Hardiness vs Alienation Personality Construct Essentially Explains Burnout Proclivity and Erroneous Computer Entry Problems in Rural Hellenic Hospital Labs
Erroneous computer entry problems [here: 'e'errors] in hospital labs threaten the patients-–health carers- relationship, undermining the health system credibility. Are e-errors random, and do lab professionals make them accidentally, or may they be traced through meaningful determinants? Theories on internal causality of mistakes compel to seek specific causal ascriptions of hospital lab eerrors instead of accepting some inescapability. Undeniably, 'To Err is Human'. But in view of rapid global health organizational changes, e-errors are too expensive to lack in-depth considerations. Yet, that efunction might supposedly be entrenched in the health carers- job description remains under dispute – at least for Hellenic labs, where e-use falls behind generalized(able) appreciation and application. In this study: i) an empirical basis of a truly high annual cost of e-errors at about €498,000.00 per rural Hellenic hospital was established, hence interest in exploring the issue was sufficiently substantiated; ii) a sample of 270 lab-expert nurses, technicians and doctors were assessed on several personality, burnout and e-error measures, and iii) the hypothesis that the Hardiness vs Alienation personality construct disposition explains resistance vs proclivity to e-errors was tested and verified: Hardiness operates as a resilience source in the encounter of high pressures experienced in the hospital lab, whereas its 'opposite', i.e., Alienation, functions as a predictor, not only of making e-errors, but also of leading to burn-out. Implications for apt interventions are discussed.
[1] M.G. Buchanan and M.E.P. Seligman, "Explanatory Style," NJ:
Lawrence Erlbaum, 1997.
[2] Institute of Medicine. To Err is Human: Building a Safer Health System.
Washington: National Academy Press, 1999.
[3] MEDMARXa, "2002 Information Summary submitted to MedMARx:
U.S. National database: hospital medication error reporting", Rockville
Maryland: U.S. (2003). Pharmacopeia. Accessd Sept. 2007: Available:
<https://www.medmarx.com/medmarx>
[4] PESYP of the Hellenic Ionian Islands, "Organizational Report", The
Ministry of Health Welfare & Social Solidarity, Corfu: Hellas, 2003.
[5] C. Urquhart, R. Currell, "Reviewing the evidence on nursing record
systems", Health Inform J; 11(1): 33-44, 2005.
[6] MEDMARXb, "2006 Information Summary submitted to MedMARx:
National database: hospital medication error reporting", Rockville,
Maryland: U.S. Pharmacopeia. 2007. Available:
<https://www.medmarx.com/medmarx> Accessd Sept. 2007.
[7] S.G. Ellis, and S.J Dushman-Ellis, "Accreditation of hospitals for
percutaneous coronary intervention on the basis of volume or clinical
outcome using MEDPAR data sets: effect on patient mortality, costs and
treatment accessibility", J of Invas Card; 12:464-471, 2000.
[8] D. Bates, L. Leape, D.J. Cullen, et al. "Effect of computerized physician
order entry: a team intervention on prevention of serious medication
errors", JAMA, 280(15):1311-1316, 1998.
[9] J.M. Overhage, W.M. Tierney, X. Zhou, et al. "A randomized trial of
ÔÇÿcorollary orders- to prevent errors of omission", J Am Med Inform
Assoc, 4(5):364-375 1997.
[10] B. Kaplan, "Evaluating informatics applications: Clinical decision
support systems literature review". Intern J Med Inform, 64(1):15-37,
2001.
[11] J.B. Sexton, E.J. Thomas, R.L Helmreich, "Error, stress, and teamwork
in medicine and aviation: Cross-sectional surveys". BMJ, 320 (7237):
745-749, 2000.
[12] C. May, L. Gask, T. Atkinson, N. Ellis, F. Mair, and A. Esmail,
"Resisting and promoting new technologies in clinical practice: the case
of telepsychiatry", Soc Sci & Med, 52(12): 1889-1901, 2001.
