Professor Christine Jorm

Professor Christine Jorm

Conjoint Professor

School of Medicine and Public Health

Career Summary

Biography

Christine Jorm is the Director of NSW Regional Health Partners, an NHMRC accredited Centre for Innovation in Regional Health. The Centre’s role is to accelerate the translation of research into practice order to improve regional and rural health. The Centre receives support from its eight partners (HNELHD, CCLHD, MNCLHD, Calvary Mater, UON, UNE, HMRI), the NSW Ministry of Health and the Medical Research Future Fund. 

Christine is a safety and quality expert, with experience as a clinician, policy maker, researcher and educator. 

As well as specialty medical qualifications, Christine has doctorates in neuropharmacology and sociology: Her PhD thesis explored aspects of medical culture. From it she published a book: Reconstructing Medical Practice - Engagement, Professionalism and Critical Relationships in Health Care’. Based on study of teaching hospital consultants, it examines why doctors are limited in their ability to lead change in the current system. Doctors' self-esteem was found to be delicate due to the uncertain nature of their work; colleagues provide necessary support but both factors limit their ability to admit to error or engage with ‘the system’. It argues that regulation is a clumsy approach to ensuring good care instead, detailed attention to organisational relationships is needed. 

Christine worked as an anaesthetist for more than 15 years before her interest in quality assurance led to full-time cross-disciplinary work in patient safety and quality at hospital level and then later as the foundation Senior Medical Advisor for the Australian Commission on Safety and Quality in Healthcare. After leaving the Commission, Christine worked at Sydney Medical School as Associate Dean (Professionalism) before focusing on interprofessional health education. The interprofessional team she led won a Sydney University Vice Chancellor’s Award for Outstanding Educational Engagement and Innovation and an Australian Award for University Teaching in 2017. 

Christine has been part of several successful research teams and supervised PhD students. She is currently a member of an ARC Discovery Grant team (Manias E lead) DP170100308 'Communicating about medications with older people across transition points of care' and co-supervising two PhD students:

  • A/Prof Paul McGurgan UWA: What factors influence judgements about medical students' professional behavior? Commenced 2106
  • Dr Nancy Sturman UQ: Peer assessment in the transition from medical student to junior doctor. Commenced 2106

Christine’s past consultancy work includes analyses for the Australian Institute of Health and Welfare, development of a number of online units of study and a major report on Clinician Engagement for the Victorian Department of Health and Human Services. She is a graduate of the Institute of Company Directors, has been a member of several Boards and is currently a member of the UNSW Centre for Big Data Research in Health Advisory Committee and is a long-term member of the Grattan Health Program Advisory Group. Christine co-authored with Stephen Duckett, the three recent Grattan safety and quality reports:

Christine has published more than 80 opinion pieces, peer reviewed articles, books and book chapters in a diverse range of fields and been cited by others more than 1400 times. Her google scholar profile is here.


Keywords

  • interprofessional education
  • organisational change
  • quality improvement

Fields of Research

Code Description Percentage
150310 Organisation and Management Theory 30
130209 Medicine, Nursing and Health Curriculum and Pedagogy 30
111799 Public Health and Health Services not elsewhere classified 40
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Chapter (1 outputs)

Year Citation Altmetrics Link
2005 White NL, Bray MD, 'The processes of workplace change for nurses in NSW public hospitals', Workplace reform in the health care industry: the Australian experience, Palgrave Macmillan, Basingstoke 131-149 (2005) [B1]
Citations Scopus - 9
Co-authors Mark Bray

Journal article (61 outputs)

Year Citation Altmetrics Link
2019 Jorm C, Hudson R, Wallace E, 'Turning attention to clinician engagement in Victoria', Australian Health Review, 43 123-125 (2019)

© 2019 Journal Compilation AHHA. The engagement of clinicians with employing organisations and with the broader health system results in better safer care for patients. Concerns a... [more]

© 2019 Journal Compilation AHHA. The engagement of clinicians with employing organisations and with the broader health system results in better safer care for patients. Concerns about the adequacy of clinician engagement in the state of Victoria led the Victorian Department of Health and Human Services to commission a scoping study. During this investigation more than 100 clinicians were spoken with and 1800 responded to surveys. The result was creation of a clear picture of what engagement and disengagement looked like at all levels-from the clinical microsystem to state health policy making. Multiple interventions are possible to enhance clinician engagement and thus the care of future patients. A framework was developed to guide future Victorian work with four elements: setting the agenda, informing, involving and empowering clinicians. Concepts of work or employee engagement that are used in other industries don't directly translate to healthcare and thus the definition of engagement chosen for use centred on involvement. This was designed to encourage system managers to ensure clinicians are full participants in design, planning and evaluation and in all decisions that affect them and their patients.

DOI 10.1071/AH17100
2018 Jorm C, Blease J, Haq I, 'Time to establish comprehensive long-term monitoring of Australian medical graduates?', Australian Health Review, 42 635-639 (2018)

© AHHA 2018. We believe that the well being of our medical students (and medical staff throughout the continuum of practice) matters too much not to ask, 'How do they feel?&a... [more]

© AHHA 2018. We believe that the well being of our medical students (and medical staff throughout the continuum of practice) matters too much not to ask, 'How do they feel?' Society, and students themselves, have invested too much in their education not to query 'How well are they performing in the workplace?'. Our accountability to the community demands we ask, 'How are their patients going?' This article presents a schema for building long-term monitoring in Australia, using linked and reliable data, that will enable these questions to be answered. Although the answers will be of interest to many, medical schools will then be well placed to alter their programs and processes based on these three domains of graduate well being, workplace performance and patient outcomes.

DOI 10.1071/AH16292
2018 Roper L, Shulruf B, Jorm C, Currie J, Gordon CJ, 'Validation of the self-assessment teamwork tool (SATT) in a cohort of nursing and medical students', Medical Teacher, 40 1072-1075 (2018)

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Introduction: Poor teamwork has been implicated in medical error and teamwork training has been shown t... [more]

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Introduction: Poor teamwork has been implicated in medical error and teamwork training has been shown to improve patient care. Simulation is an effective educational method for teamwork training. Post-simulation reflection aims to promote learning and we have previously developed a self-assessment teamwork tool (SATT) for health students to measure teamwork performance. This study aimed to evaluate the psychometric properties of a revised self-assessment teamwork tool. Methods: The tool was tested in 257 medical and nursing students after their participation in one of several mass casualty simulations. Results: Using exploratory and confirmatory factor analysis, the revised self-assessment teamwork tool was shown to have strong construct validity, high reliability, and the construct demonstrated invariance across groups (Medicine & Nursing). Conclusions: The modified SATT was shown to be a reliable and valid student self-assessment tool. The SATT is a quick and practical method of guiding students¿ reflection on important teamwork skills.

DOI 10.1080/0142159X.2017.1418849
Citations Scopus - 1
2018 Walton M, Harrison R, Smith-Merry J, Kelly P, Manias E, Jorm C, Iedema R, 'Disclosure of adverse events: A data linkage study reporting patient experiences among Australian adults aged =45 years', Australian Health Review, (2018)

© 2018 AHHA. Objective: Since Australia initiated national open disclosure standards in 2002, open disclosure policies have been adopted in all Australian states and territories. ... [more]

© 2018 AHHA. Objective: Since Australia initiated national open disclosure standards in 2002, open disclosure policies have been adopted in all Australian states and territories. Yet, research evidence regarding their adoption is limited. The aim of the present study was to determine the frequency with which patients who report an adverse event had information disclosed to them about the incident, including whether they participated in a formal open disclosure process, their experiences of the process and the extent to which these align with the current New South Wales (NSW) policy. Methods: A cross-sectional survey about patient experiences of disclosure associated with an adverse event was administered to a random sample of 20 000 participants in the 45 and Up Study who were hospitalised in NSW, Australia, between January and June 2014. Results: Of the 18 993 eligible potential participants, completed surveys were obtained from 7661 (40% response rate), with 474 (7%) patients reporting an adverse event. Of those who reported an adverse event, a significant majority reported an informal or bedside disclosure (91%; 430/474). Only 79 patients (17%) participated in a formal open disclosure meeting. Most informal disclosures were provided by nurses, with only 25% provided by medical practitioners. Conclusions: Experiences of open disclosure may be enhanced by informing patients of their right to full disclosure in advance of or upon admission to hospital, and recognition of and support for informal or bedside disclosure for appropriate types of incidents. A review of the open disclosure guidelines in relation to the types of adverse events that require formal open disclosure and those more suitable to informal bedside disclosure is indicated. Guidelines for bedside disclosure should be drafted to assist medical practitioners and other health professionals facilitate and improve their communications about adverse events. Alignment of formal disclosure with policy requirements may also be enhanced by training multidisciplinary teams in the process. What is known about the topic?: While open disclosure is required in all cases of serious adverse events, patients' experiences are variable, and lack of, or poor quality disclosures are all too common. What does this paper add?: This paper presents experiences reported by patients across New South Wales in a large cross-sectional survey. Unlike previous studies of open disclosure, recently hospitalised patients were identified and invited using data linkage with medical records. Findings suggest that most patients receive informal disclosures rather than a process that aligns with the current policy guidance. What are the implications for practitioners?: Experiences of open disclosure may be enhanced by informing patients of their right to full disclosure in advance of or upon admission to hospital, and recognition of and support for informal or bedside disclosure for appropriate types of incidents.

