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Toma M, Dreischulte T, Gray NM, Guthrie B. A balanced approach to identifying, prioritising and evaluating all potential consequences of quality improvement: modified Delphi study. BMJ Open 2019; 9:e023890. [PMID: 30904844 PMCID: PMC6475234 DOI: 10.1136/bmjopen-2018-023890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Healthcare is a complex system, so quality improvement will commonly lead to unintended consequences which are rarely evaluated. In previous qualitative work, we proposed a framework for considering the range of these potential consequences, in terms of their desirability and the extent to which they were predictable or expected during planning. This paper elaborates on the previous findings, using consensus methods to examine what consequences should be identified, why and how to prioritise, evaluate and interpret all identified consequences, and what stakeholders should be involved throughout this process. DESIGN Two-round modified Delphi consensus study. SETTING AND PARTICIPANTS Both rounds were completed by 60 panellists from an academic, clinical or management background and experience in designing, implementing or evaluating quality improvement programmes. RESULTS Panellists agreed that trade-offs (expected undesirable consequences) and unpleasant surprises (unexpected undesirable consequences) should be actively considered. Measurement of harmful consequences for patients, and those with high workload or financial impact was prioritised, and their evaluation could also involve the use of qualitative methods. Clinical teams were agreed as important to involve at all stages, from identifying potential consequences, prioritising which of those to systematically evaluate, undertaking appropriate evaluation and interpreting the findings. Patients were necessary in identifying consequences, managers in identifying and prioritising, and improvement advisors in interpreting the data. CONCLUSION There was consensus that a balanced approach to considering all the consequences of improvement can be achieved by carefully considering predictable trade-offs from the outset and deliberately pausing after implementation to identify any unexpected surprises and make an informed decision as to whether quantitative or qualitative evaluation is needed and feasible. Stakeholders' roles in in the process of identifying, prioritising, evaluating and interpreting potential consequences should be explicitly addressed within planning and revisited during and after implementation.
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Affiliation(s)
- Madalina Toma
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Tobias Dreischulte
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
- NHS Tayside, Prescribing Support Unit, Dundee, UK
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Nicola M Gray
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Bruce Guthrie
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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402
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Littlejohns P, Kieslich K, Weale A, Tumilty E, Richardson G, Stokes T, Gauld R, Scuffham P. Creating sustainable health care systems. J Health Organ Manag 2019; 33:18-34. [PMID: 30859907 PMCID: PMC7068726 DOI: 10.1108/jhom-02-2018-0065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/28/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022]
Abstract
PURPOSE In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process. DESIGN/METHODOLOGY/APPROACH Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach. FINDINGS A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool. RESEARCH LIMITATIONS/IMPLICATIONS The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience. PRACTICAL IMPLICATIONS All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges. SOCIAL IMPLICATIONS This study helps in increasing public involvement in complex health challenges. ORIGINALITY/VALUE No other groups have used this combination of approaches to address this issue.
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Affiliation(s)
- Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | | | - Albert Weale
- School of Public Policy, University College London, London, UK
| | - Emma Tumilty
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Georgina Richardson
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- School of Business, University of Otago, Dunedin, New Zealand
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Southport, Australia
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403
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Beighton C, Victor C, Carey IM, Hosking F, DeWilde S, Cook DG, Manners P, Harris T. 'I'm sure we made it a better study…': Experiences of adults with intellectual disabilities and parent carers of patient and public involvement in a health research study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:78-96. [PMID: 28812949 PMCID: PMC6383106 DOI: 10.1177/1744629517723485] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 05/26/2023]
Abstract
Patient and public involvement is considered integral to health research in the United Kingdom; however, studies documenting the involvement of adults with intellectual disabilities and parent carers in health research studies are scarce. Through group interviews, this study explored the perspectives and experiences of a group of adults with intellectual disabilities and a group of parent carers about their collaborative/participatory involvement in a 3-year study which explored the effectiveness of annual health checks for adults with intellectual disabilities. Thematic analysis identified five key themes consistent across both groups; authenticity of participation, working together, generating new outcome measures, dissemination of findings and involvement in future research. Although reported anecdotally rather than originating from the analysis, increased self-confidence is also discussed. The groups' unique perspectives led to insights not previously considered by the research team which led to important recommendations to inform healthcare practice.
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Affiliation(s)
- Carole Beighton
- Carole Beighton, Population Health Research
Institute, St Georges University of London, London SW17 ORE, UK.