[13] S.R. Maddi, and S.C. Kobasa, "The hardy executive: Health under
stress", Homewood, IL: Dow Jones-Irwin, 1984.
[14] A.-M. Paleologou, "Expanding brief cognitive therapy for holistic longterm
management: Self-help Hardiness Intervention". Paper Presented at
the 28th EABCT Congress, Cork, Ireland, 1998.
[15] S.R. Maddi, "Personality theories: A comparative analysis" (5thEd.).
Homewood, IL: Dorsey Press, 1988.
[16] S. R. Maddi, "The Story of Hardiness: Twenty Years of Theorizing,
Research, and Practice", Cons Psychol J; 54(3): 173-185, 2002.
[17] A.-M. Paleologou, "Psychological Hardiness" In: A.-M. Paleologou
(Ed.) "Clinical Psychology Orientations" Athens: Ellinika Grammata,
(2001).
[18] H.D. Gustafson, J. Wyatt, "Evaluation of e-health systems & services".
BMJ, 328:1150, 2004.
[19] W. Ventres., S. Kooienga, N. Vuckovic, R. Marlin, P. Nygren, V.
Stewart, "Physicians, patients, Electronic Health Record: An
ethnographic analysis" .Ann Fam Med, 4(2):124-131, 2006.
[20] M.P. Leiter, and C. Maslach, "Preventing burnout and building
engagement: A complete program for renewal organizational", San
Francisco, CA: Jossey-Bass 2000.
[21] C. Maslach, "Burnout: The cost of caring", Engelwood Cliffs, NJ:
Prenice Hall, 1982.
[22] C. Maslach, "Measurement of Experienced Burnout" J Occup Beh, v.2.,
1981.
[23] A. Kantas, "The occupational burnout syndrome of teachers and health
professionals". Psychology (the Hellenic Journal), 3(3):71-85, 1996.
[24] D.A. Alexander, and S. Klein, "Ambulance personnel, critical
incidents:Impact of accident emergency work on mental health and
emotional well-being". Brit J Psychiat; 178:76-81, 2001.
[25] A.Boyle, M. Grap, J. Younger, D. Thornby, Personality hardiness,
ways of coping, social support and burnout in critical care nurses. J Adv
Nurs; 16: 850-857, 1991.
[26] R. Gopal, J.J. Glasheen, T.J. Miyoshi, A.V. Prochazka, "Burnout and
Internal Medicine Resident Work-Hour Restrictions". Arch Intern Med.,
165 (22):2595-2600, 2005.
[27] J.B. Hopkinson, C.E. Hallett and K.A. Luker, "Everyday death: How do
nurses cope with caring for dying people in hospital?" Int J of Nur
Studies; 42 (2): 125-133, 2005.
[28] S. Stordeur, W. D-Hoore, and C. Vandenberghe "Leadership,
organisational stress and emotional exhaustion among hospital nursing
staff". J Adv Nurs; 35: 533-542, 2001.
[29] C.M. Aldwin, and D.F. Gilman, "Health, Illness and Optimal Ageing".
London: Sage 2004.
[30] S.R. Maddi, "The Personality Construct of Hardiness: Effects on
Experiencing, Coping, and Strain". Cons Psychol J; 51(2): 83-95, 1999.
[31] C. Maslach, "Burnout Inventory Manual". Consulting Psychologists
Press, CA:Palo Alto, 1986.
[32] R.J. Burke, "Toward a Phase Model of Burnout: Some Conceptual and
Methodological Concerns". Group Organiz Stud; 14(1): 23-32, pp.27,
1989.
[33] R.T. Lee, B.E. Ashforth, "On the Meaning of Maslach-s Three
Dimensions of Burnout". J Appl Psychol; 75(6): 743-747, pp.743, 1990.
[34] C.L. Cordes, T.W. Dougherty, "A Review and an Integration of
Research on Job Burnout". Acad Manag Rev; 18(4):621-656, 1993.
