Albert W. Wu

Objective: To develop and conduct preliminary testing of the reliability and validity of the Healthcare Worker (HCW) Culture of Support Scale (COS), intended to assess health worker perceptions of institutional support resources and organizational culture related to their well-being. Methods: A cross-sectional survey was conducted with 533 HCWs from ambulatory clinic and rural hospital settings. The survey included validated measures and newly developed items. Exploratory and confirmatory factor analyses (EFA/CFA) were employed to determine the factor structure. Internal consistency and construct validity were assessed using Cronbach alpha and correlation with mental health outcomes. Results: The COS demonstrated a robust three-factor structure: 1) Organizational Support (Cronbach alpha = 0.83), 2) Access to Peer Support (Cronbach alpha = 0.92), and 3) Availability of Support (Cronbach alpha = 0.97), accounting for 84.9% of variance. Cronbach alpha for the overall scale was 0.94. CFA confirmed excellent model fit (RMSEA = .049, CFI = .992). Higher COS scores correlated with lower burnout (r = -.47, p < .001) and anxiety (r = -.35, p < .001), and greater resilience (r = .30, p < .001). Conclusion: Preliminary evidence suggests that the COS is a reliable and valid measure of HCWs' perceptions of organizational support for worker well-being. This scale and the three subscales can provide healthcare institutions with a way to evaluate organizational initiatives to enhance worker well-being and workforce resilience. Further testing is recommended in diverse settings.

Background: Burnout among healthcare workers (HCWs) threatens workforce stability and patient care, particularly in rural hospitals where staff shortages, limited resources, and professional isolation amplify stress. Peer support interventions have demonstrated promise in urban centers, but their feasibility and impact in rural settings remain underexplored. Methods: We implemented and evaluated the Johns Hopkins RISE (Resilience in Stressful Events) peer support program across two rural hospital systems in the Mid-Atlantic United States. Using pre- and post-implementation surveys, we assessed anxiety (GAD-7), burnout (Maslach Burnout Inventory), resilience (CD-RISC), and perceptions of organizational culture of well-being. Linear and logistic regression models adjusted for age, site, and employment duration were used to evaluate outcomes over time. Results: A total of 868 respondents participated across three time points. Burnout and anxiety declined modestly post-implementation, while resilience improved initially but was not sustained at 2-year follow-up. Older employees demonstrated lower anxiety and burnout, while mid-career employees (3–10 years of employment) reported significantly higher distress. Importantly, access to peer support and perceived availability of supportive resources improved significantly over time, reflecting growing program integration. Conclusions: RISE was adapted successfully in rural hospital settings, with evidence of reduced burnout, lower anxiety, and increased perceived access to peer support. While resilience gains were not sustained, results suggest that a peer support program tailored to each organization can mitigate workforce distress in rural health systems. Addressing implementation and contextual barriers and sustaining organizational commitment are important for long-term impact. Expanding peer support to rural hospitals may improve workforce retention and care delivery in underserved communities.

Purpose Breast cancer (BC) is the most prevalent cancer among women, with hormone receptor-positive BC making up approximately 70% of cases. Adjuvant Endocrine Therapy (AET) is critical in reducing recurrence in this patient population. Still, it often leads to side effects that negatively impact patients' health-related quality of life (HRQoL). Patient-reported outcome measures (PROMs) are widely used to assess HRQoL, but there is inconsistency in the instruments used to evaluate the impact of AET on BC patients. This systematic review aimed to identify and evaluate PROMs that assess HRQoL in BC patients undergoing AET, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Methods A systematic search was conducted across MEDLINE, EMBASE, Cochrane Library, and Google Scholar for studies published between 2007 and 2023. Studies that developed and validated PROMs for BC patients on AET were included. The measurement properties of each PROM were appraised following COSMIN guidelines, and their relevance, comprehensiveness, and comprehensibility were assessed. Results The review included 24 studies assessing six PROMs. The European Organization for Research and Treatment of Cancer-Breast Cancer45 (EORTC BR45) and Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES) demonstrated sufficient content validity and covered the majority of AET-related symptoms. Both instruments were rated highly for structural validity, internal consistency, cross-cultural validity, and reliability. FACT-ES also demonstrated strong responsiveness to treatment-related changes. Conclusions EORTC BR45 and FACT-ES are the most suitable PROMs for assessing HRQoL in BC patients undergoing AET due to their robust psychometric properties and comprehensive coverage of AET-related symptoms.