DOI 10.1071/AH17179
Citations Scopus - 1
2018 Jorm C, Roberts C, 'Using complexity theory to guide medical school evaluations', Academic Medicine, 93 399-405 (2018)

© 2017 by the Association of American Medical Colleges. Contemporary medical school evaluations are narrow in focus and often do not consider the wider systems implications of the... [more]

© 2017 by the Association of American Medical Colleges. Contemporary medical school evaluations are narrow in focus and often do not consider the wider systems implications of the relationship between learning and teaching, research, clinical care, and community engagement. The result is graduates who lack the necessary knowledge and skills for the modern health care system and an educational system that is limited in its ability to learn and change. To address this issue, the authors apply complexity theory to medical school evaluation, using four key factors-nesting, diversity, self-organization, and emergent outcomes. To help medical educators apply this evaluation approach in their own settings, the authors offer two tools-a modified program logic model and sensemaking. In sensemaking, they use the organic metaphor of the medical school as a neuron situated within a complex neural network to enable medical educators to reframe the way they think about program evaluation. The authors then offer practical guidance for applying this model, including describing the example of addressing graduates' engagement in the health care system. The authors consider the input of teachers, the role of culture and curriculum, and the clinical care system in this example. Medical school evaluation is reframed as an improvement science for complex social interventions (medical school is such an intervention) in this model. With complexity theory's focus on emergent outcomes, evaluation takes on a new focus, reimagining medical students as reaching their future potential as change agents, who transform health systems and the lives of patients.

DOI 10.1097/ACM.0000000000001828
Citations Scopus - 4
2018 Harrison R, Walton M, Kelly P, Manias E, Jorm C, Smith-Merry J, et al., 'Hospitalization from the patient perspective: A data linkage study of adults in Australia', International Journal for Quality in Health Care, 30 358-365 (2018)

© The Author(s) 2018. Objective: Evidence of the patient experience of hospitalization is an essential component of health policy and service improvement but studies often lack a ... [more]

© The Author(s) 2018. Objective: Evidence of the patient experience of hospitalization is an essential component of health policy and service improvement but studies often lack a representative population sample or do not examine the influence of patient and hospital characteristics on experiences. We address these gaps by investigating the experiences of a large cohort of recently hospitalized patients aged 45 years and over in New South Wales (NSW), Australia who were identified using data linkage. Design: Cross-sectional survey. Setting: Hospitals in NSW, Australia. Participants: The Picker Patient Experience Survey (PPE-15) was administered to a random sample of 20 000 patients hospitalized between January and June 2014. Main outcome measure: Multivariable negative binomial regression was used to investigate factors associated with a higher PPE-15 score. Results: There was a 40% response rate (7661 completed surveys received). Respondents often reported a positive experience of being treated with dignity and respect, yet almost 40% wanted to be more involved in decisions about their care. Some respondents identified other problematic aspects of care such as receiving conflicting information from different care providers (18%) and feeling that doctors spoke in front of them as if they were not there (14%). Having an unplanned admission or having an adverse event were both very strongly associated with a poorer patient experience (P < 0.001). No other factors were found to be associated. Conclusions: Patient involvement in decision-making about care was highlighted as an important area for improvement. Further work is needed to address the challenges experienced by patients, carers and health professionals in achieving a genuine partnership model.

DOI 10.1093/intqhc/mzy024
Citations Scopus - 1
2018 Iedema R, Jorm C, Hooker C, Hor SY, Wyer M, Gilbert GL, 'To follow a rule? On frontline clinicians¿ understandings and embodiments of hospital-acquired infection prevention and control rules', Health (United Kingdom), (2018)

© 2018, The Author(s) 2018. This article reports on a study of clinicians¿ responses to footage of their enactments of infection prevention and control. The study¿s approach was t... [more]

© 2018, The Author(s) 2018. This article reports on a study of clinicians¿ responses to footage of their enactments of infection prevention and control. The study¿s approach was to elicit clinicians¿ reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own infection prevention and control practices by articulating previously unheeded tensions and constraints including infection control rules that were incomplete, undergoing change, and conflicting; material obstructions limiting infection control efforts; and habituated and divergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians¿ learning about these complexities as they affect the accomplishment of effective infection control. The process is further shown to strengthen clinicians¿ appreciation of infection control as necessitating deliberation to decide what are locally appropriate standards, interpretations, assumptions, habituations and enactments of infection control. The article concludes that clinicians¿ ¿practical wisdom¿ is unlikely to reach its full potential without video-assisted scrutiny of and deliberation about in situ clinical work. This enables clinicians to anchor their in situ enactments, reasonings and interpretations to local agreements about the intent, applicability, limits and practical enactment of rules.

DOI 10.1177/1363459318785677
2018 Currie J, Kourouche S, Gordon C, Jorm C, West S, 'Mass casualty education for undergraduate nursing students in Australia', Nurse Education in Practice, 28 156-162 (2018)

© 2017 Elsevier Ltd With the increasing risk of mass casualty incidents from extreme climate events, global terrorism, pandemics and nuclear incidents, it&apos;s important to prep... [more]

© 2017 Elsevier Ltd With the increasing risk of mass casualty incidents from extreme climate events, global terrorism, pandemics and nuclear incidents, it's important to prepare nurses with skills and knowledge necessary to manage such incidents. There are very few documented accounts of the inclusion of mass casualty education within undergraduate nursing programs. This paper is the first to describe undergraduate mass casualty nursing education in Australia. A final year Bachelor of Nursing undergraduate subject was developed. The subject focused on initial treatment and stabilisation of casualties predominantly within pre-hospital environments, and included a capstone inter-professional mass casualty simulation. Students experience of the subject was evaluated using the Satisfaction with Simulation Experience Scale (Levett-Jones et al., 2011) and a subject evaluation survey. Student satisfaction and evaluations were extremely positive. As a tool for developing clinical skills, 93% (n = 43) agreed that the simulation developed their clinical reasoning and decision making skills. In particular, the simulation enabled students to apply what they had learned (77%, n = 35, strongly agree). Due to the frequency of mass casualty events worldwide, there is a need for educational exposure in undergraduate nursing curricula. We believe that this mass casualty education could be used as a template for development in nursing curricula.