[35] H. Kim, J. Ji, and M. Stoner, "Factorial Validity and Invariance of
Maslach Burnout Inventory-Human Survey (MBI-HSS) across
Differently Characterized Social Worker Groups". Paper Presented at
the 11th Annual Conference of the Society for Social Work and
Research, Jan. 11-14: San Francisco, 2007.
[36] B. Byrne, "Burnout: Testing for the validity replication and causal
structure across elementary, intermediate, secondary teachers" Amer
Educ Res J; 31:645-673, 1994.
[37] B. Byrne, "The nomological network of teacher burnout: A literature
review and empirically validated model". In: A. Huberman & R.
Vandenberghe (Eds.). Understanding and preventing teacher burnout: A
source book of international research and practice (pp. 15-37). NY:
Cambridge University Press, 1999.
[38] H. Coolican, "Research Methods and Statistics in Psychology" (2nd ed).
Hodder & Stoughton, U.K,, 1994.
[39] J.F. Playle, "Developing research questions and searching the literature".
J Comm Nurs. 14; 2: 20-24, 2000.
[40] N.Burns, and S.K. Grove, "The Practice of Nursing Research: Conduct,
Critique and Utilisation". (3rd ed). W.B. Saunders Co., Philadelphia,
1997.
[41] A.Boyle, M.Grap, J.Younger, and D.Thornby, "Personality hardiness,
ways of coping, social support and burnout in critical care nurses". J
Adv Nurs; 16: 850-857, 1991.
[42] E. Pedhazur, L.Pedhazur-Schmelkin, "Measurement, design, and
analysis: An integrated approach. Hillsdale", NJ.: Lawrence Erlbaum
Assoc., 1991.
[43] M. Gatz, and M.J. Karel, "Individual Change in Perceived Control over
20 Years". Int J Behav Devel, 16(2):305-322, 1993.
[44] S.R. Maddi, M. Hightower, M. "Hardiness and Optimism as Expressed
in Coping Patterns".Consulting Psychology J, 51(2): 95-106, 1999.
[45] C. May, L. Gask, T. Atkinson, N. Ellis, F. Mair, and A. Esmail,
"Resisting and promoting new technologies in clinical practice: the case
of telepsychiatry," Soc Sci & Med; 52(12): 1889-1901, 2001.
[46] V. Rodney, "Nurse stress associated to aggression in people with
dementia: its relationship to hardiness, cognitive appraisal, coping". J
Adv Nurs; 31(1): 172-180, 2000.
[47] J.P. Lemkau, R.R. Purdy, J.P. Rafferty, and J.R. Rudisill, "Correlates of
burnout among family practice residents", J Med Educ; 63:682-691,
1988.
[48] R. Gopal, J.J. Glasheen, T.J. Miyoshi, A.V. Prochazka, "Burnout and
Internal Medicine Resident Work-Hour Restrictions," Arch Int Med.
165(22):2595-2600 2005.
[49] C. Taylor, J. Graham, H.W. Potts, M.A. Richards, and A.J. Ramirez,
"Changes in mental health of UK hospital consultants since the mid-
-90s". Lancet, 366 (9487): 742-744, 2005.
[50] R. Tyssen, P. Vaglum, N.T. Gronvold, and O. Ekeberg, "Factors in
medical school that predict postgraduate mental health problems in need
of treatment. A nationwide and longitudinal study". Med Educ, 35:110-
120, 2001.
[51] C.Maslach, and M.P. Leiter, "The truth about burnout: How
organizations cause personal stress and what to do about it". San
Francisco, CA: Jossey-Bass, pp.74, 1997.
[52] S.N. Weingart, R.McL. Wilson, R.W. Gibberd, and B. Harrison,
"Epidemiology of medical error". BMJ; 320:774-777, 2000.
[53] W. Ventres, S. Kooienga, N. Vuckovic, R. Marlin, P. Nygren, and V.
Stewart, "Physicians, patients, Electronic Health Record: An
ethnographic analysis".Ann Fam Med; 4(2):124-131, 2006.
[1] M.G. Buchanan and M.E.P. Seligman, "Explanatory Style," NJ:
Lawrence Erlbaum, 1997.
