Mrs. Simone Kramer Board of Graduate Studies Faculty of Medicine, University of Basel Klingelbergstr. 61 CH - 4056 Basel

Basel, 26th August 2015

PhD Agreement

Name XX PhD project title The relationship between patient safety climate and healthcare-associated infections Discipline Nursing Science Duration 3 years Immatriculation as a PhD 2009 student since Expected Graduation 2012 PhD committee members PhD advisor Prof. Dr. Sabina De Geest Coreferee Dr. René Schwendimann External expert Prof. Dr. Mary Blegen Further experts or remarks PhD committee meetings (to be scheduled at least yearly) Passed 14 June 2010 10-12h, 16 June 2011 14-16h Planned for June 2012 13-16h Resources and finances availability Resources Sufficiently available until the expected graduation Funding Sufficiently available until the expected graduation Main location of research Nursing Science, University of Basel Credit points (full points only) Required ECTS 12 Accomplished ECTS 10 Remarks

Attachments:  Learning agreement  Research plan including time table 2

Basel, 18.07.2011 3

Mrs Simone Kramer PhD Commission Faculty of Medicine, University Basel Klingelbergstr. 61 CH - 4056 Basel

Basel, 21st June 2011

Progress report, xx PhD Student at Institute of Nursing Science, (INS), University of Basel, Evaluation of the 2nd year

Dear members of the PhD-commission

With the academic year 2009/2010 I started my PhD studies at the Institute of Nursing Science (INS) of the University of Basel. At their first meeting on 14th June 2010 the doctoral committee agreed with me to continue the PhD study.

At the second annual meeting the doctoral committee discussed with me the progress of my PhD study based on the student’s self-assessment and the PhD timeplan / PhD-Portfolio (see attachment).

Now, I would like to review and summarize the major achievements and experiences of my second year at the INS and working on my PhD studies on “The relationship between patient safety climate and healthcare-associated infections”, a substudy of the Swiss arm of the EU funded international RN4CAST (Nurse forecasting: Human resources planning in nursing) study.

Please find below my activities related to research, project management and leadership, methodological research training and education / teaching from June 2010 – May 2011 as well as my aims / planned activities for the next year.

Feedback from the doctoral committee

Prof. Dr. Sabina DeGeest : I have observed an impressive development in xx's scientific development in the 2nd year of his PhD. It is obvious that he has much potential for further scientific growth. He has achieved the planned milestones for his 2nd year within the schedule time frame. Xx is a PhD student

Basel, 18.07.2011 who combines maturity with excellent human relation skills and is an asset for our organization in many respects. I wish him a good continuation of his PhD and a wonderful marriage Oct 1st! 4

Dr. René Schwendimann: It is my great pleasure as advisor to comment on Xx’s PhD study progress and to confirm that he has successfully achieved the objectives of his second study year. As the PhD commission can easily infer from his self-assessment his second study year was characterized by a full load of activities in research, project management, and education. From my perspective Xx has clearly proven his ability to handle a huge workload in terms of conducting research within the RN4CAST project including data management, performing uni- to multilevel data analysis, reporting and dissemination of findings on meetings with mixed audiences. This set of competencies have been achieved due to his careful planning, participation and successful completion of various research methods courses aligned to the project and beyond. Furthermore, Xx assisted in two semester courses in lecturing including reviewing and grading of students’ paper works. Xx is a highly motivated PhD student and has become an esteemed colleague within the RN4CAST research group as well as valuable supporter of the INS mission. I very much appreciate he’s personal integrity, he’s grown skill set as a researcher and he’s professional attitude to share with and support colleagues, peer’s and other students in their work and progression. In summary I recommend to let Xx “pass” his second PhD study year. Finally I wish Xx the very best in completing his PhD studies until summer 2012 and I have no doubt on he’s capabilities to reach this next milestone of he’s career.

Prof. Dr. Mary Blegen: It is with pleasure that I have observed and assisted the excellent work that Xx has done in his doctoral studies. He has met and exceeded the objectives he set for his first and second year of study and is now poised to complete the work for his dissertation in his third year. His scholarliness and ability to focus are apparent as is his intellect and devotion to this work. Best wishes for similar successes in the coming year.

Please find in the attached files a detailed reflection on my learning processes according to the standardized PhD portfolio document of the INS, an overview of my PhD agreement, and my PhD-time plan / portfolio. As you can see, I am fully in line with the planned time plan. Therefore the conclusion of my dissertation is planned for June 2012.

Yours sincerely,

XX, MNS

Attachments: mentioned

CC: Dr. R. Schwendimann Prof. Dr. S. De Geest Prof. Dr. M. Blegen

Basel, 18.07.2011 SECOND YEAR ASSESSMENT: Sheet for the annual PhD committee meeting.

