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Double reading rates and quality assurance practices in Norwegian hospital radiology departments: two parallel national surveys.

https://arctichealth.org/en/permalink/ahliterature261241
Source
Acta Radiol. 2015 Jan;56(1):78-86
Publication Type
Article
Date
Jan-2015
Author
Peter M Lauritzen
Petter Hurlen
Gunnar Sandbæk
Pål Gulbrandsen
Source
Acta Radiol. 2015 Jan;56(1):78-86
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Diagnostic Imaging - utilization
Health Care Surveys
Norway
Observer Variation
Physician's Practice Patterns - utilization
Quality Assurance, Health Care - statistics & numerical data
Radiology Department, Hospital - statistics & numerical data
Reproducibility of Results
Sensitivity and specificity
Unnecessary Procedures
Abstract
Double reading as a quality assurance (QA) tool is employed extensively in Norwegian hospital radiology departments. The practice is resource consuming and regularly debated.
To investigate the rates of double reading in Norwegian hospital radiology departments, to identify department characteristics associated with double reading rates, and to investigate associations between double reading and other quality improvement.
We issued two parallel national surveys to management and to consultant radiologists, respectively. Management was defined as the chief medical officer and/or the head of the radiology department. The management survey covered staffing, perceived resource situation, double reading, guidelines, and quality improvement. The radiologist survey served to validate management responses concerning double reading. Management survey items concerning practices of quality improvement were organized into three indices reflecting different quality approaches, namely: appropriateness of investigations; personal performance feedback; and system performance feedback.
The response rates of the surveys were 100% (45/45) for management and 55% (266/483) for radiologists. Of all exams read by consultants, 33% were double read. The double reading rate was highest in university hospital departments (59%), intermediate in other teaching departments (30%), and lowest in non-teaching departments (11%) (P?=?0.01). Among the quality indices, mean scores were highest on appropriateness index (68%), intermediate on the person index (56%), and lowest on system index (37%). There were no correlations between double reading rates and scores on any of the quality indices.
The rate of double reading in Norwegian hospital radiology is significantly correlated to department teaching status, but not to other practices of quality work.
PubMed ID
24425793 View in PubMed
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Effectiveness of a short course in clinical communication skills for hospital doctors: results of a crossover randomized controlled trial (ISRCTN22153332).

https://arctichealth.org/en/permalink/ahliterature139544
Source
Patient Educ Couns. 2011 Aug;84(2):163-9
Publication Type
Article
Date
Aug-2011
Author
Bård Fossli Jensen
Pål Gulbrandsen
Fredrik A Dahl
Edward Krupat
Richard M Frankel
Arnstein Finset
Author Affiliation
HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway.
Source
Patient Educ Couns. 2011 Aug;84(2):163-9
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Clinical Coding - standards
Clinical Competence - standards
Communication
Cross-Over Studies
Education, Medical, Continuing - organization & administration
Female
Hospital Bed Capacity, 500 and over
Humans
Male
Middle Aged
Norway
Physician-Patient Relations
Physicians
Program Evaluation
Questionnaires
Videotape Recording
Abstract
To test the hypothesis that a 20-h communication skills course based on the Four Habits model can improve doctor-patient communication among hospital employed doctors across specialties.
Crossover randomized controlled trial in a 500-bed hospital with interventions at different time points in the two arms. Assessments were video-based and blinded. Intervention consisted of 20 h of communication training, containing alternating plenary with theory/debriefs and practical group sessions with role-plays tailored to each doctor.
Of 103 doctors asked to participate, 72 were included, 62 received the intervention, 51 were included in the main analysis, and another six were included in the intention-to-treat analysis. We found an increase in the Four Habits Coding Scheme of 7.5 points (p = 0.01, 95% confidence interval 1.6-13.3), fairly evenly distributed on subgroups. Baseline score (SD) was 60.3 (9.9). Global patient satisfaction did not change, neither did average encounter duration.
Utilizing an outpatient-clinic training model developed in the US, we demonstrated that a 20-h course could be generalized across medical and national cultures, indicating improvement of communication skills among hospital doctors.
The Four Habits model is suitable for communication-training courses in hospital settings. Doctors across specialties can attend the same course.
Notes
Comment In: Patient Educ Couns. 2011 Aug;84(2):141-221696909
PubMed ID
21050695 View in PubMed
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Emotional cues and concerns in hospital encounters with non-Western immigrants as compared with Norwegians: an exploratory study.