[2] Institute of Medicine. To Err is Human: Building a Safer Health System.
Washington: National Academy Press, 1999.
[3] MEDMARXa, "2002 Information Summary submitted to MedMARx:
U.S. National database: hospital medication error reporting", Rockville
Maryland: U.S. (2003). Pharmacopeia. Accessd Sept. 2007: Available:
<https://www.medmarx.com/medmarx>
[4] PESYP of the Hellenic Ionian Islands, "Organizational Report", The
Ministry of Health Welfare & Social Solidarity, Corfu: Hellas, 2003.
[5] C. Urquhart, R. Currell, "Reviewing the evidence on nursing record
systems", Health Inform J; 11(1): 33-44, 2005.
[6] MEDMARXb, "2006 Information Summary submitted to MedMARx:
National database: hospital medication error reporting", Rockville,
Maryland: U.S. Pharmacopeia. 2007. Available:
<https://www.medmarx.com/medmarx> Accessd Sept. 2007.
[7] S.G. Ellis, and S.J Dushman-Ellis, "Accreditation of hospitals for
percutaneous coronary intervention on the basis of volume or clinical
outcome using MEDPAR data sets: effect on patient mortality, costs and
treatment accessibility", J of Invas Card; 12:464-471, 2000.
[8] D. Bates, L. Leape, D.J. Cullen, et al. "Effect of computerized physician
order entry: a team intervention on prevention of serious medication
errors", JAMA, 280(15):1311-1316, 1998.
[9] J.M. Overhage, W.M. Tierney, X. Zhou, et al. "A randomized trial of
ÔÇÿcorollary orders- to prevent errors of omission", J Am Med Inform
Assoc, 4(5):364-375 1997.
[10] B. Kaplan, "Evaluating informatics applications: Clinical decision
support systems literature review". Intern J Med Inform, 64(1):15-37,
2001.
[11] J.B. Sexton, E.J. Thomas, R.L Helmreich, "Error, stress, and teamwork
in medicine and aviation: Cross-sectional surveys". BMJ, 320 (7237):
745-749, 2000.
[12] C. May, L. Gask, T. Atkinson, N. Ellis, F. Mair, and A. Esmail,
"Resisting and promoting new technologies in clinical practice: the case
of telepsychiatry", Soc Sci & Med, 52(12): 1889-1901, 2001.
[13] S.R. Maddi, and S.C. Kobasa, "The hardy executive: Health under
stress", Homewood, IL: Dow Jones-Irwin, 1984.
[14] A.-M. Paleologou, "Expanding brief cognitive therapy for holistic longterm
management: Self-help Hardiness Intervention". Paper Presented at
the 28th EABCT Congress, Cork, Ireland, 1998.
[15] S.R. Maddi, "Personality theories: A comparative analysis" (5thEd.).
Homewood, IL: Dorsey Press, 1988.
[16] S. R. Maddi, "The Story of Hardiness: Twenty Years of Theorizing,
Research, and Practice", Cons Psychol J; 54(3): 173-185, 2002.
[17] A.-M. Paleologou, "Psychological Hardiness" In: A.-M. Paleologou
(Ed.) "Clinical Psychology Orientations" Athens: Ellinika Grammata,
(2001).
[18] H.D. Gustafson, J. Wyatt, "Evaluation of e-health systems & services".
BMJ, 328:1150, 2004.
[19] W. Ventres., S. Kooienga, N. Vuckovic, R. Marlin, P. Nygren, V.
Stewart, "Physicians, patients, Electronic Health Record: An
ethnographic analysis" .Ann Fam Med, 4(2):124-131, 2006.
[20] M.P. Leiter, and C. Maslach, "Preventing burnout and building
engagement: A complete program for renewal organizational", San
Francisco, CA: Jossey-Bass 2000.
[21] C. Maslach, "Burnout: The cost of caring", Engelwood Cliffs, NJ:
Prenice Hall, 1982.
[22] C. Maslach, "Measurement of Experienced Burnout" J Occup Beh, v.2.,
1981.