Participants: Prof. Sabina De Geest; Prof. Mary Blegen; Dr. René Schwendimann. 5 Doctoral student: XX

Second year assessment

PhD proposal to the PhD-committee of the Faculty of Medicine

After the agreement between the supervisor and the PhD candidate to start the work on the PhD project, he will usually elaborate a research proposal. This proposal is normally submitted to the PhD-committee of the Faculty of Medicine of the University of Basel as a prerequisite for being accepted as a PhD student by the respective University. Based on this initial work and a self-assessment by the PhD student a fist year assessment will be carried out by the PhD committee. A decision about continuation of the PhD project will be taken.

Date of acceptance (PhD commission): July 4th, 2009.

First year assessment by the members of the doctoral PhD-committee

The PhD-committee and the student have met for their first annual meeting on June 14th and discussed the progress of the PhD study based on the student’s self-assessment. At the first meeting of the doctoral committee it has been agreed with the student to continue the PhD study.

Date of acceptance (PhD commission): July 1st, 2010.

Assessment by the members of the doctoral PhD-committee

The student provides a written statement, which includes current achievements and next steps by answering the following questions:

Annex: Updated PhD time plane and PhD activities.

Current achievements

Which experiences improved your competencies?

At the INS, I was able to expand my professional competencies and capacity for the academic work (e.g. performing research, teaching and reviewing manuscripts/proposals) due to the inspiring work environment and collaboration with experienced senior researchers including visiting professors.

Project management and leadership skills

I’ve developed self-confidence as a fellow and manager within a research organisation by:

o Being fully integrated into the RN4CAST project and being given the opportunity to take

Basel, 18.07.2011 responsibility on major parts of the study (e.g. data analysis, preparing and writing the hospital report, preparing presentations on study results) 6

o Being involved in the organisation of meetings and conferences (e.g. the national RN4CAST stakeholder meetings and the international conference in 2012)

Advanced research skills

I am able to develop own original papers and to support peers, as I,

o Reviewed and processed quiet a volume of scientific literature regarding patient safety and quality of care in general and of patient safety culture in particular as for the introduction and discussion sections of my dissertation.

o Discussed on content (clinical) and methodological issues with peers, senior researcher and visiting professors from the U.S.

o Developed specific research aims, questions and hypothesis for my manuscripts

o Gained experience in presenting results from own statistical analyses into tables and figures and describing and discussing findings (numbers) in a narrative way

o Provided critical feedback to study proposals of peers and senior colleagues (e.g SHURP)

o Reviewed manuscripts for the International Journal for Quality in Health Care, Swiss Medical Weekly and Health Policy (with feedback from Prof. Sabina De Geest)

o “(Co)-Supervised” a Master-student and a collaborator in writing their thesis, and journal manuscript respectively

I am able to use advanced statistical methods to test psychometric properties of measurement instruments and to clarify associations between study variables, as I,

o Attended and successfully completed methodological and statistical training courses (e.g. SSPH course on “Analyses of clustered data: multilevel modelling”)

o Read books and scientific literature on statistical methods (e.g. data analysis using Mplus)

o Controlled and cleaned data on the RN4CAST study to guarantee data quality

o Performed independently statistical analysis within my field of research, discussed and reported analyses / results with experts (e.g. with Dr. Tracy Glass, Biostatistician at the STPH Institute)

Education / Teaching skills

I am able to communicate study findings and implications for practice / research and to translate these implications to a broader audience, as I,

Basel, 18.07.2011 o Actively participate in teaching as an assistant within the INS Bachelor and Master’s study program (e.g. lecturing in the courses “Scientific writing” and “Patient safety and quality of car”) 7

o Presented multiple times on study projects (e.g RN4CAST study at the Congress of the Swiss Nurse Director Association)

“Soft” skills

After two years of work experience, I feel fully integrated into the Swiss- and the INS-culture/system. I’ve learned on how to perform on high workloads and fast workplace while keeping my work-life balance. The most important thing for high performance revealed for me having a stable social environment and friendships. Particularly, my girlfriend was the most important contributory factor for achieving psychological and emotional stability. This was an additional reason that I decided to marry her (October 1st, 2011).

Which experiences improved your competencies to conduct research?

In summary, I think that all above mentioned experiences contributed to my professional abilities to conduct research, as they allowed me to grow on a professional and personal level.

Which gaps do you identify, which are relevant for your PhD studies?

Research oriented: Statistics and research methods concerning prospective studies, language- speaking (sometimes speaking French would be helpful) and dissemination/communication of findings e.g. dealing with the media.

Project management oriented: Methodological knowledge about optimal project planning, to be able to plan and lead future projects in an efficient and effective way.

Health care oriented: To be involved in discussion about future trends in healthcare, patient safety and quality of care including policy and public health level.

Which tasks are you involved in (e.g. teaching assignments) or would you like to be involved in the near future?

