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This intervention study examined the effects of a career crafting training on physicians' perceptions of their job crafting behaviors, career self-management, and employability. A total of 154 physicians working in two hospitals in a large Dutch city were randomly assigned to a waitlist control group or an intervention group. Physicians in the intervention group received an accredited training on career crafting, including a mix of theory, self-reflection, and exercises. Participants developed four career crafting goals during the training, to work on in the subsequent weeks, after which a coaching conversation took place over the phone. Physicians in the control group received no intervention. A pre- and post-test 8 weeks later measured changes in job crafting and career self-management (primary outcomes) and employability (secondary outcome) of 103 physicians that completed the pre- and post-test. RM ANOVAs showed that the intervention enhanced perceptions of career self-management and job crafting behavior to decrease hindering job demands. No support was found for the effect of the intervention on other types of job crafting and employability. This study offers novel insights into how career crafting can be enhanced through training, as this is the first empirical study to examine a career crafting intervention. HR managers can use the outcomes to develop tailored career policies and career development practices. [ABSTRACT FROM AUTHOR]

Objectives: Medical residents can play key roles in improving health care quality by speaking up and giving suggestions for improvements. However, previous research on speaking up by medical residents has shown that speaking up is difficult for residents. This study explored: (i) whether two main aspects of medical residents' work context (job control and supervisor support) are associated with speaking up by medical residents, and (ii) whether these associations differ between in‐hospital and out‐of‐hospital settings. Methods: Speaking up was operationalised and measured as voice behaviour. Structural equation modelling using a cross‐sectional survey design was used to identify and test factors pertaining to speaking up and to compare hospital settings. Results: A total of 499 medical residents in the Netherlands participated in the study. Correlational analysis showed significant positive associations between each of support and control, and voice behaviour. The authors assumed that the associations between support and control, and voice behaviour would be partially mediated by engagement. This partial mediation model fitted the data best, but showed no association between support and voice. However, multi‐group analysis showed that for residents in hospital settings, support is associated with voice behaviour. For residents outside hospital settings, control is more important. Engagement mediated the effects of control and support outside hospital settings, but not within the hospital. Conclusions: This study shows that in order to enable medical residents to share their suggestions for improvement, it is beneficial to invest in supportive supervision and to increase their sense of control. Boosting medical residents' support would be most effective in hospital settings, whereas in other health care organisations it would be more effective to focus on job control. Job control and supervisor support are identified through this research as resources associated with residents "speaking up" and making suggestions for change, but the importance of each may depend on the setting in which residents work. [ABSTRACT FROM AUTHOR]

Background: Implementing an accredited quality and patient safety management system is inevitable for hospitals. Even in the case of an obligatory rule system, different approaches to implement such a system can be used: coercive (based on monitoring and threats of punishment) and catalytic (based on dialogue and suggestion). This study takes these different approaches as a starting point to explore whether and how implementation actions are linked to compliance. By doing so, this study aims to contribute to the knowledge on how to increase compliance with obligatory rules and regulations. Methods: The internal audit system (the 'tracer system') of a large Dutch academic hospital is used as a case to investigate different implementation approaches and their effect on compliance. This case allowed us to use a multi-actor and multi-method approach for data collection. Internal audits (N = 16) were observed, audit reports were analyzed, and semi-structured interviews were conducted with both the internal auditors (N = 23) and the ward leaders (N = 14) responsible for compliance. Framework analysis was used to analyze the data. Results: Although all auditors use catalytic enforcement actions, these do not lead to (intended) compliance of all ward leaders. Rather, the catalytic actions contribute to (intended) compliance of ward leaders that are motivated, whereas they do not for the ward leaders that are not motivated. For the motivated ward leaders, catalytic enforcement actions contribute to (intended) compliance by increasing ward leaders' knowledge of the rules and how to comply with them. Conclusions: Our findings suggest that the effectiveness of implementation actions depends not only on the actions themselves, but also on the pre-existing motivation to comply. These findings imply that there is not one 'best' approach to the implementation of obligatory rules. Rather, the most effective approach depends on the willingness to comply with rules and regulations. [ABSTRACT FROM AUTHOR]

Objective: To develop an educational intervention that targets residents' beliefs and attitudes to quality Improvement (QI) and leadership in order to demonstrate proactive behaviour.Design: Theory-driven, mixed methods study including document analysis, interviews, observations and open-ended questionnaires.Setting: Six Dutch teaching hospitals.Intervention: Using expertise from medicine, psychology, organizational and educational sciences we developed a situated learning programme named Ponder and IMProve (PIMP). The acronym PIMP reflects the original upbeat name in Dutch, Verwonder & Verbeter. It has a modern, positive meaning that relates to improving your current circumstances. In quarterly 1-h sessions residents are challenged to identify daily workplace frustrations and translate them into small-scale QI activities.Main Outcome Measures: Organizational awareness, beliefs and attitudes to QI and organizational responsibilities, resident behaviour, barriers and facilitators to successful learning and the programme's potential impact on the organization.Results: Overall, 19 PIMP meetings were held over a period of 3 years. Residents defined 119 PIMP goals, resolved 37 projects and are currently working on another 39 projects. Interviews show that PIMP sessions make residents more aware of the organizational aspects of their daily work. Moreover, residents feel empowered to take up the role of change agent. Facilitators for success include a positive cost-benefit trade-off, a valuable group process and a safe learning environment.Conclusion: This article demonstrates the added value of multidisciplinary theory-driven research for the design, development and evaluation of educational programmes. Residents can be encouraged to develop organizational awareness and reshape their daily frustrations in QI work. [ABSTRACT FROM AUTHOR]

Background: Centralised incident reporting in a Dutch collaboration of nine out-of-hours services yielded very few incident reports. To improve incident reporting and the awareness of primary caregivers about patient safety issues, a local incident-reporting procedure was implemented.Aim: To compare the number and nature of incident reports collected in a local incident-reporting procedure (intervention) versus the currently used centralised incident-reporting procedure.Design Of Study: Quasi experiment.Setting: Three GPs' out-of-hours services (OHSs) in the centre of the Netherlands participated over 2 years before and 2 years after the intervention.Method: A local incident-reporting procedure was implemented in OHS1, in which participants were encouraged to report all occurring incidents. A local committee with peers analysed the reported incidents fortnightly in order to initiate improvements if necessary. In OHS2 and OHS3, the current centralised incident-reporting procedure was continued, where incidents were reported to an advisory committee of the board of directors of the OHSs collaboration and were assessed every 2 months. The main outcome measures were the number and nature of incidents reported.Results: At baseline, participants reported fewer than 10 incidents per year each. In the follow-up period, the number of incidents reported in OHS1 increased 16-fold compared with the controls. The type of incidents reported did not alter. In the local incident-reporting procedure, improvements were implemented in a shorter time frame, but reports in the centralised incident-reporting procedure led to a more systematic addressing of general and recurring safety problems.Conclusion: It is likely that a local incident-reporting procedure increases the willingness to report and facilitates faster implementation of improvements. In contrast, the central procedure, by collating reports from many settings, seems better at addressing generic and recurring safety issues. The advantages of both approaches should be combined. [ABSTRACT FROM AUTHOR]