DOI 10.1016/j.nepr.2017.10.006
2017 Roper L, Jorm C, 'Preparing medical students for the e-patient: Is a theoretical grounding required?', Medical Teacher, 39 1101 (2017)
DOI 10.1080/0142159X.2017.1353072
2017 Roberts C, Jorm C, Gentilcore S, Crossley J, 'Peer assessment of professional behaviours in problem-based learning groups', Medical Education, 51 390-400 (2017)

© 2017 John Wiley &amp; Sons Ltd and The Association for the Study of Medical Education Context: Peer assessment of professional behaviour within problem-based learning (PBL) gr... [more]

© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education Context: Peer assessment of professional behaviour within problem-based learning (PBL) groups can support learning and provide opportunities to identify and remediate problem behaviours. Objectives: We investigated whether a peer assessment of learning behaviours in PBL is sufficiently valid to support decision making about student professional behaviours. Methods: Data were available for two cohorts of students, in which each student was rated by all of their PBL group peers using a modified version of a previously validated scale. Following the provision of feedback to the students, their behaviours were again peer-assessed. A generalisability study was undertaken to calculate the students¿ professional behaviour scores, sources of error that impacted the reliability of the assessment, changes in student rating behaviour, and changes in mean scores after the delivery of feedback. Results: Peer assessment of professional learning behaviour was highly reliable for within-group comparisons (G = 0.81¿0.87), but poor for across-group comparisons (G = 0.47¿0.53). Feedback increased the range of ratings given by assessors and brought their mean ratings into closer alignment. More of the increased variance was attributable to assessee performance than to assessor stringency and hence there was a slight improvement in reliability, especially for comparisons across groups. Mean professional behaviour scores were unchanged. Conclusions: Peer assessment of professional learning behaviours may be unreliable for decision making outside a PBL group. Faculty members should not draw conclusions from peer assessment about a student's behaviour compared with that of their peers in the cohort, and such a tool may not be appropriate for summative assessment. Health professional educators interested in assessing student professional behaviours in PBL groups might focus on opportunities for the provision of formative peer feedback and its impact on learning.

DOI 10.1111/medu.13151
Citations Scopus - 5
2017 Walton MM, Harrison R, Kelly P, Smith-Merry J, Manias E, Jorm C, Iedema R, 'Patients' reports of adverse events: A data linkage study of Australian adults aged 45 years and over', BMJ Quality and Safety, 26 743-750 (2017)

© Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights... [more]

© Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. Background Understanding a patient's hospital experience is fundamental to improving health services and policy, yet, little is known about their experiences of adverse events (AEs). This study redresses this deficit by investigating the experiences of patients in New South Wales hospitals who suffered an AE. Methods Data linkage was used to identify a random sample of 20000 participants in the 45 and Up Cohort Study, out of 267153 adults aged 45years and over, who had been hospitalised in the prior 6months. A cross-sectional survey was administered to these patients to capture their experiences, including whether they had an AE and received honest communication about it. Results Of the 18993 eligible participants, 7661 completed surveys were received (40% response rate) and 474 (7%) reported having an AE. Most AEs related to clinical processes and procedures (33%), or medications and intravenous fluids (21%). Country of birth and admission through emergency were significant predictors of the occurrence of an event. An earlier admission in the prior 6months or a transfer to another healthcare facility was also associated with more AEs. Of those who suffered an AE, 58% reported serious or moderate effects. Conclusions Given the exclusions in our sample population (under 45years), the AE rate reported by patients of 7% is similar to the approximately 10% rate reported in the general population by retrospective medical record reviews. AE data that include patient experience may provide contextual information currently missing. Capturing and using patient experience data more effectively is critical; there may be opportunities for applying co-design methodology to improve the management of AEs and be more responsive to patients' concerns.

DOI 10.1136/bmjqs-2016-006339
Citations Scopus - 4
2017 Hor SY, Hooker C, Iedema R, Wyer M, Gilbert GL, Jorm C, O'Sullivan MVN, 'Beyond hand hygiene: A qualitative study of the everyday work of preventing cross-contamination on Hospital wards', BMJ Quality and Safety, 26 552-558 (2017)

© 2017 BMJ Publishing Group. All rights reserved. Background: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial... [more]

© 2017 BMJ Publishing Group. All rights reserved. Background: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial crosscontamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. Methods: We report on an interventionist videoreflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. Results: We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Conclusions: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.

DOI 10.1136/bmjqs-2016-005878
Citations Scopus - 4
2017 Roper L, Jorm C, 'Please leave your phone outside: Policymakers and medical app providers are encouraging patient participation, but doctors in the consult room are not', BMJ Innovations, 3 65-70 (2017)
DOI 10.1136/bmjinnov-2016-000134
Citations Scopus - 1
2017 Nisbet G, Jorm C, Roberts C, Gordon CJ, Chen TF, 'Content validation of an interprofessional learning video peer assessment tool', BMC Medical Education, 17 (2017)

© 2017 The Author(s). Background: Large scale models of interprofessional learning (IPL) where outcomes are assessed are rare within health professional curricula. To date, there ... [more]

© 2017 The Author(s). Background: Large scale models of interprofessional learning (IPL) where outcomes are assessed are rare within health professional curricula. To date, there is sparse research describing robust assessment strategies to support such activities. We describe the development of an IPL assessment task based on peer rating of a student generated video evidencing collaborative interprofessional practice. We provide content validation evidence of an assessment rubric in the context of large scale IPL. Methods: Two established approaches to scale development in an educational setting were combined. A literature review was undertaken to develop a conceptual model of the relevant domains and issues pertaining to assessment of student generated videos within IPL. Starting with a prototype rubric developed from the literature, a series of staff and student workshops were undertaken to integrate expert opinion and user perspectives. Participants assessed five-minute videos produced in a prior pilot IPL activity. Outcomes from each workshop informed the next version of the rubric until agreement was reached on anchoring statements and criteria. At this point the rubric was declared fit to be used in the upcoming mandatory large scale IPL activity. Results: The assessment rubric consisted of four domains: patient issues, interprofessional negotiation; interprofessional management plan in action; and effective use of video medium to engage audience. The first three domains reflected topic content relevant to the underlying construct of interprofessional collaborative practice. The fourth domain was consistent with the broader video assessment literature calling for greater emphasis on creativity in education. Conclusions: We have provided evidence for the content validity of a video-based peer assessment task portraying interprofessional collaborative practice in the context of large-scale IPL activities for healthcare professional students. Further research is needed to establish the reliability of such a scale.

DOI 10.1186/s12909-017-1099-5
2017 Wyer M, Iedema R, Hor SY, Jorm C, Hooker C, Gilbert GL, 'Patient involvement can affect clinicians¿ perspectives and practices of infection prevention and control: A ¿post-qualitative¿ study using video-reflexive ethnography', International Journal of Qualitative Methods, 16 (2017)

© The Author(s) 2017. This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnogr... [more]

© The Author(s) 2017. This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnography (VRE) to engage patients and clinicians in an exploration of the practical and relational complexities of patient involvement in infection prevention and control (IPC). This study included individual reflexive sessions with eight patients and six group reflexive sessions with 35 nurses. VRE usually involves participants reflecting on video footage of their own (and colleagues¿) practices in group reflexive sessions. We extended the method here by presenting, to nurses, video clips of their clinical interactions with patients, in conjunction with footage of the patients themselves analyzing the videos of their own care, for infection risks.We found that this novel approach affected the nurses¿ capacities to recognize, support, and enable patient involvement in IPC and to reflect on their own, sometimes inconsistent, IPC practices from patients¿ perspectives. As a ¿post-qualitative¿ approach, VRE prioritizes participants¿ roles, contributions, and learning. Invoking affect as an explanatory lens, we theorize that a ¿safe space¿ was created for participants in our study to reflect on and reshape their assumptions, positionings, and practices.

DOI 10.1177/1609406917690171
Citations Scopus - 3
2016 Roper L, Foster K, Garlan K, Jorm C, 'The challenge of authenticity for medical students', Clinical Teacher, 13 130-133 (2016)

© 2016 John Wiley &amp; Sons Ltd. Background: The development of a professional identity occurs during medical school. Formal study of students&apos; reflections on this process... [more]

© 2016 John Wiley & Sons Ltd. Background: The development of a professional identity occurs during medical school. Formal study of students' reflections on this process may provide insight into how to better support them. Methods: A qualitative data analysis of 56 student essays was undertaken. Results: Students' early interactions with patients seem to be influential in their process of identity development. Students were preoccupied with creating or preserving a professional persona in front of patients. They responded to this perceived challenge in three ways: some were concerned with controlling the experience and expression of emotion, others felt that they failed to be authentic, and the third group focused on the patient's experience of the interaction and agonised over what the patients might want. Discussion: This article adds to the literature by highlighting the struggles medical students encounter trying to behave and feel the way they think they ought. Students may be less troubled and participate more naturally in empathic communication if they learn to access authentic emotions in their interactions with patients. This article discusses strategies for medical faculties and clinical tutors to support and encourage them to do so.