I’m happy to be involved as a teaching assistant in the scientific writing course, the patient safety course and in the research course (introduction into philosophy of science). I would like to further develop my teaching skills to be prepared to take more responsibilities in the upcoming year.

I would like to assist / and (co-) mentor student’s in their master thesis.

Next steps: timeline and a plan for achieving competencies needed for the PhD, for obtaining support and for completing the research project

What additional competencies do you need to acquire at the present stage?

All the above mentioned competencies should get strengthened, by attending additional courses such as in statistics; writing workshops, media and didactic training.

Develop specific, measurable action steps, which go beyond a list of planned courses: For example:

Basel, 18.07.2011 write a data analysis plan, or a plan with whom you will discuss your article draft at what stage (peers, supervisors, other experts). Set the date for the next PhD committee meetings. 8

. Data analysis plan is developed in the research proposal and analysis are completed at this stage

. Monthly meetings (so called “PhD updates”) are held with Dr. Renè Schwendimann to discuss the PhD process in general and specific topics (e.g. manuscripts).

. Asking experts as Prof. Blegen to review my manuscripts before submission and offering co- authorship.

. Participating in the doctoral seminar every semester as peer review for manuscripts at the beginning of the writing (first- second draft) and the introduction/discussion section of PhD thesis

. Attending conferences on patient safety and quality of care to meet experts for networking and to exchange knowledge at the national and international level.

. Attending international summer schools to extend international network with peers.

Decision of the doctoral PhD-committee

o Continuation / Interruption:

o Signature student:

o Signature supervisor:

Basel, 18.07.2011 Time plan / PhD-Portfolio (Planned Publications, Professional Training, and Teaching) 2009-

20092012, XX 2010 2011 2012 General Overview Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Step 1: Research proposal on “Patient Safety climate and healthcare associated infections (PaSaI)“

Step 2: Data Collection & Data Management work (RN4CAST)

Step 3: Data entry, controlling, cleaning & analysis (RN4CAST / PaSaI)

Step 4: Elaboration of results: Addressing results, synthesis of results, publication work (PaSaI) M1 M2 M3

Step 5: Finalization of the thesis (PaSaI) M4

Time plan after first year (June M1 Submission “Manuscript 1” M3 Submission “Manuscript 3 and 4” 2010) Time plan after second year M2 Submission “Manuscript 2” M4 Doctoral defense (June 2011)

Basel, 21.06.2011 Research Activities with detailed Plan of PhD Thesis Work

Time Plan Work unit/ Activities Goals Current State Step 1: Research Proposal June 2009- July 2009 Systematic search on organizational, unit and To get expertise on the topic Completed clinician factors that impact the occurrence of Development of the first draft of the research adverse events, especially healthcare associated proposal for the official registration of the infections university

Aug 2009- Feb 2010 Finalization of the research proposal (Methodology) Discussion of the proposal at the INS completed doctoral seminar (Nov. 2009)

Step 2: Data Collection and Data Management Nov 2009 – May 2010 Data collection of the RN4CAST study (Organization Responsibility for Italian speaking completed of the questionnaires, response rate control, Switzerland, and coordination of the data scanning) co-responsibility in German- & French- Step 3: Data controlling, cleaning & analysis

June 2010 – July 2010 Data controlling and cleaning To guarantee accurate data quality and Completed multivariate analysis. July 2010 - July 2011 Data analysis according to the plan of the research To perform descriptive statistic, Ongoing, performing proposal psychometrical testing and multivariable independent statistical analysis regression analysis and discussing with experts

Step 4: Addressing results, synthesis of results

Sep 2010- Dec 2011 Tying work together, summarize and discuss the Manuscript completing and submission to Finalizing and submitting the different findings scientific journals next 2 publications of my project: (1) the relationship

Basel, 21.06.2011 between patient safety climate and health care associated infections, (2) providing evidence based on content for a safety culture in hospital measure through the use of the content validity index.

Basel, 21.06.2011 Step 5: Completion of thesis and thesis exam

Jan. – Mar. 2012 Writing of the introduction, the discussion of the Submit dissertation to referent and co- Planned for February-April thesis and last chapters of the dissertation referent. 2012

Finalizing the entire tasks of the PhD demands. Apr. – June 2012 Approval of dissertation Planned for June 15 or 22 Defense of the dissertation

Basel, 21.06.2011 Publication plan

Publications Title Submission to Journal Current State

International Journal for Validation of the German, Italian and French version of the Quality in Health 1 Submitted Safety Organizing Scale (SOS) Care (Impact Factor: 1.881)

Patient safety climate in Swiss hospitals – Are there any Swiss medical weekly (IF: 2 differences between type of hospital, type of ward and language Submitted 1.618) region?

