Mixed-Method Cultural Assessment: High Reliability Characteristics in United States Pathology Residency and Pathologists’ Assistant Programs

Background: Literature has demonstrated that deficiencies in pathology training programs are related to the "safety culture" currently described in medicine. Safety in this context is defined as providing optimal patient care without error as a value within the pathology field's culture. Recently, "safety culture" has been promoted in U.S. hospital settings and sustained through supportive leadership. Researchers have demonstrated how a "safety culture" can reduce error in clinical settings. Past studies described error reduction occurring in high reliability organizational (HRO) settings such as aviation and nuclear power plants. The HRO process consists of five principles: a preoccupation with failure, sensitivity to operations, deference to expertise, reluctance to simplification, and a commitment to resilience. Investigators quantified these principles in business administration programs and control room settings but not in medical education, which could account for inadequate training. Purpose: The purpose of this study was to discover how HRO process characteristics are enacted within U.S. pathology residency and Pathologists' Assistant (PathA) training programs. These characteristics were indicative of leadership behaviors exhibited and perceived by directors and educators. The HRO process was assessed to find a correlation with demographic factors such as an educator's training, program type, degrees, and how they are correlated. This study answered the research questions: what leadership's demographic factors correlate with HRO characteristics, and what do educators perceive concerning the HRO characteristics? By answering the preceding research questions, the antecedents of HRO processes can be targeted, and deficiencies can be addressed. Methods: By utilizing a mixed-method explanatory sequential design, the researcher v surveyed 31 pathology residency and PathA program directors and interviewed 11 program educators, including pathologists and PathAs. A semi-structured interview script was constructed following the survey's demonstration of the correlations between demographic factors and HRO principles in this study's theoretical framework hidden within the survey questions. The researcher interviewed to derive the recurring existence or absence of HRO principles as covert themes and to discover emergent subthemes with deductive analysis to explain the survey findings. Results: The survey results demonstrated that HRO principles were present to some degree in both programs, specifically three out of five principles correlated with terminal degrees of the program directors in regression models showing higher variable scores for directors with master's or bachelor's degrees relative to those with doctorates. Two principles correlated with a PathA educator's exposure to the facets of academic medicine while in training with the "yes" group displaying higher variable scores than the "no" group following regression analysis. The dialogical interview data explained these findings by providing various revelations relative to two emerging subthemes: 1) proactive behavior of educators in the frontlines and 2) leadership, educators, and learners forming contextual paradigms dictating the paradigm as effects of cultural nesting. Conclusion: The study results indicated the strongest predictors of HRO correlation corresponded with proactive behavior of the PathAs while promoting safer practice while confronted by cultural effectors. Future implications include further inquiry regarding the origin of values per subculture forming contextual paradigms or affecting practice standards within the pathology field.

Name thesis:degree_name

Doctor of Education

Discipline thesis:degree_discipline

Health Education

Grantor

University of Houston

Year dc:date.issued

2021

Author dc:creator

• McCluskey, Kristine Marie Fuchs

Advisors dc:contributor.advisor

• McNeil, Sara
• Hausmann, Robert

Committee members dc:contributor.committeemember

• Diwan, Abdul Hafeez
• Herman, Christopher
• Snead, Lauren

• Pathology
• Health Sciences
• Psychology, Industrial

Language dc:language.iso

English

Handle dc:identifier.uri

https://hdl.handle.net/10657/20972

OAI identifier oai:identifier

oai:uh-ir.tdl.org:10657/20972