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404
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Parker SG, Downes T, Godfrey M, Matthews R, Martin FC. Age and Ageing to introduce a new category of paper: healthcare improvement science. Age Ageing 2019; 48:178-184. [PMID: 30395169 DOI: 10.1093/ageing/afy175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/03/2018] [Indexed: 12/29/2022] Open
Abstract
Age and Ageing is now inviting papers on healthcare improvement for older people. In this article we outline the nature and scope of healthcare improvement and reference improvement models and the tools and methods of improvement science. We emphasise the issues of sustainability, including scale and spread; evaluation - including associated ethical consideration and the involvement of patients and the public in healthcare improvement and associated research. Throughout we refer to resources the authors have found useful in their own work, and provide a bibliography of sources and web-links which will provide essential guidance and support for potential contributors to this new category of submission to Age and Ageing.
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Affiliation(s)
- S G Parker
- Newcastle Institute for Ageing, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - T Downes
- Sheffield Teaching Hospitals - Geriatric Department Glossop Road, Sheffield, UK
| | - M Godfrey
- Leeds University, Faculty of Medicine and Health, Leeds, UK
| | - R Matthews
- National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, UK
| | - F C Martin
- St Thomas' Hospital - Lambeth Palace Road, London, UK
- King's College London School of Medical Education Division of Health and Social Care, London, UK
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405
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Synnot AJ, Cherry CL, Summers MP, Stuckey R, Milne CA, Lowe DB, Hill SJ. Consumer engagement critical to success in an Australian research project: reflections from those involved. Aust J Prim Health 2019; 24:197-203. [PMID: 29875031 DOI: 10.1071/py17107] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/08/2018] [Indexed: 11/23/2022]
Abstract
This paper describes the people, activities and methods of consumer engagement in a complex research project, and reflects on the influence this had on the research and people involved, and enablers and challenges of engagement. The 2.5-year Integrating and Deriving Evidence Experiences and Preferences (IN-DEEP) study was conducted to develop online consumer summaries of multiple sclerosis (MS) treatment evidence in partnership with a three-member consumer advisory group. Engagement methods included 6-monthly face-to-face meetings and email contact. Advisory group members were active in planning, conduct and dissemination and translational phases of the research. Engaging consumers in this way improved the quality of the research process and outputs by: being more responsive to, and reflective of, the experiences of Australians with MS; expanding the research reach and depth; and improving the researchers' capacity to manage study challenges. Advisory group members found contributing their expertise to MS research satisfying and empowering, whereas researchers gained confidence in the research direction. Managing the unpredictability of MS was a substantive challenge; the key enabler was the 'brokering role' of the researcher based at an MS organisation. Meaningfully engaging consumers with a range of skills, experiences and networks can make important and unforeseen contributions to research success.
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Affiliation(s)
- Anneliese J Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3068, Australia
| | - Catherine L Cherry
- Centre for Biomedical Research, Burnet Institute 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Michael P Summers
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3068, Australia
| | - Rwth Stuckey
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, Vic. 3086, Australia
| | - Catherine A Milne
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Dianne B Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3068, Australia
| | - Sophie J Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3068, Australia
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406
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Banner D, Bains M, Carroll S, Kandola DK, Rolfe DE, Wong C, Graham ID. Patient and Public Engagement in Integrated Knowledge Translation Research: Are we there yet? RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:8. [PMID: 30805202 PMCID: PMC6373045 DOI: 10.1186/s40900-019-0139-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/18/2019] [Indexed: 05/25/2023]
Abstract
PLAIN ENGLISH SUMMARY There have been many attempts to improve how healthcare services are developed and delivered. Despite this, we know that there are many gaps and differences in practice and that these can lead to poor patient outcomes. In addition, there are also concerns that research is being undertaken that does not reflects the realities or needs of those using healthcare services, and that the use of research findings in practice is slow. As such, shared approaches to research, such as integrated knowledge translation, are being used.Integrated knowledge translation (IKT) is a research approach that brings together researchers, along with other stakeholders that have knowledge about a particular healthcare issue. Stakeholders may include healthcare providers and policy-makers. More recently, there has been a growing awareness of the need to include patients and members of the public within research processes. These collaborative and patient-oriented research approaches are seen as a way to develop research that tackles ongoing gaps in practice and reflect the insights, needs and priorities of those most affected by health research outcomes. Despite great support, little is known about how these major research approaches are connected, or how they may bring about improvements in the development and use of research evidence. In this paper, we examine how IKT and patient engagement processes are linked, as well as exploring where differences exist. Through this, we highlight opportunities for greater patient engagement in IKT research and to identify areas that need to be understood further. ABSTRACT Healthcare organizations across the world are being increasingly challenged to develop and implement services that are evidence-based and bring about improvement in patient and health service outcomes. Despite an increasing emphasis upon evidence-based practice, large variations in practice remain and gaps pervade in the creation and application of knowledge that improves outcomes. More collaborative models of health research have emerged over recent years, including integrated knowledge translation (IKT), whereby partnerships with key knowledge users are developed to enhance the responsiveness and application of the findings. Likewise, the meaningful engagement of patients, in addition to the inclusion of patient-reported outcomes and priorities, has been hailed as another mechanism to improve the relevance, impact and efficiency of research.Collectively, both IKT and patient engagement processes provide a vehicle to support research that can address health disparities and improve the delivery of effective and responsive healthcare services. However, the evidence to support their impact is limited and while these approaches are inextricably connected through their engagement focus, it is unclear how IKT and patient engagement processes are linked conceptually, theoretically, and practically. In this paper, we will begin to critically examine some of the linkages and tensions that exist between IKT and patient-engagement for research and will examine potential opportunities for IKT researchers as they navigate and enact meaningful partnerships with patients and the public.