DOI 10.1111/tct.12440
Citations Scopus - 2
2016 Jorm C, Roberts C, Lim R, Roper J, Skinner C, Robertson J, et al., 'A large-scale mass casualty simulation to develop the non-technical skills medical students require for collaborative teamwork', BMC Medical Education, 16 (2016)

© 2016 Jorm et al. Background: There is little research on large-scale complex health care simulations designed to facilitate student learning of non-technical skills in a team-wo... [more]

© 2016 Jorm et al. Background: There is little research on large-scale complex health care simulations designed to facilitate student learning of non-technical skills in a team-working environment. We evaluated the acceptability and effectiveness of a novel natural disaster simulation that enabled medical students to demonstrate their achievement of the non-technical skills of collaboration, negotiation and communication. Methods: In a mixed methods approach, survey data were available from 117 students and a thematic analysis undertaken of both student qualitative comments and tutor observer participation data. Results: Ninety three per cent of students found the activity engaging for their learning. Three themes emerged from the qualitative data: the impact of fidelity on student learning, reflexivity on the importance of non-technical skills in clinical care, and opportunities for collaborative teamwork. Physical fidelity was sufficient for good levels of student engagement, as was sociological fidelity. We demonstrated the effectiveness of the simulation in allowing students to reflect upon and evidence their acquisition of skills in collaboration, negotiation and communication, as well as situational awareness and attending to their emotions. Students readily identified emerging learning opportunities though critical reflection. The scenarios challenged students to work together collaboratively to solve clinical problems, using a range of resources including interacting with clinical experts. Conclusions: A large class teaching activity, framed as a simulation of a natural disaster is an acceptable and effective activity for medical students to develop the non-technical skills of collaboration, negotiation and communication, which are essential to team working. The design could be of value in medical schools in disaster prone areas, including within low resource countries, and as a feasible intervention for learning the non-technical skills that are needed for patient safety.

DOI 10.1186/s12909-016-0588-2
Citations Scopus - 10
2016 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A, 'Development of a self-assessment teamwork tool for use by medical and nursing students', BMC Medical Education, 16 (2016)

© 2016 The Author(s). Background: Teamwork training is an essential component of health professional student education. A valid and reliable teamwork self-assessment tool could as... [more]

© 2016 The Author(s). Background: Teamwork training is an essential component of health professional student education. A valid and reliable teamwork self-assessment tool could assist students to identify desirable teamwork behaviours with the potential to promote learning about effective teamwork. The aim of this study was to develop and evaluate a self-assessment teamwork tool for health professional students for use in the context of emergency response to a mass casualty. Methods: The authors modified a previously published teamwork instrument designed for experienced critical care teams for use with medical and nursing students involved in mass casualty simulations. The 17-item questionnaire was administered to students immediately following the simulations. These scores were used to explore the psychometric properties of the tool, using Exploratory and Confirmatory Factor Analysis. Results: 202 (128 medical and 74 nursing) students completed the self-assessment teamwork tool for students. Exploratory factor analysis revealed 2 factors (5 items - Teamwork coordination and communication; 4 items - Information sharing and support) and these were justified with confirmatory factor analysis. Internal consistency was 0.823 for Teamwork coordination and communication, and 0.812 for Information sharing and support. Conclusions: These data provide evidence to support the validity and reliability of the self-assessment teamwork tool for students This self-assessment tool could be of value to health professional students following team training activities to help them identify the attributes of effective teamwork.

DOI 10.1186/s12909-016-0743-9
Citations Scopus - 5
2016 Jorm C, Nisbet G, Roberts C, Gordon C, Gentilcore S, Chen TF, 'Using complexity theory to develop a student-directed interprofessional learning activity for 1220 healthcare students', BMC Medical Education, 16 (2016)

© 2016 The Author(s). Background: More and better interprofessional practice is predicated to be necessary to deliver good care to the patients of the future. However, universitie... [more]

© 2016 The Author(s). Background: More and better interprofessional practice is predicated to be necessary to deliver good care to the patients of the future. However, universities struggle to create authentic learning activities that enable students to experience the dynamic interprofessional interactions common in healthcare and that can accommodate large interprofessional student cohorts. We investigated a large-scale mandatory interprofessional learning (IPL) activity for health professional students designed to promote social learning. Methods: A mixed methods research approach determined feasibility, acceptability and the extent to which student IPL outcomes were met. We developed an IPL activity founded in complexity theory to prepare students for future practice by engaging them in a self-directed (self-organised) learning activity with a diverse team, whose assessable products would be emergent creations. Complicated but authentic clinical cases (n = 12) were developed to challenge student teams (n = 5 or 6). Assessment consisted of a written management plan (academically marked) and a five-minute video (peer marked) designed to assess creative collaboration as well as provide evidence of integrated collective knowledge; the cohesive patient-centred management plan. Results: All students (including the disciplines of diagnostic radiology, exercise physiology, medicine, nursing, occupational therapy, pharmacy, physiotherapy and speech pathology), completed all tasks successfully. Of the 26 % of students who completed the evaluation survey, 70 % agreed or strongly agreed that the IPL activity was worthwhile, and 87 % agreed or strongly agreed that their case study was relevant. Thematic analysis found overarching themes of engagement and collaboration-in-action suggesting that the IPL activity enabled students to achieve the intended learning objectives. Students recognised the contribution of others and described negotiation, collaboration and creation of new collective knowledge after working together on the complicated patient case studies. The novel video assessment was challenging to many students and contextual issues limited engagement for some disciplines. Conclusions: We demonstrated the feasibility and acceptability of a large scale IPL activity where design of cases, format and assessment tasks was founded in complexity theory. This theoretically based design enabled students to achieve complex IPL outcomes relevant to future practice. Future research could establish the psychometric properties of assessments of student performance in large-scale IPL events.

DOI 10.1186/s12909-016-0717-y
Citations Scopus - 8
2015 Jorm C, Parker M, 'Medical leadership is the New Black: Or is it?', Australian Health Review, 39 217-219 (2015)

© AHHA 2015. Considerable resources are being invested in healthcare leadership development programs and there is a new requirement for leadership teaching for Australian medical ... [more]

© AHHA 2015. Considerable resources are being invested in healthcare leadership development programs and there is a new requirement for leadership teaching for Australian medical students. The new attention to medical leadership may be a reaction to loss of medical status and power. There is little evidence for return on investment from such programs. It is simply not clear what kind of leadership training is needed for collaborative work to improve healthcare nor what kind of organisational structures enable productive exercise of medical leadership skills. Caution is recommended.

DOI 10.1071/AH14013
Citations Scopus - 6
2015 Wyer M, Jackson D, Iedema R, Hor SY, Gilbert GL, Jorm C, et al., 'Involving patients in understanding hospital infection control using visual methods', Journal of Clinical Nursing, 24 1718-1729 (2015)

© 2015 John Wiley &amp; Sons Ltd. Aims and Objectives: This paper explores patients&apos; perspectives on infection prevention and control. Background: Healthcare-associated inf... [more]

© 2015 John Wiley & Sons Ltd. Aims and Objectives: This paper explores patients' perspectives on infection prevention and control. Background: Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored. Design: Video-reflexive ethnography. Methods: Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions. Findings: Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. Conclusion: This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. Relevance to clinical practice: This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour.

DOI 10.1111/jocn.12779
Citations Scopus - 14
2015 Iedema R, Hor SY, Wyer M, Gilbert GL, Jorm C, Hooker C, O¿Sullivan MVN, 'An innovative approach to strengthening health professionals¿ infection control and limiting hospital-acquired infection: Video-reflexive ethnography', BMJ Innovations, 1 157-162 (2015)

© 2015, BMJ Publishing Group. All rights reserved. Objective To strengthen clinicians¿ infection control awareness and risk realisation by engaging them in scrutinising footage of... [more]

© 2015, BMJ Publishing Group. All rights reserved. Objective To strengthen clinicians¿ infection control awareness and risk realisation by engaging them in scrutinising footage of their own infection control practices and enabling them to articulate challenges and design improvements. Design and participants Clinicians and patients from selected wards of 2 hospitals in western Sydney. Main outcome measures Evidence of risk realisation and new insights into infection control as articulated during video-reflexive feedback meetings. Results Frontline clinicians identified previously unrecognised infection risks in their own practices and in their team¿s practices. They also formulated safer ways of dealing with, for example, charts and patient transfers. Conclusions Video-reflexive ethnography enables frontline clinicians to identify infection risks and to design locally tailored solutions for existing risks and emerging ones.