[23] A. Kantas, "The occupational burnout syndrome of teachers and health
professionals". Psychology (the Hellenic Journal), 3(3):71-85, 1996.
[24] D.A. Alexander, and S. Klein, "Ambulance personnel, critical
incidents:Impact of accident emergency work on mental health and
emotional well-being". Brit J Psychiat; 178:76-81, 2001.
[25] A.Boyle, M. Grap, J. Younger, D. Thornby, Personality hardiness,
ways of coping, social support and burnout in critical care nurses. J Adv
Nurs; 16: 850-857, 1991.
[26] R. Gopal, J.J. Glasheen, T.J. Miyoshi, A.V. Prochazka, "Burnout and
Internal Medicine Resident Work-Hour Restrictions". Arch Intern Med.,
165 (22):2595-2600, 2005.
[27] J.B. Hopkinson, C.E. Hallett and K.A. Luker, "Everyday death: How do
nurses cope with caring for dying people in hospital?" Int J of Nur
Studies; 42 (2): 125-133, 2005.
[28] S. Stordeur, W. D-Hoore, and C. Vandenberghe "Leadership,
organisational stress and emotional exhaustion among hospital nursing
staff". J Adv Nurs; 35: 533-542, 2001.
[29] C.M. Aldwin, and D.F. Gilman, "Health, Illness and Optimal Ageing".
London: Sage 2004.
[30] S.R. Maddi, "The Personality Construct of Hardiness: Effects on
Experiencing, Coping, and Strain". Cons Psychol J; 51(2): 83-95, 1999.
[31] C. Maslach, "Burnout Inventory Manual". Consulting Psychologists
Press, CA:Palo Alto, 1986.
[32] R.J. Burke, "Toward a Phase Model of Burnout: Some Conceptual and
Methodological Concerns". Group Organiz Stud; 14(1): 23-32, pp.27,
1989.
[33] R.T. Lee, B.E. Ashforth, "On the Meaning of Maslach-s Three
Dimensions of Burnout". J Appl Psychol; 75(6): 743-747, pp.743, 1990.
[34] C.L. Cordes, T.W. Dougherty, "A Review and an Integration of
Research on Job Burnout". Acad Manag Rev; 18(4):621-656, 1993.
[35] H. Kim, J. Ji, and M. Stoner, "Factorial Validity and Invariance of
Maslach Burnout Inventory-Human Survey (MBI-HSS) across
Differently Characterized Social Worker Groups". Paper Presented at
the 11th Annual Conference of the Society for Social Work and
Research, Jan. 11-14: San Francisco, 2007.
[36] B. Byrne, "Burnout: Testing for the validity replication and causal
structure across elementary, intermediate, secondary teachers" Amer
Educ Res J; 31:645-673, 1994.
[37] B. Byrne, "The nomological network of teacher burnout: A literature
review and empirically validated model". In: A. Huberman & R.
Vandenberghe (Eds.). Understanding and preventing teacher burnout: A
source book of international research and practice (pp. 15-37). NY:
Cambridge University Press, 1999.
[38] H. Coolican, "Research Methods and Statistics in Psychology" (2nd ed).
Hodder & Stoughton, U.K,, 1994.
[39] J.F. Playle, "Developing research questions and searching the literature".
J Comm Nurs. 14; 2: 20-24, 2000.
[40] N.Burns, and S.K. Grove, "The Practice of Nursing Research: Conduct,
Critique and Utilisation". (3rd ed). W.B. Saunders Co., Philadelphia,
1997.
[41] A.Boyle, M.Grap, J.Younger, and D.Thornby, "Personality hardiness,
ways of coping, social support and burnout in critical care nurses". J
Adv Nurs; 16: 850-857, 1991.
[42] E. Pedhazur, L.Pedhazur-Schmelkin, "Measurement, design, and
analysis: An integrated approach. Hillsdale", NJ.: Lawrence Erlbaum
Assoc., 1991.