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Affiliation(s)
- Davina Banner
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, V2N4Z9 Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Sandra Carroll
- School of Nursing, Faculty of Health Sciences, McMaster University and Associate Scientist, the Population Health Research Institute, Hamilton, Canada
| | - Damanpreet K Kandola
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, V2N4Z9 Canada
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Danielle E Rolfe
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Caroline Wong
- Centre of Excellence in Partnership with Patients and the Public, Montreal, Canada
| | - Ian D. Graham
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa and Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada
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407
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Ní Shé É, Morton S, Lambert V, Ní Cheallaigh C, Lacey V, Dunn E, Loughnane C, O'Connor J, McCann A, Adshead M, Kroll T. Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process. Health Expect 2019; 22:298-306. [PMID: 30729621 PMCID: PMC6543157 DOI: 10.1111/hex.12865] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/16/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022] Open
Abstract
Objective Public and patient involvement is increasingly embedded as a core activity in research funding calls and best practice guidelines. However, there is recognition of the challenges that prevail to achieve genuine and equitable forms of engagement. Our objective was to identify the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research. Methods A rapid realist review of the literature that included: (a) a systematic search of CINAHL, PsycINFO, PubMed and Open Grey (2007‐2017); (b) documents provided by expert panel members of relevant journals and grey literature. Six reference panels were undertaken with homeless, women's, transgender, disability and Traveller and Roma organizations to capture local insights. Data were extracted into a theory‐based grid linking context to behaviour change policy categories. Main results From the review, 20 documents were identified and combined with the reference panel summaries. The expert panel reached consensus about 33 programme theories. These relate to environmental and social planning (7); service provision (6); guidelines (4); fiscal measures (6); communication and marketing (4); and regulation and legislation (6). Conclusions While there is growing evidence of the merits of undertaking PPI, this rarely extends to the meaningful involvement of seldom heard groups. The 33 programme theories agreed by the expert panel point to a variety of mechanisms and resources that need to be considered. Many of the programme theories identified point to the need for a radical shift in current practice to enable the reciprocal involvement of seldom heard groups.
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Affiliation(s)
- Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sarah Morton
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| | - Veronica Lambert
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Cliona Ní Cheallaigh
- Consultant in General Medicine and Infectious Diseases, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Vanessa Lacey
- Transgender Equality Network Ireland, Dublin, Ireland
| | | | | | | | - Amanda McCann
- UCD Conway Institute of Biomolecular and Biomedical Science and UCD School of Medicine, University College Dublin UCD, Dublin, Ireland
| | - Maura Adshead
- School of Politics and Public Administration, University of Limerick, Limerick, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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408
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Fulop NJ, Ramsay AIG, Hunter RM, McKevitt C, Perry C, Turner SJ, Boaden R, Papachristou I, Rudd AG, Tyrrell PJ, Wolfe CDA, Morris S. Evaluation of reconfigurations of acute stroke services in different regions of England and lessons for implementation: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background
Centralising acute stroke services is an example of major system change (MSC). ‘Hub and spoke’ systems, consisting of a reduced number of services providing acute stroke care over the first 72 hours following a stroke (hubs), with a larger number of services providing care beyond this phase (spokes), have been proposed to improve care and outcomes.
