13439
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
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更新日期:2007-04-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2012.01870.x
更新日期:2013-10-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13289
更新日期:2020-04-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12927
更新日期:2019-08-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.1998.tb00088.x
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12369
更新日期:2016-08-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.2007.00908.x
更新日期:2008-08-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Occupational violence is increasingly recognized as a problem in general practice, and has been suggested as adversely affecting general practitioners' (GPs) provision of services to patients. The aim of this study was to investigate the association of experiences of violence and percepti...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2007.00864.x
更新日期:2008-04-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2000.00264.x
更新日期:2000-08-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.1996.tb00034.x
更新日期:1996-05-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The goal is to fully automate the calculation of a breast ptosis measure from clinical photographs through automatic localization of fiducial points relevant to the measure. METHODS:Sixty-eight women (97 clinical photographs) who underwent or were scheduled for breast reconstruction were...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12397
更新日期:2015-10-01 00:00:00