https://arctichealth.org/en/permalink/ahliterature133873
Source
Patient Educ Couns. 2011 Sep;84(3):325-31
Publication Type
Article
Date
Sep-2011
Author
Emine Kale
Arnstein Finset
Hanne-Lise Eikeland
Pål Gulbrandsen
Author Affiliation
Norwegian Centre for Minority Health Research, Oslo University Hospital, Oslo, Norway. emine.kale@nakmi.no
Source
Patient Educ Couns. 2011 Sep;84(3):325-31
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Communication
Cues
Cultural Competency
Databases as Topic
Emigrants and Immigrants - psychology
Emotions
Female
Geography
Humans
Inpatients
Kinesics
Language
Male
Middle Aged
Norway
Physician-Patient Relations
Statistics, nonparametric
Videotape Recording
Abstract
To identify potential barriers in communication with non-Western immigrant patients by comparing the frequency and nature of emotional cues and concerns, as well as physician responses during consultations, between ethnically Norwegian patients and immigrant patients in a general hospital setting.
Consultations with 56 patients (30 non-Western immigrants and 26 ethnic Norwegians) were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (Verona Codes-P).
There were no significant differences in frequencies of cues and concerns between immigrant and Norwegian patients. However, the immigrant patients with high language proficiency expressed more concerns compared to immigrant patients with language problems and Norwegian patients. Moreover, more concerns were expressed during consultations with female physicians than with male physicians.
Expression of cues and concerns in immigrant patients is dependent on the patient's language proficiency and the physician's gender.
Providers should recognize that immigrant patients may have many emotional cues and concerns, but that language problems may represent a barrier for the expression of these concerns.
PubMed ID
21652163 View in PubMed
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"Four Habits" goes abroad: report from a pilot study in Norway.

https://arctichealth.org/en/permalink/ahliterature156206
Source
Patient Educ Couns. 2008 Sep;72(3):388-93
Publication Type
Article
Date
Sep-2008
Author
Pål Gulbrandsen
Ed Krupat
Jurate Saltyte Benth
Andrew Garratt
Dana Gelb Safran
Arnstein Finset
Richard Frankel
Author Affiliation
HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway. pal.gulbrandsen@ahus.no
Source
Patient Educ Couns. 2008 Sep;72(3):388-93
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adult
Female
Focus Groups
Habits
Hospitalists - education
Humans
Male
Middle Aged
Norway
Patient satisfaction
Physician-Patient Relations
Pilot Projects
Principal Component Analysis
Questionnaires
Staff Development
Teaching - methods
Abstract
"Four Habits" is the first larger generic clinical communication program to have a documented effect. It has not been evaluated outside USA. In a pilot study, Norwegian hospital physicians assessed its usefulness, and we developed a questionnaire where patients reported "Four Habits"-specific physician behaviour.
We ran a 3-day course with 16 participants and three US facilitators. The questionnaire mapping "Four Habits" with 23 items was distributed by participating physicians to 210 patients. Participating physicians met in evaluative focus groups 3 months after the course.
The questionnaire was condensed to 10 items after factorial analysis. The resulting scale performed well. A large amount of missing data on some items suggested that patients found it difficult to evaluate details of "Four Habits"-specific physician behaviour. Participants found that the "Four Habits" short course led to improvement of their encounters. Some elements of the method were not perceived as relevant for all types of encounters (habits II and III).
"Four Habits" is applicable outside US with some adjustments. A shortened version of the questionnaire will be used in a planned randomized controlled trial.
PubMed ID
18619759 View in PubMed
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How do international medical graduates and colleagues perceive and deal with difficulties in everyday collaboration? A qualitative study.

