To err is human: An Institute of Medicine report.

In November 1999, the Institute of Medicine (IOM) Committee on Quality of Health Care in America released its report To Err Is Human; Building a Safer Health System. The IOM committee had found that between 44,000 and 98,000 Americans die each year as a direct result of medical errors committed in hospitals, The lower estimate made this the eighth leading cause of death, exceeding traffic accidents, breast cancer, and AIDS. Medication errors alone, occurring either in or out of hospitals, account for 7,000 deaths annually, more than the number of deaths from workplace injuries. The economic cost of preventable adverse events (medical errors resulting in injury) approximates $17-$29 billion. The committee recommended a four-tiered approach: (1) establish a national focus to create Leadership, research, tools, and protocols to enhance the knowledge base about safety; (2) identify and learn from errors through mandatory reporting; (3) raise standards and expectations for improvements in safety through the actions of oversight organizations, group purchasers, and professional groups; and (4) create safety systems inside health care organizations to implement safe practices at the delivery level. The committee called for the establishment of a Center for Patient Safety within the recently renamed Agency for Healthcare Research and Quality (AHRQ). The committee's rationale was thus: Health care in the United States is a decade or more behind other high-risk industries in its attention to ensuring basic safety. The report repeatedly called for establishing a "culture of safety," in which providers are encouraged to identify and prevent errors. In this regard, health care providers can learn from other industries, such as from aviation and occupational health, which have made systematic efforts to uncover and learn from past accidents and mistakes. To encourage prevention of errors, both facilities and practitioners must be held to objective performance standards and expectations (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Occupational health psychology.

Reviews the book, Occupational health psychology edited by Stavroula Leka and Jonathon Houdmont (see record 2010-10988-000). Leka and Houdmont describe their book as the first textbook devoted to occupational health psychology intended for undergraduate instruction in the field. Leka and Houdmont have chosen an interesting strategy in creating an edited textbook with individual chapters written by established experts in the field. In doing so, they have in many cases gotten “the best” people in a particular area to write chapters in their area of expertise. Despite their reliance on multiple authors, the editors have maintained a consistent style throughout the volume—each chapter begins with a chapter outline and ends with a chapter summary. Textboxes throughout are used to highlight individuals prominent in the field (e.g., Tom Cox) or to highlight applications and research issues and to provide definitions of key terms. I would expect that students will appreciate such pedagogical features in addition to the depth of expertise that underlies each chapter. Although not divided into sections, one can intuit a structure to the book that begins with a broad perspective on occupational health psychology and then progressively adopts a narrower focus. When I first heard of this book, I was pleased at the prospect of being able to assign a single textbook that would offer a survey of occupational health psychology. Although the authors met their explicit goal of covering the core education curriculum defined by the European Academy of Occupational Health Psychology, I am not convinced that they have produced a “stand-alone” text that provides an adequate coverage of the field. In particular, issues of workplace safety are strikingly absent from the text. Personally, I would feel the need to supplement this text with specific readings on issues of occupational safety and occupational disease in order to cover the major topics that comprise the field of occupational health psychology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Premature separation of centromere and aneuploidy: an indicator of high risk in unaffected individuals from familial breast cancer families?