Objective
To use formative evaluation methods to analyse reconfigurations of acute stroke services in different regions of England and to identify lessons that will help to guide future reconfigurations, by studying the following contrasting cases: (1) London (implemented 2010) – all patients eligible for Hyperacute Stroke Units (HASUs); patients admitted 24 hours a day, 7 days a week; (2) Greater Manchester A (GMA) (2010) – only patients presenting within 4 hours are eligible for HASU treatment; one HASU operated 24/7, two operated from 07.00 to 19.00, Monday to Friday; (3) Greater Manchester B (GMB) (2015) – all patients eligible for HASU treatment (as in London); one HASU operated 24/7, two operated with admission extended to the hours of 07.00–23.00, Monday to Sunday; and (4) Midlands and East of England – planned 2012/13, but not implemented.
Design
Impact was studied through a controlled before-and-after design, analysing clinical outcomes, clinical interventions and cost-effectiveness. The development, implementation and sustainability of changes were studied through qualitative case studies, documentation analysis (n = 1091), stakeholder interviews (n = 325) and non-participant observations (n = 92; ≈210 hours). Theory-based framework was used to link qualitative findings on process of change with quantitative outcomes.
Results
Impact – the London centralisation performed significantly better than the rest of England (RoE) in terms of mortality [–1.1%, 95% confidence interval (CI) –2.1% to –0.1%], resulting in an estimated additional 96 lives saved per year beyond reductions observed in the RoE, length of stay (LOS) (–1.4 days, 95% –2.3 to –0.5 days) and delivering effective clinical interventions [e.g. arrival at a Stroke Unit (SU) within 4 hours of ‘clock start’ (when clock start refers to arrival at hospital for strokes occurring outside hospital or the appearance of symptoms for patients who are already in-patients at the time of stroke): London = 66.3% (95% CI 65.6% to 67.1%); comparator = 54.4% (95% CI 53.6% to 55.1%)]. Performance was sustained over 6 years. GMA performed significantly better than the RoE on LOS (–2.0 days, 95% CI –2.8 to –1.2 days) only. GMB (where 86% of patients were treated in HASU) performed significantly better than the RoE on LOS (–1.5 days, 95% CI –2.5 to –0.4 days) and clinical interventions [e.g. SU within 4 hours: GMB = 79.1% (95% CI 77.9% to 80.4%); comparator = 53.4% (95% CI 53.0% to 53.7%)] but not on mortality (–1.3%, 95% CI –2.7% to 0.01%; p = 0.05, accounting for reductions observed in RoE); however, there was a significant effect when examining GMB HASUs only (–1.8%, 95% CI –3.4% to –0.2%), resulting in an estimated additional 68 lives saved per year. All centralisations except GMB were cost-effective at 10 years, with a higher net monetary benefit than the RoE at a willingness to pay for a quality-adjusted life-year (QALY) of £20,000–30,000. Per 1000 patients at 10 years, London resulted in an additional 58 QALYs, GMA resulted in an additional 18 QALYs and GMB resulted in an additional 6 QALYs at costs of £1,014,363, –£470,848 and £719,948, respectively. GMB was cost-effective at 90 days. Despite concerns about the potential impact of increased travel times, patients and carers reported good experiences of centralised services; this relied on clear information at every stage. Planning change – combining top-down authority and bottom-up clinical leadership was important in co-ordinating multiple stakeholders to agree service models and overcome resistance. Implementation – minimising phases of change, use of data, service standards linked to financial incentives and active facilitation of changes by stroke networks was important. The 2013 reforms of the English NHS removed sources of top-down authority and facilitative capacity, preventing centralisation (Midlands and East of England) and delaying implementation (GMB). Greater Manchester’s Operational Delivery Network, developed to provide alternative network facilitation, and London’s continued use of standards suggested important facilitators of centralisation in a post-reform context.
Limitations
The main limitation of our quantitative analysis was that we were unable to control for stroke severity. In addition, findings may not apply to non-urban settings. Data on patients’ quality of life were unavailable nationally, clinical interventions measured changed over time and national participation in audits varied. Some qualitative analyses were retrospective, potentially influencing participant views.
