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Papers by William Martinez
Academic Pediatrics, 2020
OBJECTIVES Speaking up is increasingly recognized as essential for patient safety. We aimed to de... more OBJECTIVES Speaking up is increasingly recognized as essential for patient safety. We aimed to determine pediatric trainees' experiences, attitudes, and anticipated behaviors with speaking up about safety threats including unprofessional behavior. METHODS Anonymous, cross-sectional survey of 512 pediatric trainees at two large US academic children's hospitals that queried experiences, attitudes, barriers and facilitators, and vignette responses for unprofessional behavior and traditional safety threats. RESULTS Responding trainees (223/512, 44%) more commonly observed unprofessional behavior than traditional safety threats (57%, 127/223 vs. 34%, 75/223; P<0.001), but reported speaking up about unprofessional behavior less commonly (48%, 27/56 vs. 79%, 44/56; P<0.001). Respondents reported feeling less safe speaking up about unprofessional behavior than patient safety concerns (52%, 117/223 vs. 78%, 173/223; P<0.001). Respondents were significantly less likely to speaking up to, and use assertive language with, an attending physician in the unprofessional behavior vignette than the traditional safety vignette (10%, 22/223 vs. 64%, 143/223, P<0.001 and 12%, 27/223 vs. 57%, 128/223, P<0.001, respectively); these differences persisted even among respondents that perceived high potential for patient harm in both vignettes (20%, 16/81 vs. 69%, 56/81, P<0.001 and 20%, 16/81 vs. 69% (56/81), P<0.001, respectively). Fear of conflict was the predominant barrier to speaking up about unprofessional behavior and more commonly endorsed for unprofessional behavior than traditional safety threats (67%, 150/223 vs. 45%, 100/223; P<0.001). CONCLUSIONS Findings suggest pediatric trainee reluctance to speak up when presented with unprofessional behavior compared to traditional safety threats and highlight a need to improve elements of the clinical learning environment to support speaking up.
Joint Commission journal on quality and patient safety, 2017
Conferences, processes, and/or meetings in which adverse events and near misses are reviewed with... more Conferences, processes, and/or meetings in which adverse events and near misses are reviewed within clinical programs at a single academic medical center were identified. Leaders of conferences, processes, or meetings-"process leaders"-in which adverse events and near misses were reviewed were surveyed. On the basis of responses from all 45 process leaders, processes were classified into (1) Morbidity and Mortality Conferences (MMCs), (2) Quality Assurance (QA) Meetings, and (3) Educational Conferences. Some 22% of the clinical programs used more than one of these three processes to identify and review adverse events and near misses, while 10% had no consistent participation in any of them. Explicit criteria for identifying and selecting cases to be reviewed were used by 58% of MMCs and 69% of QA Meetings. The explicit criteria used by MMCs and QA Meetings varied widely. Many MMCs (54%, 13/24), QA Meetings (54%, 7/13), and Educational Conferences (70%, 7/10) did not review...
Academic medicine : journal of the Association of American Medical Colleges, Jan 5, 2016
To develop a practical and psychometrically sound set of survey items that measures moral courage... more To develop a practical and psychometrically sound set of survey items that measures moral courage for physicians in the context of patient care. In 2013, the 731 internal medicine and surgical interns and residents from two northeastern U.S. academic medical centers were invited to anonymously complete a survey about moral courage, empathy, and speaking up about patient safety breaches. Of the eligible participants, 352 (48%) responded. Principal components analysis of the moral courage items demonstrated a single, meaningful, nine-item factor labeled the Moral Courage Scale for Physicians (MCSP). All item-total score correlations were significant (P < .001) and ranged from 0.57 to 0.76. The Cronbach alpha for the MCSP was 0.90. Consistent with expectations based on theory, MCSP scores were negatively associated with being an intern versus resident (B = -4.17, P < .001), suggesting discriminant validity. MCSP scores were positively associated with respondents' Jefferson Sc...