Objective: To summarise the literature on healthcare interventions to reduce harm to patients caused by the COVID-19 pandemic across six domains: medication safety, diagnostic safety, surgical safety, healthcare-associated infections, pressure injuries and falls. Methods: We performed a mixed-methods systematic review, with the intention to present results narratively. We combined parallel searches and expert input across each domain of interest, identifying 13 019 unique articles across the six domains. Of these, 590 full texts were assessed for eligibility. 7 were included for the medication safety domain; 7 for diagnostic safety; 32 for surgical safety; 11 for healthcare-associated infections; 5 for the pressure injuries and 2 for falls. Overall, a total of 61 unique articles were included—4 articles were represented across more than one domain. Findings: There were few rigorous evaluations of specific interventions to reduce patient harm caused by the pandemic. Adjustments in treatments, triage and procedures, and use of risk stratification tools reduced delays and permitted more elective surgery and diagnostic testing to proceed. These changes also led to improvements in medication safety practices and prevention of healthcare-associated infections. Conclusion: There has been little research on interventions to reduce patient harm caused in healthcare settings during the COVID-19 pandemic. Interventions focused on preventing nosocomial transmission of COVID-19 and on permitting access to urgent surgical and diagnostic needs. A few studies tested strategies to reduce new risks imposed by the pandemic for medication safety, healthcare-associated infections, pressure injuries and falls. Development of high-reliability health systems and healthcare organisations to protect patients and health workers from harm will be essential to mitigating the impact of future pandemics within the objectives of the Global Patient Safety Action Plan 2021–2030.

The investigation of incidents and accidents, together with subsequent reflection and action, is an essential component of safety management in every safety-critical industry, including healthcare. A number of formal methods of incident analysis were developed in the early days of risk management and patient safety, including the London Protocol which was published in 2004. In this paper, we describe the development of a new edition of the London Protocol. We explain the need for a revised and expanded version of the London Protocol, addressing both the changes in healthcare in the last two decades and what has been learnt from the experience of incident analysis across the world. We describe a systematic process of development of the new edition drawing on the findings of a narrative review of incident analysis methods. The principal changes in the new edition are as follows: increased emphasis and guidance on the engagement of patients and families as partners in the investigation; giving more attention to the support of patients, families and staff in the aftermath of an incident; emphasising the value of a small number of in-depth analyses combined with thematic reviews of wider problems; including proposals and guidance for the examination of much longer time periods; emphasising the need to highlight good care as well as problems; adding guidance on direct observation of the work environment; providing a more structured and wide-ranging approach to recommendations and including more guidance on how to write safety incident reports. Finally, we offer some proposals to place research on incident analysis on a firmer foundation and make suggestions for the practice and implementation of incident investigation within safety management systems.

Background/Objectives: Despite the importance of the second victim phenomenon for healthcare systems, there is limited research on Italian healthcare providers. We assessed emotional distress in individuals impacted by an adverse event using the Withstand-PSY Questionnaire (WS-PSY-Q). Additionally, we aimed to identify potential risk factors for anxiety and depression. Methods: A cross-sectional online survey of 284 participants. Measures included the WS-PSY-Q, Beck Depression Inventory-II (BDI-II), and State-Trait Anxiety Inventory (STAI-Y). Descriptive analyses and seemingly unrelated regression, jointly estimating anxiety and depression, were conducted using Stata (version 18). Results: Fifty-nine percent of the participants tested positive for anxiety (WS-PSY-Q anxiety subscale ≥ 16), thirty-seven percent for depression (WS-PSY-Q depression subscale ≥ 22), and thirty-five percent for both. In the final model, anxiety symptoms following the adverse event were associated with pre-event anxiety levels (p < 0.01), seeking psychological help (p < 0.05), self-perceived responsibility (p < 0.01), severity of the adverse event for the patient (p < 0.05), and punitive workplace climate (p < 0.05). Correlates of post-event depressive symptoms included pre-existing depression (p < 0.01), self-perceived responsibility (p < 0.01), severity of the impact of the adverse event (p < 0.01), punitive or neutral workplace climate (p < 0.05), and seeking psychological help (p < 0.01). Conclusions: This study adds to the growing understanding of the mental health difficulties that healthcare workers in Italy encounter after adverse events, addressing both individual and systemic risk factors. Proactive implementation of mental health measures for healthcare workers could foster their well-being after adverse events and promote a stronger, more just organizational culture.