DOI 10.1136/bmjinnov-2014-000032
Citations Scopus - 19
2015 Khoiriyah U, Roberts C, Jorm C, Van Der Vleuten CPM, 'Enhancing students' learning in problem based learning: Validation of a self-assessment scale for active learning and critical thinking', BMC Medical Education, 15 (2015)

© 2015 Khoiriyah et al. Background: Problem based learning (PBL) is a powerful learning activity but fidelity to intended models may slip and student engagement wane, negatively i... [more]

© 2015 Khoiriyah et al. Background: Problem based learning (PBL) is a powerful learning activity but fidelity to intended models may slip and student engagement wane, negatively impacting learning processes, and outcomes. One potential solution to solve this degradation is by encouraging self-assessment in the PBL tutorial. Self-assessment is a central component of the self-regulation of student learning behaviours. There are few measures to investigate self-assessment relevant to PBL processes. We developed a Self-assessment Scale on Active Learning and Critical Thinking (SSACT) to address this gap. We wished to demonstrated evidence of its validity in the context of PBL by exploring its internal structure. Methods: We used a mixed methods approach to scale development. We developed scale items from a qualitative investigation, literature review, and consideration of previous existing tools used for study of the PBL process. Expert review panels evaluated its content; a process of validation subsequently reduced the pool of items. We used structural equation modelling to undertake a confirmatory factor analysis (CFA) of the SSACT and coefficient alpha. Results: The 14 item SSACT consisted of two domains "active learning" and "critical thinking." The factorial validity of SSACT was evidenced by all items loading significantly on their expected factors, a good model fit for the data, and good stability across two independent samples. Each subscale had good internal reliability (>0.8) and strongly correlated with each other. Conclusions: The SSACT has sufficient evidence of its validity to support its use in the PBL process to encourage students to self-assess. The implementation of the SSACT may assist students to improve the quality of their learning in achieving PBL goals such as critical thinking and self-directed learning.

DOI 10.1186/s12909-015-0422-2
Citations Scopus - 8
2012 Jorm CM, O'Sullivan G, 'Laptops and smartphones in the operating theatre - how does our knowledge of vigilance, multi-tasking and anaesthetist performance help us in our approach to this new distraction?', ANAESTHESIA AND INTENSIVE CARE, 40 71-78 (2012)
Citations Scopus - 23Web of Science - 20
2012 Jorm CM, 'Are the checkers bored?-The need to develop better routines for checking anaesthesia delivery systems', ANAESTHESIA AND INTENSIVE CARE, 40 925-926 (2012)
DOI 10.1177/0310057X1204000602
Citations Scopus - 1Web of Science - 1
2011 Katelaris A, Jorm CM, 'Improved assessment needed for young doctors', MEDICAL JOURNAL OF AUSTRALIA, 195 369-369 (2011)
DOI 10.5694/mja11.c1003
Citations Scopus - 5Web of Science - 5
2011 Jorm CM, Frommer MS, 'Government plans for public reporting of performance data in health care: The case for', Medical Journal of Australia, 195 40 (2011)
Citations Scopus - 2
2011 Katelaris A, Jorm C, 'Solving the problems of practice-based education', Medical Journal of Australia, 195 163 (2011)
2011 Jackson T, Nghiem HS, Rowell D, Jorm C, Wakefield J, 'Marginal costs of hospital-acquired conditions: Information for priority-setting for patient safety programmes and research', Journal of Health Services Research and Policy, 16 141-146 (2011)

Objective: To estimate the relative inpatient costs of hospital-acquired conditions. Methods: Patient level costs were estimated using computerized costing systems that log indivi... [more]

Objective: To estimate the relative inpatient costs of hospital-acquired conditions. Methods: Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian 'condition-onset' flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n = 1,699,997) treated in Australian public hospitals in Victoria (2005/ 06) and Queensland (2006/07). Results: The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU$21,827 to the cost of an episode, followed by MRSA (AU$19,881) and enterocolitis due to Clostridium difficile (AU$19,743). Aggregate costs to the system, however, were highest for septicaemia (AU$41.4 million), complications of cardiac and vascular implants other than septicaemia (AU$28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU$27.8 million) and UTI (AU$24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. Conclusions: Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on 'indicators' of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions. © The Royal Society of Medicine Press Ltd 2011.

DOI 10.1258/jhsrp.2010.010050
Citations Scopus - 28
2010 Jorm CM, 'Patient safety: time for a transformational change in medical education', MEDICAL JOURNAL OF AUSTRALIA, 193 487-488 (2010)
2010 Rowell D, Nghiem HS, Jorm C, Jackson TJ, 'How different are complications that affect the older adult inpatient?', Quality and Safety in Health Care, 19 (2010)

Objective: The incidence and cost of complications occurring in older and younger inpatients were compared.esign Secondary analysis of hospital-recorded diagnosis and costs for mu... [more]

Objective: The incidence and cost of complications occurring in older and younger inpatients were compared.esign Secondary analysis of hospital-recorded diagnosis and costs for multiday-stay inpatients in 68 public hospitals in two Australian states. Main outcome measures A complication is defined as a hospital-acquired diagnosis that required additional treatment. The Australian Classification of Hospital-Acquired Diagnoses system is used to identify these complications. Results: Inpatients aged >70 years have a 10.9% complication rate, which is not substantially different from the 10.89% complication rate found in patients aged <70 years. Examination of the probability by single years, however, showed that the peak incidence associated with the neonatal period and childbirth is balanced by rates of up to 20% in patients >80 years. Examining the adult patient population (40e70 years), we found that while some common complications are not age specific (electrolyte disorders and cardiac arrhythmias), others (urinary tract and lower respiratory tract infections) are more common in the older adult inpatient. Conclusion For inpatients aged >70 years, the risks of complications increase. The incidence of hospitalacquired diagnoses in older adults differs significantly from incidence rates found in younger cohorts. Urinary tract infection and alteration to mental state are more common in older adult inpatients. Surprisingly, these complexities do not result in additional costs when compared with costs for the same complications in younger adults. Greater awareness of these differing patterns will allow patient safety efforts for older patients to focus on complications with the highest incidence and cost.

DOI 10.1136/qshc.2009.032235
Citations Scopus - 5
2009 Jorm CM, White S, Kaneen T, 'Clinical handover: critical communications', MEDICAL JOURNAL OF AUSTRALIA, 190 S108-S109 (2009)
Citations Web of Science - 33
2009 Baggoley CJ, Curtis IE, Dunbar NJ, Jorm CM, 'A conversation about health care safety and quality', MEDICAL JOURNAL OF AUSTRALIA, 191 7-8 (2009)
Citations Scopus - 1Web of Science - 1
2009 Jackson TJ, Michel JL, Roberts RF, Jorm CM, Wakefield JG, 'A classification of hospital-acquired diagnoses for use with routine hospital data', MEDICAL JOURNAL OF AUSTRALIA, 191 544-548 (2009)
Citations Scopus - 22Web of Science - 21
2009 Jorm CM, White S, Kaneen T, 'Clinical handover: critical communications.', The Medical journal of Australia, 190 (2009)
Citations Scopus - 40
2009 Iedema R, Jorm C, Wakefield J, Ryan C, Dunn S, 'Practising open disclosure: Clinical incident communication and systems improvement', Sociology of Health and Illness, 31 262-277 (2009)

This article explores the way that professionals are being inducted into articulating apologies to consumers of their services, in this case clinicians apologising to patients. Th... [more]

This article explores the way that professionals are being inducted into articulating apologies to consumers of their services, in this case clinicians apologising to patients. The article focuses on the policy of Open Disclosure that is being adopted by health care organisations in the US, Canada, the UK and Australia and other nations. Open Disclosure policy mandates 'open discussion of clinical incidents' with patient victims. In Australia, Open Disclosure policy implementation is currently being complemented by intensive staff training, involving simulation of apology scenarios with actor-patients. The article presents an analysis of data collected from such training sessions. The analysis shows how simulated apologising engages frontline staff in evaluating the efficacy of their disclosures, and how staff may thereby be inducted into reconciling their affective and reflexive sensibilities with their organisational and professional responsibilities, and thereby produce the required organisational apology. The article concludes that Open Disclosure, besides potentially relaxing tensions between clinicians and consumers, may also affect how staff experience and enact their role in the overall system of health care organisation. © 2008 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