Conclusions
Centralising acute stroke services can improve clinical outcomes and care provision. Factors related to the service model implemented, how change is implemented and the context in which it is implemented are influential in improvement. We recommend further analysis of how different types of leadership contribute to MSC, patient and carer experience during the implementation of change, the impact of change on further clinical outcomes (disability and QoL) and influence of severity of stroke on clinical outcomes. Finally, our findings should be assessed in relation to MSC implemented in other health-care specialties.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Angus IG Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - Rachael M Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, School of Population Health & Environmental Sciences Research, King’s College London, London, UK
| | - Catherine Perry
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Simon J Turner
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | | | - Anthony G Rudd
- Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
| | - Pippa J Tyrrell
- Stroke and Vascular Centre, University of Manchester, Manchester Academic Health Science Centre, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | - Charles DA Wolfe
- Department of Population Health Sciences, School of Population Health & Environmental Sciences Research, King’s College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
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409
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Ree E, Wiig S, Manser T, Storm M. How is patient involvement measured in patient centeredness scales for health professionals? A systematic review of their measurement properties and content. BMC Health Serv Res 2019; 19:12. [PMID: 30621682 PMCID: PMC6323701 DOI: 10.1186/s12913-018-3798-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/06/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient centeredness is an important component of patient care and healthcare quality. Several scales exist to measure patient centeredness, and previous literature provides a critical appraisal of their measurement properties. However, limited knowledge exists regarding the content of the various scales in terms of what type of patient centeredness they represent and how they can be used for quality improvement. The aim of this study was to explore the measurement properties of patient centeredness scales and their content with a special focus on patient involvement, and assess whether and how they can be used for quality improvement. METHODS A systematic review of patient centeredness scales was conducted in Medline, CINAHL, Embase, and SCOPUS in April and May 2017. Inclusion criteria were limited to articles written in English published from 2005 to 2017. Eligible studies were critically appraised in terms of internal consistency and reliability, as well as their content, structural, and cross-cultural validity. Type of studies included were scale-development articles and validation studies of relevant scales, with healthcare personnel as respondents. We used directed content analysis to categorize the scales and items according to Tritter's conceptual framework for patient and public involvement. RESULTS Eleven scales reported in 22 articles were included. Most scales represented individual, indirect, and reactive patient involvement. Most scales included items that did not reflect patient centeredness directly, but rather organizational preconditions for patient centered practices. None of the scales included items explicitly reflecting the use of patient experiences of quality improvement. CONCLUSIONS There is a lack of patient centeredness scales focusing on direct and proactive involvement of patients in quality improvement. It would be useful to develop such instruments to further study the role of patient involvement in quality improvement in healthcare. Furthermore, they could be used as important tools in quality improvement interventions.
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Affiliation(s)
- Eline Ree
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Tanja Manser
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Marianne Storm
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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410
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Stergiopoulos S, Michaels DL, Kunz BL, Getz KA. Measuring the Impact of Patient Engagement and Patient Centricity in Clinical Research and Development. Ther Innov Regul Sci 2019. [DOI: 10.1177/2168479018817517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Stella Stergiopoulos
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, Boston, MA, USA
| | - Debra L. Michaels
- Drug Information Association, DIA Global Center, Washington, DC, USA
| | | | - Kenneth A. Getz
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, Boston, MA, USA
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411
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Santos ADO, Barros FPCD, Delduque MC. A pesquisa em saúde no Brasil: desafios a enfrentar. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O ensaio apresenta reflexões sobre o quanto a pesquisa e o desenvolvimento são capazes de promover um ciclo virtuoso nos sistemas universais de saúde, como o Sistema Único de Saúde (SUS), dotando-os de ciência para a tomada de decisão e de propostas inovadoras, quando consideradas as opiniões de seus usuários. A partir das demandas por 'pesquisa' expostas no relatório final da VIII Conferência Nacional de Saúde, apresenta o cenário atual da pesquisa no Brasil, com ênfase na insuficiência do financiamento e na lacuna entre a produção científica e as práticas em saúde. Conclui apresentando os desafios que devem ser transpostos pelos pesquisadores em saúde para inserir os brasileiros, suas realidades e capacidades na geração de mudança e inovação para o SUS, na redução de desigualdades sociais, a partir de debates sobre o futuro dos sistemas universais.