Academic Pediatrics, 2020
OBJECTIVES Speaking up is increasingly recognized as essential for patient safety. We aimed to de... more OBJECTIVES Speaking up is increasingly recognized as essential for patient safety. We aimed to determine pediatric trainees' experiences, attitudes, and anticipated behaviors with speaking up about safety threats including unprofessional behavior. METHODS Anonymous, cross-sectional survey of 512 pediatric trainees at two large US academic children's hospitals that queried experiences, attitudes, barriers and facilitators, and vignette responses for unprofessional behavior and traditional safety threats. RESULTS Responding trainees (223/512, 44%) more commonly observed unprofessional behavior than traditional safety threats (57%, 127/223 vs. 34%, 75/223; P<0.001), but reported speaking up about unprofessional behavior less commonly (48%, 27/56 vs. 79%, 44/56; P<0.001). Respondents reported feeling less safe speaking up about unprofessional behavior than patient safety concerns (52%, 117/223 vs. 78%, 173/223; P<0.001). Respondents were significantly less likely to speaking up to, and use assertive language with, an attending physician in the unprofessional behavior vignette than the traditional safety vignette (10%, 22/223 vs. 64%, 143/223, P<0.001 and 12%, 27/223 vs. 57%, 128/223, P<0.001, respectively); these differences persisted even among respondents that perceived high potential for patient harm in both vignettes (20%, 16/81 vs. 69%, 56/81, P<0.001 and 20%, 16/81 vs. 69% (56/81), P<0.001, respectively). Fear of conflict was the predominant barrier to speaking up about unprofessional behavior and more commonly endorsed for unprofessional behavior than traditional safety threats (67%, 150/223 vs. 45%, 100/223; P<0.001). CONCLUSIONS Findings suggest pediatric trainee reluctance to speak up when presented with unprofessional behavior compared to traditional safety threats and highlight a need to improve elements of the clinical learning environment to support speaking up.
Joint Commission journal on quality and patient safety, 2017
Conferences, processes, and/or meetings in which adverse events and near misses are reviewed with... more Conferences, processes, and/or meetings in which adverse events and near misses are reviewed within clinical programs at a single academic medical center were identified. Leaders of conferences, processes, or meetings-"process leaders"-in which adverse events and near misses were reviewed were surveyed. On the basis of responses from all 45 process leaders, processes were classified into (1) Morbidity and Mortality Conferences (MMCs), (2) Quality Assurance (QA) Meetings, and (3) Educational Conferences. Some 22% of the clinical programs used more than one of these three processes to identify and review adverse events and near misses, while 10% had no consistent participation in any of them. Explicit criteria for identifying and selecting cases to be reviewed were used by 58% of MMCs and 69% of QA Meetings. The explicit criteria used by MMCs and QA Meetings varied widely. Many MMCs (54%, 13/24), QA Meetings (54%, 7/13), and Educational Conferences (70%, 7/10) did not review...
Academic medicine : journal of the Association of American Medical Colleges, Jan 5, 2016
To develop a practical and psychometrically sound set of survey items that measures moral courage... more To develop a practical and psychometrically sound set of survey items that measures moral courage for physicians in the context of patient care. In 2013, the 731 internal medicine and surgical interns and residents from two northeastern U.S. academic medical centers were invited to anonymously complete a survey about moral courage, empathy, and speaking up about patient safety breaches. Of the eligible participants, 352 (48%) responded. Principal components analysis of the moral courage items demonstrated a single, meaningful, nine-item factor labeled the Moral Courage Scale for Physicians (MCSP). All item-total score correlations were significant (P < .001) and ranged from 0.57 to 0.76. The Cronbach alpha for the MCSP was 0.90. Consistent with expectations based on theory, MCSP scores were negatively associated with being an intern versus resident (B = -4.17, P < .001), suggesting discriminant validity. MCSP scores were positively associated with respondents' Jefferson Sc...