DOI 10.1111/j.1467-9566.2008.01131.x
Citations Scopus - 14
2009 Wakefield JG, Jorm CM, 'Patient safety - a balanced measurement framework', AUSTRALIAN HEALTH REVIEW, 33 382-389 (2009)
DOI 10.1071/AH090382
Citations Scopus - 8Web of Science - 9
2009 Jorm CM, Dunbar N, Sudano L, Travaglia JF, 'Should patient safety be more patient centred?', AUSTRALIAN HEALTH REVIEW, 33 390-399 (2009)
DOI 10.1071/AH090390
Citations Scopus - 19Web of Science - 19
2009 Jorm CM, White SJ, 'Using research to make health care safer', AUSTRALIAN HEALTH REVIEW, 33 400-407 (2009)
DOI 10.1071/AH090400
Citations Scopus - 4Web of Science - 4
2009 Iedema R, Jorm C, Wakefield J, Ryan C, Sorensen R, 'A new structure of attention?: Open disclosure of adverse events to patients and their families', Journal of Language and Social Psychology, 28 139-157 (2009)

This article presents an inquiry into how clinicians realize a health policy reform initiative called Open Disclosure. Open Disclosure mandates that discussions with patients/fami... [more]

This article presents an inquiry into how clinicians realize a health policy reform initiative called Open Disclosure. Open Disclosure mandates that discussions with patients/family and team staff about adverse events are now no longer ad hoc, individualized, and without consequences for how the work is done, but planned, collaborative, and leading to systems change. The article presents an empirical analysis of a corpus of interviews about the impact of Open Disclosure on clinicians' practices. It situates Open Disclosure in the context of arguments that health care workers are increasingly expected to do emotional labor with patients and their families, in that staff are advised to practise reflexive listening as a means of managing patients' and family members' emotions in response to incidents. The analysis suggests that thanks to the intensity of Open Disclosure interactions, clinicians may be introduced to an affective-interactive space that they were hitherto unaware of and unable to enter or attain what Nigel Thrift calls a new structure of attention. © 2009 Sage Publications.

DOI 10.1177/0261927X08330614
Citations Scopus - 4
2009 Iedema R, Jorm C, Lum M, 'Affect is central to patient safety: The horror stories of young anaesthetists', Social Science and Medicine, 69 1750-1756 (2009)

This paper analyses talk produced by twenty-four newly qualified anaesthetists. Data were collected from round table discussions at the Young Fellows Conference of the Australia a... [more]

This paper analyses talk produced by twenty-four newly qualified anaesthetists. Data were collected from round table discussions at the Young Fellows Conference of the Australia and New Zealand College of Anaesthetists 2006. The talk consisted to an important extent of narratives about experiences of horror. The paper isolates three themes: the normalization of horror, the functionalisation of horror for pedagogic purposes, and the problematization of horror. The last theme provides a springboard into our argument that confronting the affect invested in coping with medical-clinical failure is central to enabling young doctors, and clinicians generally, to address and resolve such adverse events. We conclude that the negotiation of affect through shared or 'dialogic' narrative is central to enabling doctors to deal with adverse events on a personal level, and to enabling them at a collective level to become attentive to threats to patients' safety. © 2009 Elsevier Ltd.

DOI 10.1016/j.socscimed.2009.09.043
Citations Scopus - 23
2008 Ledema RAM, Mallock NA, Sorensen RJ, Manias E, Tuckett AG, Williams AF, et al., 'The national open disclosure pilot: evaluation of a policy implementation initiative', MEDICAL JOURNAL OF AUSTRALIA, 188 397-400 (2008)
Citations Scopus - 28Web of Science - 23
2008 Iedema R, Sorensen R, Manias E, Tuckett A, Piper D, Mallock N, et al., 'Patients' and family members' experiences of open disclosure following adverse events', International Journal for Quality in Health Care, 20 421-432 (2008)

Objective: To explore patients&apos; and family members&apos; perceptions of Open Disclosure of adverse events that occurred during their health care. Design: We interviewed 23 pe... [more]

Objective: To explore patients' and family members' perceptions of Open Disclosure of adverse events that occurred during their health care. Design: We interviewed 23 people involved in adverse events and incident disclosure using a semi-structured, open-ended guide. We analyzed transcripts using thematic discourse analysis. Setting: Four States in Australia: New South Wales, Victoria, Queensland and South Australia. Study participants: Twenty-three participants were recruited as part of an evaluation of the Australian Open Disclosure pilot commissioned by the Australian Commission on Safety and Quality in Health Care. Results: All participants (except one) appreciated the opportunity to meet with staff and have the adverse event explained to them. Their accounts also reveal a number of concerns about how Open Disclosure is enacted: disclosure not occurring promptly or too informally; disclosure not being adequately followed up with tangible support or change in practice; staff not offering an apology, and disclosure not providing opportunities for consumers to meet with the staff originally involved in the adverse event. Analysis of participants' accounts suggests that a combination of formal Open Disclosure, a full apology, and an offer of tangible support has a higher chance of gaining consumer satisfaction than if one or more of these components is absent. Conclusions: Staff need to become more attuned in their disclosure communication to the victim s perceptions and experience of adverse events, to offer an appropriate apology, to support victims long-term as well as short-term, and to consider using consumers' insights into adverse events for the purpose of service improvement. © The Author 2008. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

DOI 10.1093/intqhc/mzn043
Citations Scopus - 47
2008 Iedema R, Jorm C, Braithwaite J, 'Managing the scope and impact of root cause analysis recommendations', Journal of Health Organization and Management, 22 569-585 (2008)

Purpose Increased public awareness of clinical failure and rising levels of litigation are spurring health policy makers in industrialized countries to mandate that clinicians rep... [more]

Purpose Increased public awareness of clinical failure and rising levels of litigation are spurring health policy makers in industrialized countries to mandate that clinicians report and investigate clinical errors and near misses. This paper seeks to understand the value of root cause analysis (RCA) recommendations for practice improvement purposes. The paper presents an analysis of interviews with nine senior health managers who were asked about their views on RCA as practice improvement method. Design/methodology/approach Interview data were collected as part of a multi-method evaluation consultancy project investigating a local Health Safety Improvement Program. The interview data were discourse analysed and arranged into over-arching themes. Findings The analysis reveals rather negative views of the improvement potential of RCA: RCA is subject to too many constraints to be able to produce valuable recommendations; RCA recommendations: are perceived to be of ¿variable quality¿; generate considerable extra work for senior management to do with vetting RCA recommendations; are experienced as contributing in only a limited way to organizational and practice improvement. Research limitations/implications This study focuses on nine interviewees only and presents an analysis of single (not multiple) interviews. However, these nine interviewees fulfil crucial roles in implementing clinical practice improvement initiatives in their respective geographic areas. Practical implications The findings suggest that RCA requires much time and negotiation, and that the recommendations produced may not live up to the philosophy of clinical practice improvement's expectations. It may be necessary to reorient the expectations of the power of RCA, or accept that RCA produces communication about clinical processes that would otherwise not have taken place, and whose effects may not be registering for some time to come. Originality/value Besides drawing out the implications for RCA as investigative practice, the analysis argues that interviewees' responses harbour indications to suggest that these officials are finding themselves engaged in increasing levels of communicative and emotional labour, in having to manage and compensate for the ambiguities, incommensurabilities and conflicting goals inscribed into ¿post-bureaucratic¿ initiatives such as RCA. © 2008, Emerald Group Publishing Limited

DOI 10.1108/14777260810916551
Citations Scopus - 16
2007 Westbrook MT, Braithwaite J, Travaglia JF, Long D, Jorm C, Iedema RA, 'Promoting safety: Longer-term responses of three health professional groups to a safety improvement programme', International Journal of Health Care Quality Assurance, 20 555-571 (2007)

Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system-wide approach. The pr... [more]

Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system-wide approach. The programme involved two-day courses to educate healthcare professionals to monitor and report incidents and analyse adverse events by conducting root cause analysis (RCA). This paper aims to predict that all professions would favour SIP but that their work and educational histories would result in doctors holding the least and nurses the most positive attitudes. Alternative hypotheses were that doctors' relative power and other professions' team-working skills would advantage the respective groups when conducting RCAs. Responses to a 2005 follow-up questionnaire survey of doctors (n=53), nurses (209) and allied health staff (59), who had participated in SIP courses, were analysed to compare: their attitudes toward the course; safety skills acquired and applied; perceived benefits of SIP and RCAs; and their experiences conducting RCAs. Significant differences existed between professions' responses with nurses being the most and doctors the least affirming. Allied health responses resembled those of nurses more than those of doctors. The professions' experiences conducting RCAs (number conducted, leadership, barriers encountered, findings implemented) were similar. Observational studies are needed to determine possible professional differences in the conduct of RCAs and any ensuing culture change that this may be eliciting. There is strong professional support for SIPs but less endorsement from doctors, who tend not to prefer the knowledge content and multidisciplinary teaching environment considered optimal for safety improvement education. This is a dilemma that needs to be addressed. Few longer-term SIPs' assessments have been realised and the differences between professional groups have not been well quantified. As a result of this paper, benefits of and barriers to conducting RCAs are now more clearly understood. © 2007, Emerald Group Publishing Limited

DOI 10.1108/09526860710822707
Citations Scopus - 18
2007 Braithwaite J, Westbrook MT, Travaglia JF, Iedema R, Mallock NA, Long D, et al., 'Are health systems changing in support of patient safety?: A multi-methods evaluation of education, attitudes and practice', International Journal of Health Care Quality Assurance, 20 585-601 (2007)

Purpose - The purpose of this study is to evaluate the effects of a health system-wide safety improvement program (SIP) three to four years after initial implementation. Design/me... [more]

Purpose - The purpose of this study is to evaluate the effects of a health system-wide safety improvement program (SIP) three to four years after initial implementation. Design/methodology/approach - The study employs multi-methods studies involving questionnaire surveys, focus groups, in-depth interviews, observational work, ethnographic studies, documentary analysis and literature reviews with regard to the state of New South Wales, Australia, where 90,000 health professionals, under the auspices of the Health Department, provide healthcare to a seven-million population. After enrolling many participants from various groups, the measurements included: numbers of staff trained and training quality; support for SIP; clinicians' reports of safety skills acquired, work practices changed and barriers to progress; RCAs undertaken; observation of functioning of teams; committees initiated and staff appointed to deal with adverse events; documentation and computer records of reports; and peak-level responses to adverse events. Findings - A cohort of 4 per cent of the state's health professionals has been trained and now applies safety skills and conducts RCAs. These and other senior professionals strongly support SIP, though many think further culture change is required if its benefits are to be more fully achieved and sustained. Improved information-handling systems have been adopted. Systems for reporting adverse incidents and conducting RCAs have been instituted, which are co-ordinated by NSW Health. When the appropriate structures, educational activities and systems are made available in the form of an SIP, measurable systems change might be introduced, as suggested by observations of the attitudes and behaviours of health practitioners and the increased reporting of, and action about, adverse events. Originality/value - Few studies into health systems change employ wide-ranging research methods and metrics. This study helps to fill this gap. © Emerald Group Publishing Limited.

DOI 10.1108/09526860710822725
Citations Scopus - 22
2007 Wakefield J, Jorm C, Ryan C, 'Open disclosure: Details matter [10]', Health Affairs, 26 903-904 (2007)
DOI 10.1377/hlthaff.26.3.903-a
Citations Scopus - 4
2007 Fitzgerald L, Annabelle ML, Braithwaite J, Iedema RA, Jorm C, 'Trust, communication, theory of mind and the social brain hypothesis: Deep explanations for what goes wrong in health care', Journal of Health Organization and Management, 21 353-367 (2007)

Purpose The purpose of the paper is to examine the deep conceptual underpinnings of trust and communication breakdowns via selected health inquiries into things that go wrong usin... [more]

Purpose The purpose of the paper is to examine the deep conceptual underpinnings of trust and communication breakdowns via selected health inquiries into things that go wrong using evolutionary psychology. Designomethodologyoapproach This paper explains how this is carried out, and explores some of the adverse consequences for patient care. Evolutionary psychology provides a means of explaining important mental capacities and constructs including theory of mind and the social brain hypothesis. To have a theory of mind is to be able to read others' behaviours, linguistic and non-verbal cues, and analyse their intentions. To have a social (or Machiavellian) brain means being able to assess, compete with and, where necessary, outwit others. In the tough and complex environment of the contemporary health setting, not too different from the Pleistocene, humans display a well-developed theory of mind and social brains and, using mental attributes and behavioural repertoires evolved for the deep past in hunter-gatherer bands, survive and thrive in difficult circumstances. Findings The paper finds that, while such behaviours cannot be justified, armed with an evolutionary approach one can predict survival mechanisms such as turf protection, competitive strategies, sending transgressors and whistleblowers to Coventry, self-interest, and politics and tribal behaviours. Originalityovalue The paper shows that few studies examine contemporary health sector behaviours through an evolutionary psychology lens or via such deep accounts of human nature. © 2007, Emerald Group Publishing Limited

DOI 10.1108/14777260710778899
Citations Scopus - 18
2006 Iedema RAM, Jorm C, Long D, Braithwaite J, Travaglia J, Westbrook M, 'Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error', Social Science and Medicine, 62 1605-1615 (2006)

In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We... [more]

In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We open with a discussion of the levers used by policy makers to mandate that clinicians not just report errors, but also gather to investigate those errors using root cause analysis (RCA). We focus on the tensions created for clinicians as they are expected to formulate 'systems solutions' that go beyond blame. In addressing these matters, we present a discourse analysis of data derived during an evaluation of the NSW Health Safety Improvement Program. Data include transcripts of RCA meetings which were recorded in a local metropolitan teaching hospital. From this analysis we move back to the argument that RCA involves clinicians in 'immaterial labour', or the production of communication and information, and that this new labour realizes two important developments. First, because RCA is anchored in the principle of health care practitioners not just scrutinizing each other, but scrutinizing each others' errors, RCA is a challenging task. Second, thanks to turning the clinical gaze in on the clinical observer, RCA engenders a new level of reflexivity of clinical self and of clinical practice. We conclude with asking whether this reflexivity will lock the clinical gaze into a micro-sociology of error, or whether it will enable this gaze to influence matters superordinate to the specifics of practice and the design of clinical treatments; that is, the over-arching governance and structuring of hospital care. © 2005 Elsevier Ltd. All rights reserved.

DOI 10.1016/j.socscimed.2005.08.049
Citations Scopus - 66
2006 Braithwaite J, Westbrook J, Pawsey M, Greenfield D, Naylor J, Iedema R, et al., 'A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737]', BMC Health Services Research, 6 10 (2006) [C1]
DOI 10.1186/1472-6963-6-113
Citations Scopus - 65Web of Science - 55
2006 Iedema R, Flabouris A, Grant S, Jorm C, 'Narrativizing errors of care: Critical incident reporting in clinical practice', Social Science and Medicine, 62 134-144 (2006)

This paper considers the rise across acute care settings in the industrialized world of techniques that encourage clinicians to record their experiences about adverse events they ... [more]

This paper considers the rise across acute care settings in the industrialized world of techniques that encourage clinicians to record their experiences about adverse events they are personally involved in; that is, to share narratives about errors, mishaps or 'critical incidents'. The paper proposes that critical incident reporting and the 'root cause' investigations it affords, are both central to the effort to involve clinicians in managing and organizing their work, and a departure from established methods and approaches to achieve clinicians' involvement in these non-clinical domains of health care. We argue that critical incident narratives render visible details of the clinical work that have thus far only been discussed in closed, paperless meetings, and that, as narratives, they incite individuals to share personal experiences with parties previously excluded from knowledge about failure. Drawing on a study of 124 medical retrieval incident reports, the paper provides illustrations and interpretations of both the narrative and the meta-discursive dimensions of critical incident reporting. We suggest that, as a new and complex genre, critical incident reporting achieves three important objectives. First, it provides clinicians with a channel for dealing with incidents in a way that brings problems to light in a non-blaming way and that might therefore be morally satisfying and perhaps even therapeutic. Second, these narrations make available new spaces for the apprehension, identification and performance of self. Here, the incident report becomes a space where clinicians publicly perform concern about what happened. Third, incident reporting becomes the basis for radically altering the clinician-organization relationship. As a complex expression of clinical failure and its re-articulation into organizational meta-discourse, incident reporting puts doctors' selves and feelings at risk not just within the relative safety of personal or intra-professional relationships, but also in the normative context of organizational coordination, accountability, planning and management. © 2005 Elsevier Ltd. All rights reserved.