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Affiliation(s)
| | - Fernando Passos Cupertino de Barros
- Conselho Nacional de Secretários de Saúde, Brazil; Universidade Federal de Goiás, Brazil; Universidade de Brasília, Brazil; Fundação Oswaldo Cruz, Brazil
| | - Maria Célia Delduque
- Universidade de Brasília, Brazil; Associação Lusófona de Direito da Saúde, Portugal
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Tomlinson J, Medlinskiene K, Cheong VL, Khan S, Fylan B. Patient and public involvement in designing and conducting doctoral research: the whys and the hows. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:23. [PMID: 31428458 PMCID: PMC6697942 DOI: 10.1186/s40900-019-0155-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/22/2019] [Indexed: 05/16/2023]
Abstract
PLAIN ENGLISH SUMMARY Evidence shows that public and patient involvement in research has a positive effect on its quality and end-results. Thus, public and patient involvement in all stages of research is becoming commonplace. There are limited detailed examples however, that describe how to make this possible, especially for those doing PhD research. Doctoral researchers are often new to research practice or have limited experience and are often bound by strict time and financial constraints. It is also not usually a requirement of the award to involve public and patients in their research. Hence, they may not feel confident or motivated to involve or engage with public and patients during their research. We, four doctoral researchers, share examples from our own research studies that have included different approaches to public and patient involvement. Two studies formed public and patient advisory groups who helped design the research questions, data collection tools and recruitment methods. One enlisted the help of an online public and patient panel from a local hospital. A different study worked with patients from an established group to help define key medical words. We did face some challenges, such as the need to develop good group work skills and to apply for grants to cover reimbursement, but we all found it beneficial to involve patients in our studies. We noticed a positive effect on each study's progression and an improvement in our own self-esteem. In addition, having public and patient involvement helped reduce the isolation we felt as doctoral researchers. Thus, we strongly encourage more doctoral researchers to involve public and patients in their studies. ABSTRACT Public and patient involvement (PPI) has been shown to have a positive impact on health and social care research. However, adequate examples describing how to operationalise effective PPI, especially in doctoral studies, are lacking. Hence, doctoral researchers new to research, or those with limited experience, can be discouraged from facilitating PPI in their research. This paper aims to describe and discuss in detail the approaches used by four doctoral researchers to incorporate PPI at different stages of their research studies from study design to disseminating findings.We aim to inform other doctoral researchers about the challenges and limitations relating to PPI that we faced. Through these, we share pragmatic recommendations for facilitating PPI during doctoral studies.The description of four case studies demonstrated that PPI could be incorporated at various stages during doctoral research. This has had a beneficial impact on our research study progression, researcher self-esteem and lastly, helped alleviate researcher isolation during doctoral studies.
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Affiliation(s)
- Justine Tomlinson
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kristina Medlinskiene
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - V-Lin Cheong
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
- Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah Khan
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
- Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Beth Fylan
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Deane K, Delbecque L, Gorbenko O, Hamoir AM, Hoos A, Nafria B, Pakarinen C, Sargeant I, Richards DP, Skovlund SE, Brooke N. Co-creation of patient engagement quality guidance for medicines development: an international multistakeholder initiative. BMJ INNOVATIONS 2019; 5:43-55. [PMID: 31645992 PMCID: PMC6792320 DOI: 10.1136/bmjinnov-2018-000317] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Meaningful patient engagement (PE) can enhance medicines' development. However, the current PE landscape is fragmentary and lacking comprehensive guidance. METHODS We systematically searched for PE initiatives (SYNaPsE database/publications). Multistakeholder groups integrated these with their own PE expertise to co-create draft PE Quality Guidance which was evaluated by public consultation. Projects exemplifying good PE practice were identified and assessed against PE Quality Criteria to create a Book of Good Practices (BOGP). RESULTS Seventy-six participants from 51 organisations participated in nine multistakeholder meetings (2016-2018). A shortlist of 20relevant PE initiatives (from 170 screened) were identified. The co-created INVOLVE guidelines provided the main framework for PE Quality Guidance and was enriched with the analysis of the PE initiatives and the PE expertise of stakeholders. Seven key PE Quality Criteria were identified. Public consultation yielded 67 responses from diverse backgrounds. The PE Quality Guidance was agreed to be useful for achieving quality PE in practice, understandable, easy to use, and comprehensive. Overall, eight initiatives from the shortlist and from meeting participants were selected for inclusion in the BOGP based on demonstration of PE Quality Criteria and willingness of initiative owners to collaborate. DISCUSSION The PE Quality Guidance and BOGP are practical resources which will be continually updated in response to user feedback. They are not prescriptive, but rather based on core principles, which can be applied according to the unique needs of each interaction and initiative. Implementation of the guidance will facilitate improved and systematic PE across the medicines' development lifecycle.