OBJECTIVES: Injury is the leading cause of death in the male working population of Brazil. An important fraction of these deaths are work related. Very few cohort studies of steel workers, and none from developing countries, have reported on mortality from injuries. This paper analyses mortality from work and non-work related injuries among Brazilian steel workers. METHODS: Deaths during employment from 1 January 1977 to 30 November 1992 were analysed in a cohort of 21,816 male steel workers. Mortality rates specific for age and calendar year among the workers were compared with those of the male population of the state where the plant is located. Work related injuries were analysed by comparing the mortality rates for different subgroups of the cohort. RESULTS: The number of deaths (391) was less than half that expected based on death rates of the general population. Over 60% (242) of deaths were due to injuries. Mortality from most causes was substantially below that in the general population, but that from unintentional injury, was 50% above that of the general population. Standardised mortality ratios (SMRs) were highest for the youngest and the oldest employees and for labourers and clerical workers. Mortality from motor vehicle injury was twice that expected from population rates (SMR = 209, 95% confidence interval (95% CI) 176-244). There was a 67% fall in the age adjusted mortality from occupational injuries in the study period. CONCLUSION: The healthy worker effect in this cohort was greater than that commonly found in studies of occupational groups in developed countries, probably because of a greater socioeconomic gap between employed and unemployed populations in Brazil, and unequal distribution of health care resources. Mortality was especially high for motor vehicle injuries. The fall in mortality from occupational injuries during the study period was probably due to improvement in safety standards, increased automation, and better medical care. There is a need to investigate risk factors for unintentional injuries among steel workers, especially those due to motor vehicle injuries. Prevention of occupational and nonoccupational injuries should be a main priority in Brazil.     

Health care research that delivers: Introduction to the special issue on cognitive factors in health care.

Research that addresses human factors issues in health care has made good progress since the landmark 1999 Institute of Medicine report on medical error (Kohn, Corrigan, & Donaldson, 1999), yet patient safety remains a persistent challenge for the health care system. While this challenge reflects many factors, we focus on the need for research that is sufficiently comprehensive to identify threats to patient safety, yet specific enough to explain how provider and patient factors interact with task and health context to engender these threats. Such research should be theory-based, yet also problem-driven; exert experimental control over theoretically relevant variables, yet also involve participants, tasks, and contexts that represent the problems of interest. A tension exists between theory-based, experimentally controlled research on the one hand, and problem-driven research with representative situations on the other. The studies in this special issue are both informed by theory and guided by application, reflecting what Stokes (1997) referred to as “use-inspired basic research.” Collectively, these studies represent progress toward improving patient safety and the quality of health care. However, important work remains to be done to significantly improve health care by more comprehensively managing tensions between theory and application and different research methodologies. We discuss barriers to accomplishing such research in general (the challenge of testing theory in situ in rich environments), and specifically in the health care domain. Significant progress will require research programs that thoughtfully manage mixed methods across a series of converging studies. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of The psychology of health and health care: A Canadian perspective.

Reviews the book, The psychology of health and health care: A Canadian perspective by Gary Poole, Deborah Hunt Matheson, and David N. Cox (2001). This book is a timely introductory text that aims to situate the rapidly expanding field of health psychology within the geographic, socio-demographic, and empirical landscape of Canada. This textbook would be appropriate for beginning and intermediate undergraduate students across a range of disciplines, including psychology, public health, and nursing. As such, it has a number of features to commend it. It is written in a clear and concise style, with explanatory tracks guiding the reader step by step through each new concept. In keeping with health psychology's applied focus, web sites for important resources are provided and sample case studies are integrated with key concepts throughout each chapter. Finally, the up-to-date coverage of Canadian health statistics and research publications is a delight for those of us who have been struggling to find texts that reflect the unique ways in which we view, structure, fund, administer, and research health psychology and health care in this country. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing and testing a theoretical model linking work-family conflict to employee safety.

Despite work-family conflict being recognized as a source of stress, no published research to our knowledge has considered how it negatively affects workplace safety. A theoretical model linking strain-based work-family conflict and employee safety was tested with 243 health care workers. Within this model, work-family conflict is conceptualized as a workplace hazard. As expected, strong work performance norms and high work overload were associated with higher work-family conflict; increased family-to-work conflict was associated with decreased compliance with safety rules and less willingness to participate in discretionary safety meetings. Work-to-family conflict, however, was not associated with safety. These findings underscore the importance of work redesign strategies that consider work performance norms and work-family conflict for expecting a return on investment in terms of a safer workplace. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

It is past time: Moving psychology into primary health care.