https://arctichealth.org/en/permalink/ahliterature283459
Source
Scand J Public Health. 2017 Jun;45(4):428-435
Publication Type
Article
Date
Jun-2017
Author
Erik Skjeggestad
Reidun Norvoll
Gro M Sandal
Pål Gulbrandsen
Source
Scand J Public Health. 2017 Jun;45(4):428-435
Date
Jun-2017
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Attitude of Health Personnel
Clinical Competence
Communication
Communication Barriers
Cultural Characteristics
Female
Foreign Medical Graduates - psychology - statistics & numerical data
Humans
Interprofessional Relations
Male
Norway
Patient Safety
Physicians - psychology - statistics & numerical data
Qualitative Research
Young Adult
Abstract
Many medical doctors work outside their countries of origin. Consequently, language barriers and cultural differences may result in miscommunication and tension in the workplace, leading to poor performance and quality of treatment and affecting patient safety. However, there is little information about how foreign doctors and their colleagues perceive their collaboration and handle situations that can affect the quality of health services.
Individual, semi-structured in-depth interviews were conducted with two groups of informants: 16 doctors who had recently started working in Norway and 12 unrelated Norwegian-born healthcare providers who had extensive experience of working with doctors from foreign countries. The interviews were analysed according to the systematic text condensation method.
The foreign doctors described themselves as newcomers and found it difficult to speak with their colleagues about their shortcomings because they wanted to be seen as competent. Their Norwegian colleagues reported that many new foreign doctors had demanding work schedules and therefore they were reluctant to give them negative feedback. They also feared that foreign doctors would react negatively to criticism. All participants, both the new foreign doctors and their colleagues, reported that they took responsibility for the prevention of misunderstandings and errors; nevertheless, they struggled to discuss such issues with each other.
Silence was the coping strategy adopted by both the foreign doctors and native healthcare professionals when facing difficulties in their working relationships. In such situations, many foreign doctors are socialized into a new workplace in which uncertainty and shortcomings are not discussed openly. Effective leadership and procedures to facilitate communication may alleviate this area of concern.
PubMed ID
28381112 View in PubMed
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Identifying the Basis for Clinical Decisions - A Feasibility Study.

https://arctichealth.org/en/permalink/ahliterature282093
Source
Stud Health Technol Inform. 2016;228:509-13
Publication Type
Article
Date
2016
Author
Petter Hurlen
Eirik Ofstad
Pål Gulbrandsen
Source
Stud Health Technol Inform. 2016;228:509-13
Date
2016
Language
English
Publication Type
Article
Keywords
Clinical Decision-Making - methods
Electronic Health Records
Feasibility Studies
Humans
Norway
Physician-Patient Relations
Terminology as Topic
Abstract
This study explored the possibility of defining a set of terms to describe and identify the basis for clinical decisions in a set of transcriptions from clinical encounters with previously identified decisions. The paper presents the considerations behind the exploratory study and considerations for further work.
PubMed ID
27577435 View in PubMed
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International medical graduates' perceptions of entering the profession in Norway.

