A qualitative system dynamics model for effects of workplace violence and clinician burnout on agitation management in the emergency department

Background Over 1.7 million episodes of agitation occur annually across the United States in emergency departments (EDs), some of which lead to workplace assaults on clinicians and require invasive methods like physical restraints to maintain staff and patient safety. Recent studies demonstrated that experiences of workplace violence contribute to symptoms of burnout, which may impact future decisions regarding use of physical restraints on agitated patients. To capture the dynamic interactions between clinicians and agitated patients under their care, we applied qualitative system dynamics methods to develop a model that describes feedback mechanisms of clinician burnout and the use of physical restraints to manage agitation. Methods We convened an interprofessional panel of clinician stakeholders and agitation experts for a series of model building sessions to develop the current model. The panel derived the final version of our model over ten sessions of iterative refinement and modification, each lasting approximately three to four hours. We incorporated findings from prior studies on agitation and burnout related to workplace violence, identifying interpersonal and psychological factors likely to influence our outcomes of interest to form the basis of our model. Results The final model resulted in five main sets of feedback loops that describe key narratives regarding the relationship between clinician burnout and agitated patients becoming physically restrained: (1) use of restraints decreases agitation and risk of assault, leading to increased perceptions of safety and decreasing use of restraints in a balancing feedback loop which stabilizes the system; (2) clinician stress leads to a perception of decreased safety and lower threshold to restrain, causing more stress in a negatively reinforcing loop; (3) clinician burnout leads to a decreased perception of colleague support which leads to more burnout in a negatively reinforcing loop; (4) clinician burnout leads to negative perceptions of patient intent during agitation, thus lowering threshold to restrain and leading to higher task load, more likelihood of workplace assaults, and higher burnout in a negatively reinforcing loop; and (5) mutual trust between clinicians causes increased perceptions of safety and improved team control, leading to decreased clinician stress and further increased mutual trust in a positively reinforcing loop. Conclusions Our system dynamics approach led to the development of a robust qualitative model that illustrates a number of important feedback cycles that underly the relationships between clinician experiences of workplace violence, stress and burnout, and impact on decisions to physically restrain agitated patients. This work identifies potential opportunities at multiple targets to break negatively reinforcing cycles and support positive influences on safety for both clinicians and patients in the face of physical danger.

A qualitative system dynamics approach to modeling the causes and effects of design deficiencies in construction projects

Purpose Poor quality of design documents and Design Deficiencies (DDs) are critical factors that can potentially cause time and cost overrun and lead to project failure. Despite the importance of this issue, few studies have been conducted to explore the underlying relations among the causes and effects of DDs, and it is not clear how they exert influence on each other. However, it is imperative to have a clear understanding of their interrelationships so as to devise intervention strategies. The purpose of this study is, therefore, to explore these causes and effects. Design/methodology/approach To this aim, a qualitative system dynamics model was provided to visualize how various factors interact with one another. The model was developed and validated by drawing on the expertise of industry-related experts. The key causes and effects of the DDs were identified through the investigation of the model. Findings It was concluded that design management of project and the composition of design teams are critical. The obtained results also showed that more attention should be paid to the enhancement of knowledge circulation and communication within design firms and increasing the awareness of managers and owners from the technical consequences of their managerial decisions. Research limitations/implications It is worth mentioning that the design process could be deeply affected by the quality, frequency and strength of relationships among the project’s parties. Early involvement of contractors, for example, can significantly contribute to enhancing design quality. This study investigates factors’ interactions in projects delivered using the traditional design-bid-build method. As relationships between the project’s parties could be different in various project delivery methods, further research is indeed needed to assess factors’ interactions in projects delivered using other methods. Originality/value It is believed that the proposed model by providing a better insight into the connections of causes and effects could aid project managers of different parties with planning the strategies to reduce DDs and mitigate their effects.

A Qualitative System Dynamics Model for Effects of Workplace Violence and Clinician Burnout on Agitation Management in the Emergency Department

Introduction Over 1.7 million episodes of agitation occur annually across the United States in emergency departments (EDs), some of which lead to workplace assaults on clinicians and require invasive methods like physical restraints to maintain staff and patient safety. Recent studies demonstrated that experiences of workplace violence lead to symptoms of burnout, which may impact future decisions regarding use of physical restraints on agitated patients. To capture the dynamic interactions between clinicians and agitated patients under their care, we applied qualitative system dynamics methods to develop a model that describes causal feedback mechanisms of clinician burnout and the use of physical restraints to manage agitation. Methods We convened an interprofessional panel of clinician stakeholders and agitation experts for a series of model building sessions to develop the current model. The panel derived the final version of our model over ten sessions of iterative refinement and modification, each lasting approximately three to four hours. We incorporated findings from prior studies on agitation and burnout as a result of workplace violence, identifying interpersonal and psychological factors likely to influence our outcomes of interest to form the basis of our model. Results The final model resulted in five main sets of feedback loops that describe key narratives regarding the relationship between clinician burnout and agitated patients becoming physically restrained: (1) use of restraints decreases agitation and risk of assault, leading to increased perceptions of safety and decreasing use of restraints in a balancing feedback loop which stabilizes the system; (2) clinician stress leads to a perception of decreased safety and lower threshold to restrain, causing more stress in a negatively reinforcing loop; (3) clinician burnout leads to a decreased perception of colleague support which leads to more burnout in a negatively reinforcing loop; (4) clinician burnout leads to negative perceptions of patient intent during agitation, thus lowering threshold to restrain and leading to higher task load, more likelihood of workplace assaults, and higher burnout in a negatively reinforcing loop; and (5) mutual trust between clinicians causes increased perceptions of safety and improved team control, leading to decreased clinician stress and further increased mutual trust in a positively reinforcing loop. Conclusions Our system dynamics approach led to the development of a robust qualitative model that illustrates a number of important feedback cycles that underly the relationships between clinician experiences of workplace violence, stress and burnout, and impact on decisions to physically restrain agitated patients. This work identifies potential opportunities at multiple targets to break negatively reinforcing cycles and support positive influences on safety for both clinicians and patients in the face of physical danger.

Qualitative System Dynamics Model for Analyzing of Behavior Patterns of SMEs

In Iran the Small and Medium Knowledge based Enterprise (SMEs), in the development and shaping stage, face with lots of problems. Before maturity and stability, they fail. Nearly a decade passed, since science and technology parks formation happened. They were seen as a mechanism for sustainable economic development based on knowledge; through creation, support and guidance of founded SMEs. Officials and policy makers, seriously concern about sustainable success, development and growth of these SMEs which must be appropriate for needs of Iran. Identify the behavioral patterns of the stages of life (birth, growth, decline, etc.) which lead to inefficiency and decline, is essential. This helps to avoid mistake repetition and eventually reduces costs. This paper, by using participative model building tries to extract prevailed patterns which govern the behavior of SMEs in Yazd Science and Technology Park. This paper attempts to introduce positive leverage points for policy makers and senior managers who are responsible and also SMEs which are located in the Park. Therefore, in this article, while drawing the behavioral patterns of SMEs, using qualitative system dynamics modeling, the structure governing the behavior of SMEs was drawn. This structure consists of 4 reinforcing loops and 8 balancing loops. Finally, based on these loops, 12 corrective policies were proposed. Doi: 10.28991/HIJ-2021-02-01-02 Full Text: PDF