It is past time for psychologists to expand their services into primary health care. For too long, psychological work has been limited to mental health care. Psychology also has much to offer in primary health care. One of my major initiatives during my tenure as president of the American Psychological Association (APA) was to focus on psychologists' contributions to health care in general, particularly on what psychologists are doing to help cancer patients. A great need exists for professional psychologists to expand into these areas. To illustrate the value of psychological interventions in primary health care, I focus on two major health care problems: heart disease and cancer. Both are particularly important areas for health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Care, National Health Insurance, and Psychology.

The role of psychologists as health care providers and the parameters of reimbursement for health care services are timely and controversial issues. A landmark decision was reached in this controversy in the 1980 appeal of a Virginia suit by clinical psychologists in which the court ruled that Blue Shield's refusal to directly reimburse psychologists was a violation of antitrust law. Thus, the requirement that psychologists bill through physicians was not upheld. In recent years a specific aspect of this controversy involved psychologists' roles in potential national health insurance programs. A limited study (appearing in the "National Register of Health Services Providers in Psychology" 1976-1978) of clinical psychologists' attitudes toward national health insurance suggests that Congress and psychologists may have disparate views. In addition to favoring national health insurance, over 85% of psychologists surveyed responded that consumers would benefit from such a program with mental health coverage. Only 16% agreed that such a program would constitute a subsidy of the rich by the poor (Albee, 1977). Several areas of conflicting or confusing responses in this study may reflect legitimate reasons for concern by Congress regarding institution of national health insurance. Belief that providers would benefit from mental health coverage in a national health insurance program was shared by 80% of respondents. Ninety-five percent of respondents identified the inclusion or exclusion of clinical psychologists in such a national health insurance as affecting the future of the profession. Curiously, over 50% of respondents agreed that primary care physicians should be reimbursed for mental health services, although such physicians have received no formal training in psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing re-adjustment concerns, planning for veterans’ safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist’s role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ecosystem health as a clinical rotation for senior students in Canadian veterinary schools

A research nurse interviewed 55 practice staff in 11 general practices to ascertain their views about their needs for occupational health care. In a second parallel study, a specialist in occupational medicine undertook an in-depth audit of occupational health provision in five other general practices with respect to the organization, the health and safety process, the services and the working environment. In the first study, the majority of practice staff reported the need for various aspects of occupational health care, particularly stress at work. In the second study, general practitioners and practice managers possessed a basic awareness of occupational health matters such as Health and Safety legislation, but their limited knowledge was not translated into effective management. General practice staff did not know where to obtain occupational health advice; most practices had no policies or procedures in place to manage health and safety. Both studies illustrate the need for expert occupational health advice in primary care.     

Review of Shifting the paradigm in community mental health: Towards empowerment and community.

Reviews the book, Shifting the paradigm in community mental health: Towards empowerment and community by Geoffrey Nelson, John Lord, and Joanna Ochocka (2001). This book, as it combines theory, practice, and research (a case study) about the processes of empowerment and integration of consumers of mental health care in a Canadian setting, delineates strategies and approaches that can be factors in fulfilling this important aim. Shifting the Paradigm in Community Mental Health is a welcome contribution to the literature on the implementation of consumer empowerment and involvement in mental health treatment and care. The authors offer an approach enabling the reader to see the dimensions for empowerment and community integration termed the empowerment-community integration paradigm. The book will be useful for a wide audience, including consumers, professionals, stakeholders, researchers, and policy makers, and should be in the libraries of all institutions, formal and informal, that deliver mental health care. The overall clarity of the writing and all the approaches will be very much appreciated by all those who work or receive services in mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do the media have an impact on the role of health care?