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Affiliation(s)
- Katherine Deane
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laure Delbecque
- Patient Reported Outcomes, Pharmerit International, Rotterdam, Belgium
| | - Oleksandr Gorbenko
- Chief Scientific and Medical Office – Patient Affairs, ViiV Healthcare, London, UK
| | | | - Anton Hoos
- Patient Focused Medicines Development, Brussels, Belgium
| | - Begonya Nafria
- Patient Engagement in Research, Institut de Recerca Sant Joan de Déu- Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Chi Pakarinen
- Patient Focused Medicines Development, Brussels, Belgium
| | - Ify Sargeant
- Patient Focused Medicines Development, Brussels, Belgium
| | | | - Soren Eik Skovlund
- Steno Diabetes Centre North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Cable M, Kelly D. An analysis of the development of adolescent and young adult cancer care in the United Kingdom: A Foucauldian perspective. Nurs Inq 2018; 26:e12272. [DOI: 10.1111/nin.12272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 10/13/2018] [Accepted: 10/13/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Maria Cable
- School of Health; Coventry University; Coventry UK
| | - Daniel Kelly
- Royal College of Nursing Chair of Nursing Research; School of Healthcare Sciences; Cardiff University; Cardiff UK
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415
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Rolfe DE, Ramsden VR, Banner D, Graham ID. Using qualitative Health Research methods to improve patient and public involvement and engagement in research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:49. [PMID: 30564459 PMCID: PMC6293564 DOI: 10.1186/s40900-018-0129-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/09/2018] [Indexed: 05/06/2023]
Abstract
PLAIN ENGLISH SUMMARY Patient engagement (or patient and public involvement) in health research is becoming a requirement for many health research funders, yet many researchers have little or no experience in engaging patients as partners as opposed to research subjects. Additionally, many patients have no experience providing input on the research design or acting as a decision-making partner on a research team. Several potential risks exist when patient engagement is done poorly, despite best intentions. Some of these risks are that: (1) patients' involvement is merely tokenism (patients are involved but their suggestions have little influence on how research is conducted); (2) engaged patients do not represent the diversity of people affected by the research; and, (3) research outcomes lack relevance to patients' lives and experiences.Qualitative health research (the collection and systematic analysis of non-quantitative data about peoples' experiences of health or illness and the healthcare system) offers several approaches that can help to mitigate these risks. Several qualitative health research methods, when done well, can help research teams to: (1) accurately incorporate patients' perspectives and experiences into the design and conduct of research; (2) engage diverse patient perspectives; and, (3) treat patients as equal and ongoing partners on the research team.This commentary presents several established qualitative health research methods that are relevant to patient engagement in research. The hope is that this paper will inspire readers to seek more information about qualitative health research, and consider how its established methods may help improve the quality and ethical conduct of patient engagement for health research. ABSTRACT Background Research funders in several countries have posited a new vision for research that involves patients and the public as co-applicants for the funding, and as collaborative partners in decision-making at various stages and/or throughout the research process. Patient engagement (or patient and public involvement) in health research is presented as a more democratic approach that leads to research that is relevant to the lives of the people affected by its outcomes. What is missing from the recent proliferation of resources and publications detailing the practical aspects of patient engagement is a recognition of how existing research methods can inform patient engagement initiatives. Qualitative health research, for example, has established methods of collecting and analyzing non-quantitative data about individuals' and communities' lived experiences with health, illness and/or the healthcare system. Included in the paradigm of qualitative health research is participatory health research, which offers approaches to partnering with individuals and communities to design and conduct research that addresses their needs and priorities. Discussion The purpose of this commentary is to explore how qualitative health research methods can inform and support meaningful engagement with patients as partners. Specifically, this paper addresses issues of: rigour (how can patient engagement in research be done well?); representation (are the right patients being engaged?); and, reflexivity (is engagement being done in ways that are meaningful, ethical and equitable?). Various qualitative research methods are presented to increase the rigour found within patient engagement. Approaches to engage more diverse patient perspectives are presented to improve representation beyond the common practice of engaging only one or two patients. Reflexivity, or the practice of identifying and articulating how research processes and outcomes are constructed by the respective personal and professional experiences of researchers and patients, is presented to support the development of authentic, sustainable, equitable and meaningful engagement of patients as partners in health research. Conclusions Researchers will need to engage patients as stakeholders in order to satisfy the overlapping mandate in health policy, care and research for engaging patients as partners in decision-making. This paper presents several suggestions to ground patient engagement approaches in established research designs and methods.