https://arctichealth.org/en/permalink/ahliterature267180
Source
Tidsskr Nor Laegeforen. 2015 Jun 30;135(12-13):1129-32
Publication Type
Article
Date
Jun-30-2015
Author
Erik Skjeggestad
Gro Mjeldheim Sandal
Pål Gulbrandsen
Source
Tidsskr Nor Laegeforen. 2015 Jun 30;135(12-13):1129-32
Date
Jun-30-2015
Language
English
Norwegian
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Career Choice
Communication Barriers
Female
Foreign Medical Graduates - psychology
Humans
Licensure, Medical
Male
Norway
Physician's Role
Questionnaires
Abstract
There is little knowledge available about how it feels for an international medical graduate arriving in Norway. We have investigated how the initial period as an employee of the Norwegian health services is perceived.
We conducted semi-structured interviews with 16 international medical graduates who had foreign training and citizenship. They had worked as doctors in Norway for less than two years. Transcriptions of the interviews were analysed using the Systematic Text Condensation method.
Their background for working in Norway varied. Some had an affiliation to the country and a social network, which appeared to be a support during the initial period. Many perceived the authorisation process as bureaucratic and as throwing suspicion on them. The doctors felt that they could cope with most of their work assignments, but reported having faced challenges in terms of language, a lack of insight into systems and uncertainty regarding what was expected of the doctor's role in a Norwegian context. There was also uncertainty associated with a perceived absence of collegial support. Because of the availability of jobs, some had adjusted their career plans towards psychiatry, geriatrics or general practice.
It appears that preparatory measures such as training courses, tests and the authorisation process fail to provide the practice-related experience and local knowledge that many doctors feel that they need in their new job situation. Measures such as language training and introduction to systems would be likely to improve their general well-being as well as integration.
Notes
Comment In: Tidsskr Nor Laegeforen. 2015 Jun 30;135(12-13):110426130529
PubMed ID
26130545 View in PubMed
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Interrater reliability for the Four Habits Coding Scheme as part of a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature141735
Source
Patient Educ Couns. 2010 Sep;80(3):405-9
Publication Type
Article
Date
Sep-2010
Author
Bård Fossli Jensen
Pål Gulbrandsen
Jurate Saltyte Benth
Fredrik A Dahl
Edward Krupat
Arnstein Finset
Author Affiliation
HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway. b.f.jensen@medisin.uio.no
Source
Patient Educ Couns. 2010 Sep;80(3):405-9
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Clinical Coding - standards
Communication
Cross-Over Studies
Female
Habits
Hospitals, General
Humans
Infant
Infant, Newborn
Male
Middle Aged
Norway
Observer Variation
Physician's Role - psychology
Physician-Patient Relations
Professional Competence - standards
Questionnaires
Reproducibility of Results
Videotape Recording
Young Adult
Abstract
To describe the process for developing interrater reliability (IRR) for the Four Habits Coding Scheme (4HCS) for a heterogeneous material as part of a randomized controlled trial.
Videotapes from 497 hospital encounters involving 71 doctors from most clinical specialties were collected. Four experienced psychology students were trained as raters. We calculated Pearson's r and the intraclass correlation (ICC) on the total score across consecutive samples of twenty videos, and Pearson's r on single videos across items in the initial coding phase.
After 18h of training and one rating session, the total score Pearson's r and ICC exceeded .70 for all pairs of raters. Across items within single videos, the Pearson's r was never below 0.60 after the first 50 videos. At item and habit level Pearson's r remained unsatisfactory for some rater pairs mostly due to low variance on some items.
Based on the evaluation of the effect of communication skills training via a total score, IRR was satisfactory for the 4HCS as applied to heterogeneous material. However, good reliability at item level was difficult to achieve.
4HCS may be used as an outcome measure for clinical communication skills in randomized controlled trials.
PubMed ID
20685066 View in PubMed
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Job satisfaction among Norwegian general practitioners.

https://arctichealth.org/en/permalink/ahliterature70508
Source
Scand J Prim Health Care. 2005 Dec;23(4):198-202
Publication Type
Article
Date
Dec-2005
Author
Magne Nylenna
Pål Gulbrandsen
Reidun Førde
Olaf G Aasland
Author Affiliation
Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. magne.nylenna@shdir.no
Source
Scand J Prim Health Care. 2005 Dec;23(4):198-202
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Adult
Comparative Study
Female
Hospitalists
Humans
Job Satisfaction
Male
Norway
Physicians, Family - psychology
Physicians, Women - psychology
Questionnaires
Workload
Abstract
OBJECTIVE: To explore the level of job satisfaction among general practitioners (GPs) and to compare it with that of hospital doctors. DESIGN: Postal questionnaire among Norwegian doctors in 2002 and similar data from 1994 and 2000 for most of the respondents. MATERIAL: A total of 295 GPs out of 1174 doctors completed the questionnaire (73% response rate). Main outcome measures. Self-reported levels of job satisfaction according to the Job Satisfaction Scale (JSS). RESULTS: Norwegian GPs reported a high level of job satisfaction with a mean score on the JSS of 52.6 (10 is minimum and 70 maximum). The reported level of satisfaction was highest for their opportunities to use their abilities, cooperation with colleagues and fellow workers, variation in work, and freedom to choose own method of working. The GPs' level of job satisfaction remained stable in 1994, 2000, and 2004 in spite of major health reforms. GPs report a higher level of job satisfaction than hospital doctors. CONCLUSIONS: In spite of international discussions on unhappy doctors and doctors' discontent, Norwegian GPs do report a high and stable level of job satisfaction.
PubMed ID
16272066 View in PubMed
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Source
Patient Educ Couns. 2014 Jul;96(1):139-41
Publication Type
Article
Date
Jul-2014
Author
Pål Gulbrandsen
Source
Patient Educ Couns. 2014 Jul;96(1):139-41
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Communication
Humans
Norway
Patient-Centered Care
Physician-Patient Relations
Primary Health Care
PubMed ID
24690474 View in PubMed
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16 records – page 1 of 2.