Edward Asner is a well-known stage and screen performer who has starred in a variety of motion picture and television productions, including Rich Man, Poor Man, Roots, and of course is best known for The Mary Tyler Moore Show and Lou Grant. There is another side to Mr. Asner, however. It is for this side of his professional work that he was asked to present an Invited Address to this APA Convention. For several years, Mr. Asner has taken a lead role in promoting the entertainment industry's involvement in health care. He has been actively involved in advocating quality health care for all citizens and to this end has become publicly involved in several ways. Mr. Asner's belief that health care services should be available to all individuals has led him to become actively involved in the union movement in the entertainment industry, promoting stronger affirmative action clauses and increased emphasis on health/safety conditions and benefits. It is because of this sincere dedication and active participation that Mr. Asner has been asked to address this American Psychological Association convention on the topic of "Do the Media Have an Impact on the Role of Health Care?" (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current methods of estimating severity for occupational injuries and illnesses: data from the 1986 Michigan Comprehensive Compensable Injury and Illness Database

National and state estimates of the severity of occupational injuries and illnesses (severity = lost work time = missed work days+restricted work days) have come from the annual Survey of Occupational Injuries and Illnesses (Survey) produced by the U.S. Bureau of Labor Statistics. However, we show that the Survey practice of collecting injury information soon after the accident year reduces substantially the accuracy of missed work day estimates, which constitute 85.3% of the Survey lost work time estimate. To develop an independent estimate of missed work days, the research team created the Michigan Comprehensive Compensable Occupational Injury Database (Michigan Database) by linking state files with injury characteristics to files with workers' compensation information for injuries occurring in 1986. The measure of missed work time (days, weeks, or years) is the cumulative duration of compensation from the "date disability commenced," noted on the first payment form, through follow-up to March 1, 1990. Cumulative missed work time has been calculated or estimated for 72,057 injured workers, more than 97% of the 73,609 Michigan workers with compensable occupational injuries in 1986 identified through the close of the study. Our "best" estimate of missed work days, to follow-up, attributable to both fatal and nonfatal compensable occupational injuries and illnesses is 7,518,784, a figure four times that reported for Michigan by the Survey. When insurance industry data on disbursements are also considered, the estimate of missed work days increases to 8,919,079, a figure 4.75 times that reported by the Survey. When insurance data on reserves for future payments are also considered, the estimate of missed work days increases to 16,103,398, a figure 8.58-fold greater than that obtained for Michigan in the Survey. The Michigan data suggest that the national Survey may have failed to identify almost 373 million of 421 million missed work days in the private sector that have resulted, or will result, from 1986 occupational injuries. The present federal/state system for estimating occupational injury severity by measuring lost work days seriously underestimates the magnitude of the problem. The current policy of obtaining incidence and severity data from the same Survey should be reconsidered. We recommend that national estimates of injury severity be obtained from representative states by using state compensation data and that such estimates be used to evaluate current prevention and rehabilitation strategies. The redesigned occupational safety and health Survey (ROSH Survey) should be revised to permit linkage to compensation data.     

Performance Measurement, Health Care Policy, and Implications for Rehabilitation Services.

Provision of reliable, valid, and informative data to the public for evaluating the performance of health care services has been inconsistent at best and erroneous at worst. This article examines how private and governmental agencies are addressing this issue by concentrating on a well-defined set of performance indicators for several key diseases. In order to fully consider the implications of these developments for rehabilitation, the author discusses 4 topics: (a) how quality and safety concerns influence health care policy, (b) watershed events over the past half century that have contributed to a quality and safety dilemma in health care, (c) the difference between process and outcome indicators and implications for robust performance measurement, and (d) emerging coordination efforts by accreditation and regulatory agencies that will shape clinical service delivery in rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transforming Mental Health Care for Children and Their Families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of public/private health care insurance parameters for independent psychological practice.

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupational health psychology: origins, context, and direction.

Rapidly changing conditions of work and employment have brought the topic of work organization and health to the forefront of concern in occupational safety and health. This article begins with a historical overview of psychology's contribution to the occupational safety and health field. It then argues that the changing work environment creates new and special needs for research and application by psychologists in the area of work organization and health. The article also describes new initiatives by national health organizations in the United State and Europe to frame a new field of study that focuses on the topic of work organization and health, called "occupational health psychology." (PsycINFO Database Record (c) 2010 APA, all rights reserved)