International Journal of Nursing Studies (IJNS) The relationship between patient safety climate and healthcare- Development (1. draft 3 (IF: 2.310) or Journal of associated infections in acute care hospitals available) Nursing Care Quality (IF: 0.784) Pflege – Die wissenschaftliche Providing evidence based on content for a safety culture in Final approval from co- 4 Zeitschrift für hospital measure through the use of the Content Validity Index authors Pflegeberufe (IF: listed since 2008)

Basel, 21.06.2011 Professional Training during PhD Credits Methodological research training Date/ Current State Certificate Points* Doctoral Seminars at the INS 2/Semester From HS 2009- FS 2012 Yes 4th INS Summer School “Measurement in Health Care Research” (Jerilyn 2 17. - 21.08.2009 Yes K. Allen, ScD RN and Miyong Kim, PhD, RN) Statistics III (ANOVA, MANOVA, ANCOVA) – University of Basel, Faculty 4 HS 2009 (Passed) Yes of Psychology (Dr. Markus Stöcklin) Statistics IV (Factor analysis, MDS, Cluster analysis) – University of 3 FS 2010 No Basel, Faculty of Psychology (Dr. Markus Stöcklin)

5th INS Summer School “Meta-Analysis and Meta-Synthesis in Health Sciences (Sandra Engberg, PhD, RN, Susan Sereika, PhD, Sally Thorne, 1.5 16. - 20.08.2010 Yes PhD, RN) Statistics V (Structural equation modeling, confirmatory factor analysis) – 3 HS 2010 (Passed) Yes University of Basel, Faculty of Psychology (Dr. Markus Stöcklin) Analysis of clustered data : multilevel modeling - - Swiss School of Public 1.5 03. – 05.11.2011 Yes Health/SSPH (Dr. Martin Röösli) Statistical methods and handling of confounding and interactions in epidemiologic studies - Swiss School of Public Health/SSPH (Dr. 1.5 02. – 04.02.2011 Yes Christian Schindler) 6th INS Summer School “ Applied Patient Safety - real data, real tools, real solutions“ (Brayn Saxton, PhD, René Schwendimann, PhD, 1.5 15. – 19.08.2011 (upcoming) RN) Quality and safety in healthcare – Foundation for patient safety Zurich - 1.5 21. – 23.09.2011 (upcoming) Swiss School of Public Health/SSPH (Dr. David Schwappach)

Basel, 21.06.2011 Intensive Advanced Writing Workshop – University Hospital Basel (Dr. 3 22. – 26.08.2011 (upcoming) Leslie Nicoll)

Media training workshop: Communication Skills - Swiss School of Public 0.75 17. - 18.10.2011 (upcoming) Health/SSPH (Prof. Dr. L. Suzanne Suggs and Dr. Chris McIntyre)

Statistics VI (Regression and discriminant analysis) – University of Basel, 3 HS 2011 (upcoming) Faculty of Psychology (Dr. Markus Stöcklin)

Didactic Training Activities – University of Basel - TBD (autumn 2011) (upcoming)

Doctoral seminars at the INS - HS2011, FS2012 (upcoming) Total Credit points >12 *ECTS (1 CP equals for 25-30 hours student investment time)

Basel, 21.06.2011 Further academic training Congress Date Comments Swiss Society for Quality Management in Health Care – Annual Congress Baden 6. Nov 2009 Participant Patient safety - “Fachsymposium Gesundheit” St. Gallen 20./21. Jan. 2010 Participant Congress of the nursing management in the hospitals of Sanitas and Zimmerber (Horgen) 29. April 2010 Oral presentation Annual Congress of the Swiss Nursing directors (SVPL-Congress) 22. Oct. 2010 Oral presentation

Congress of the cantonal nursing management in Jenaz (Graubünden) 24. March 2011 Oral presentation Abstract accepted for Patientensicherheit – avanti! Fortschritte!? … im 2. Jahrzehnt des 3. Jahrtausends (Basel) 29./30. November 2011 poster presentation Further academic training Study visit at University of California San Francisco (UCSF): Prof. Dr. M. Blegen and Prof. 01. – 14.05 2010 Letter of “confirmation” Dr. N. Donaldson) Preparing descriptive reports on the collected data for the 35 Swiss hospitals and Fall 2011 planned organistation of translation and dissemination of reports Study visit at Johns Hopkins University December 2011 (to be planned)

Being involved in the RN4CAST conference Fall 2012 planned

Teaching HS 2010 Assistant lecturer Quantitative methods I (Philosophy of science) - Semester course

Scientific writing seminar (Literature search, EndNote, correction of the semester thesis) - HS 2010 Assistant lecturer Semester course

Basel, 21.06.2011 Patient safety and quality course (Patient safety culture, Infection management, FS 2011 Assistant lecturer Prevention of patient falls) - Semester course FS 2011 Co-promotor “Supervision” of Master Student (C. Auer) and collaborator (M.Desmedt)

Basel, 21.06.2011