[43] M. Gatz, and M.J. Karel, "Individual Change in Perceived Control over
20 Years". Int J Behav Devel, 16(2):305-322, 1993.
[44] S.R. Maddi, M. Hightower, M. "Hardiness and Optimism as Expressed
in Coping Patterns".Consulting Psychology J, 51(2): 95-106, 1999.
[45] C. May, L. Gask, T. Atkinson, N. Ellis, F. Mair, and A. Esmail,
"Resisting and promoting new technologies in clinical practice: the case
of telepsychiatry," Soc Sci & Med; 52(12): 1889-1901, 2001.
[46] V. Rodney, "Nurse stress associated to aggression in people with
dementia: its relationship to hardiness, cognitive appraisal, coping". J
Adv Nurs; 31(1): 172-180, 2000.
[47] J.P. Lemkau, R.R. Purdy, J.P. Rafferty, and J.R. Rudisill, "Correlates of
burnout among family practice residents", J Med Educ; 63:682-691,
1988.
[48] R. Gopal, J.J. Glasheen, T.J. Miyoshi, A.V. Prochazka, "Burnout and
Internal Medicine Resident Work-Hour Restrictions," Arch Int Med.
165(22):2595-2600 2005.
[49] C. Taylor, J. Graham, H.W. Potts, M.A. Richards, and A.J. Ramirez,
"Changes in mental health of UK hospital consultants since the mid-
-90s". Lancet, 366 (9487): 742-744, 2005.
[50] R. Tyssen, P. Vaglum, N.T. Gronvold, and O. Ekeberg, "Factors in
medical school that predict postgraduate mental health problems in need
of treatment. A nationwide and longitudinal study". Med Educ, 35:110-
120, 2001.
[51] C.Maslach, and M.P. Leiter, "The truth about burnout: How
organizations cause personal stress and what to do about it". San
Francisco, CA: Jossey-Bass, pp.74, 1997.
[52] S.N. Weingart, R.McL. Wilson, R.W. Gibberd, and B. Harrison,
"Epidemiology of medical error". BMJ; 320:774-777, 2000.
[53] W. Ventres, S. Kooienga, N. Vuckovic, R. Marlin, P. Nygren, and V.
Stewart, "Physicians, patients, Electronic Health Record: An
ethnographic analysis".Ann Fam Med; 4(2):124-131, 2006.
@article{"International Journal of Business, Human and Social Sciences:51935", author = "Angela–M. Paleologou and Aphrodite Dellaporta", title = "Hardiness vs Alienation Personality Construct Essentially Explains Burnout Proclivity and Erroneous Computer Entry Problems in Rural Hellenic Hospital Labs", abstract = "Erroneous computer entry problems [here: 'e'errors] in hospital labs threaten the patients-–health carers- relationship, undermining the health system credibility. Are e-errors random, and do lab professionals make them accidentally, or may they be traced through meaningful determinants? Theories on internal causality of mistakes compel to seek specific causal ascriptions of hospital lab eerrors instead of accepting some inescapability. Undeniably, 'To Err is Human'. But in view of rapid global health organizational changes, e-errors are too expensive to lack in-depth considerations. Yet, that efunction might supposedly be entrenched in the health carers- job description remains under dispute – at least for Hellenic labs, where e-use falls behind generalized(able) appreciation and application. In this study: i) an empirical basis of a truly high annual cost of e-errors at about €498,000.00 per rural Hellenic hospital was established, hence interest in exploring the issue was sufficiently substantiated; ii) a sample of 270 lab-expert nurses, technicians and doctors were assessed on several personality, burnout and e-error measures, and iii) the hypothesis that the Hardiness vs Alienation personality construct disposition explains resistance vs proclivity to e-errors was tested and verified: Hardiness operates as a resilience source in the encounter of high pressures experienced in the hospital lab, whereas its 'opposite', i.e., Alienation, functions as a predictor, not only of making e-errors, but also of leading to burn-out. Implications for apt interventions are discussed.
", keywords = "Hospital lab, personality hardiness/alienation, e-errors' cost, burnout.", volume = "3", number = "4", pages = "256-16", }