DOI 10.1016/j.socscimed.2005.05.013
Citations Scopus - 34
2006 Iedema RAM, Jorm C, Braithwaite J, Travaglia J, Lum M, 'A root cause analysis of clinical error: Confronting the disjunction between formal rules and situated clinical activity', Social Science and Medicine, 63 1201-1212 (2006)

This paper presents evidence from a root cause analysis (RCA) team meeting that was recently conducted in a Sydney Metropolitan Teaching Hospital to investigate an iatrogenic morp... [more]

This paper presents evidence from a root cause analysis (RCA) team meeting that was recently conducted in a Sydney Metropolitan Teaching Hospital to investigate an iatrogenic morphine overdose. Analysis of the meeting transcript reveals on three levels that clinical members of the team struggle with framing the uncertain and contradictory details of situated clinical activity and translating these first into 'root causes', and then into recommendations for practice change. This analysis puts two challenges into special relief. First, RCA team members find themselves in the unusual position of having to derive organizational-managerial generalizations from the specifics of in situ activity. Second, they are constrained by the expectation inscribed into RCA that their recommendations result in 'systems improvements' assumed to flow forth from an extension of formal rules and spread of procedures. We argue that this perspective misrecognizes the importance of RCA as a means to engender solutions that leave the procedural detail of clinical processes unspecified, and produce cross-hospital discussions about the organizational dimensions of care. © 2006 Elsevier Ltd. All rights reserved.

DOI 10.1016/j.socscimed.2006.03.035
Citations Scopus - 41
2004 Jorm C, Kam P, 'Does medical culture limit doctors' adoption of quality improvement? Lessons from Camelot', Journal of Health Services Research and Policy, 9 248-251 (2004)

This paper analyses aspects of medical culture, explains why this culture is antagonistic to quality improvement, and provides solutions to help medical colleges meet the challeng... [more]

This paper analyses aspects of medical culture, explains why this culture is antagonistic to quality improvement, and provides solutions to help medical colleges meet the challenge of clinical governance. Like the knights of Camelot, doctors have their own all-pervading culture, occupationally centred, exclusive to the initiated and tending to the traditional, either overtly or through assumed values. The Camelot metaphor is supported by analysis of empirical evidence, especially the documents produced by medical colleges. Suggested initiatives to overcome these organisational barriers include improvements in continuing medical education, accreditation, guideline production and responsibility for the performance of doctors. Central to these improvements should be the involvement of every doctor, via the Delphi process, and substantial contributions to college processes from other health care professions and patients. © The Royal Society of Medicine Press Ltd 2004.

DOI 10.1258/1355819042250186
Citations Scopus - 15
2003 Jorm C, 'Patient safety and quality: Can anaesthetists play a greater role?', Anaesthesia, 58 833-834 (2003)
DOI 10.1046/j.1365-2044.2003.03396.x
Citations Scopus - 8
1996 Jorm CM, Stamford JA, Strunin L, 'Doctor in the lab: What is it Like for a doctor to work with scientists?', BRITISH MEDICAL JOURNAL, 313 867-869 (1996)
Citations Scopus - 1Web of Science - 1
1995 JORM CM, STAMFORD JA, 'ACTIONS OF MORPHINE ON NORADRENALINE EFFLUX IN THE RAT LOCUS-COERULEUS ARE MEDIATED VIA BOTH OPIOID AND ALPHA(2) ADRENOCEPTOR MECHANISMS', BRITISH JOURNAL OF ANAESTHESIA, 74 73-78 (1995)
DOI 10.1093/bja/74.1.73
Citations Scopus - 14Web of Science - 14
1994 Jorm C, Strunin L, 'The Australian Incident Monitoring Study.', Anaesthesia and Intensive Care, 22 309 (1994)
Citations Scopus - 2
1993 JORM CM, STAMFORD JA, 'ACTIONS OF THE HYPNOTIC ANESTHETIC, DEXMEDETOMIDINE, ON NORADRENALINE RELEASE AND CELL FIRING IN RAT LOCUS-CERULEUS SLICES', BRITISH JOURNAL OF ANAESTHESIA, 71 447-449 (1993)
DOI 10.1093/bja/71.3.447
Citations Scopus - 60Web of Science - 55
1993 STAMFORD JA, PALIJ P, DAVIDSON C, JORM CM, MILLAR J, 'SIMULTANEOUS REAL-TIME ELECTROCHEMICAL AND ELECTROPHYSIOLOGICAL RECORDING IN BRAIN-SLICES WITH A SINGLE CARBON-FIBER MICROELECTRODE', JOURNAL OF NEUROSCIENCE METHODS, 50 279-290 (1993)
DOI 10.1016/0165-0270(93)90035-P
Citations Scopus - 51Web of Science - 46
1993 JORM CM, STAMFORD JA, 'EARLY AGE-DEPENDENT CHANGES IN NORADRENALINE EFFLUX IN THE BED NUCLEUS OF STRIA TERMINALIS - VOLTAMMETRIC DATA IN RAT-BRAIN SLICES', NEUROBIOLOGY OF AGING, 14 499-501 (1993)
DOI 10.1016/0197-4580(93)90108-N
Citations Scopus - 4Web of Science - 4
1992 JORM CM, STAMFORD JA, 'HEPATIC-METABOLISM OF XENOBIOTICS WITH REFERENCE TO ANESTHESIA', BAILLIERES CLINICAL ANAESTHESIOLOGY, 6 751-779 (1992)
DOI 10.1016/S0950-3501(05)80306-X
Citations Scopus - 2Web of Science - 1
Show 58 more journal articles

Conference (5 outputs)

Year Citation Altmetrics Link
1994 STAMFORD JA, JORM CM, 'ISOFLURANE DECREASES NORADRENALINE RELEASE IN THE RAT LOCUS-COERULEUS BY A MECHANISM NOT INVOLVING AUTORECEPTORS', BRITISH JOURNAL OF ANAESTHESIA (1994)
Citations Web of Science - 1
1993 JORM CM, STAMFORD JA, 'ACTIONS OF ALPHA2-ADRENOCEPTOR AGONISTS ON NORADRENALINE RELEASE IN THE RAT LOCUS-CERULEUS', BRITISH JOURNAL OF ANAESTHESIA (1993)
Citations Web of Science - 3
1993 PALIJ P, JORM CM, STAMFORD JA, 'CHARACTERIZATION OF MONOAMINE EFFLUX IN RAT LOCUS-CERULEUS SLICES USING FAST CYCLIC VOLTAMMETRY', BRITISH JOURNAL OF PHARMACOLOGY (1993)
Citations Web of Science - 1
1992 JORM CM, STAMFORD JA, 'AGE-RELATED DIFFERENCES IN EVOKED NORADRENALINE EFFLUX AS MEASURED BY FAST CYCLIC VOLTAMMETRY IN RAT-BRAIN SLICES', BRITISH JOURNAL OF PHARMACOLOGY (1992)
1992 MILLAR J, PALIJ P, DAVIDSON C, JORM CM, STAMFORD JA, 'SIMULTANEOUS SINGLE UNIT RECORDING AND FAST CYCLIC VOLTAMMETRY IN BRAIN-SLICES', BRITISH JOURNAL OF PHARMACOLOGY (1992)
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Grants and Funding

Summary

Number of grants 1
Total funding $2,000,000

Click on a grant title below to expand the full details for that specific grant.


20191 grants / $2,000,000

Rapid Applied Research Translation$2,000,000

Funding body: Department of Health

Funding body Department of Health
Project Team Professor Christine Jorm
Scheme MRFF Medical Research Future Fund
Role Lead
Funding Start 2019
Funding Finish 2019
GNo G1900286
Type Of Funding C1300 - Aust Competitive - Medical Research Future Fund
Category 1300
UON Y
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Professor Christine Jorm

Position

Conjoint Professor
School of Medicine and Public Health
Faculty of Health and Medicine

Contact Details

Email christine.jorm@newcastle.edu.au
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