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Affiliation(s)
- Danielle E. Rolfe
- School of Epidemiology and Public Health, University of Ottawa, 307D- 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - Vivian R. Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, West Winds Primary Health Centre, 3311 Fairlight Drive, Saskatoon, SK S7M 3Y5 Canada
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2K4C6 Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, 307D- 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
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416
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Lalani M, Baines R, Bryce M, Marshall M, Mead S, Barasi S, Archer J, Regan de Bere S. Patient and public involvement in medical performance processes: A systematic review. Health Expect 2018; 22:149-161. [PMID: 30548359 PMCID: PMC6433319 DOI: 10.1111/hex.12852] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/15/2018] [Accepted: 11/07/2018] [Indexed: 12/26/2022] Open
Abstract
Background Patient and public involvement (PPI) continues to develop as a central policy agenda in health care. The patient voice is seen as relevant, informative and can drive service improvement. However, critical exploration of PPI's role within monitoring and informing medical performance processes remains limited. Objective To explore and evaluate the contribution of PPI in medical performance processes to understand its extent, purpose and process. Search strategy The electronic databases PubMed, PsycINFO and Google Scholar were systematically searched for studies published between 2004 and 2018. Inclusion criteria Studies involving doctors and patients and all forms of patient input (eg, patient feedback) associated with medical performance were included. Data extraction and synthesis Using an inductive approach to analysis and synthesis, a coding framework was developed which was structured around three key themes: issues that shape PPI in medical performance processes; mechanisms for PPI; and the potential impacts of PPI on medical performance processes. Main results From 4772 studies, 48 articles (from 10 countries) met the inclusion criteria. Findings suggest that the extent of PPI in medical performance processes globally is highly variable and is primarily achieved through providing patient feedback or complaints. The emerging evidence suggests that PPI can encourage improvements in the quality of patient care, enable professional development and promote professionalism. Discussion and conclusions Developing more innovative methods of PPI beyond patient feedback and complaints may help revolutionize the practice of PPI into a collaborative partnership, facilitating the development of proactive relationships between the medical profession, patients and the public.
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Affiliation(s)
- Mirza Lalani
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rebecca Baines
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sol Mead
- General Medical Council, Registration and Revalidation Directorate, London, UK.,NHS England London and Southeast Regions, Regional Medical Directorate, London, UK
| | - Stephen Barasi
- General Medical Council, Registration and Revalidation Directorate (Wales), Wales, UK
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Samantha Regan de Bere
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
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Richardson E, Walshe K, Boyd A, Roberts J, Wenzel L, Robertson R, Smithson R. User involvement in regulation: A qualitative study of service user involvement in Care Quality Commission inspections of health and social care providers in England. Health Expect 2018; 22:245-253. [PMID: 30525272 PMCID: PMC6433317 DOI: 10.1111/hex.12849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 11/28/2022] Open
Abstract
Background High profile failures of care in the NHS have raised concerns about regulatory systems for health‐care professionals and organizations. In response, the Care Quality Commission (CQC), the regulator of health and social care in England overhauled its regulatory regime. It moved to inspections which made much greater use of expert knowledge, data and views from a range of stakeholders, including service users. Objective We explore the role of service users and citizens in health and social care regulation, including how CQC involved people in inspecting and rating health and social care providers. Design We analyse CQC reports and documents, and 61 interviews with CQC staff and representatives of groups of service users and citizens and voluntary sector organizations to explore the place of service user voice in regulatory processes. Results Care Quality Commission invited comments and facilitated the sharing of existing service user experiences and engaged with representatives of groups of service users and voluntary sector organizations. CQC involved service users in their inspections as “experts by experience.” Information from service users informed both the inspection regime and individual inspections, but CQC was less focused on giving feedback to service users who contributed to these activities. Discussion and conclusions Service users can make an important contribution to regulation by sharing their experiences and having their voices heard, but their involvement was somewhat transactional, and largely on terms set by CQC. There may be scope for CQC to build more enduring relationships with service user groups and to engage them more effectively in the regulatory regime.
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Affiliation(s)
- Emma Richardson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Alan Boyd
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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418
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Charron CB, Hudani A, Kaur T, Rose T, Florence K, Jama S, Pakhalé S. Assessing community (peer) researcher's experiences with conducting spirometry and being engaged in the 'Participatory Research in Ottawa: Management and Point-of-care for Tobacco-dependence' (PROMPT) project. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:43. [PMID: 30519486 PMCID: PMC6271567 DOI: 10.1186/s40900-018-0125-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/15/2018] [Indexed: 05/31/2023]
Abstract
PLAIN SUMMARY This article examines the overall experiences of community researchers in their involvement with the 'PROMPT' project for smoking cessation, which targeted community members who were homeless or at-risk for homelessness. More specifically, four community members, representing the study population were involved in the project as researchers. They were asked to complete surveys at both the beginning and end of each research training session to better understand their learning as it related to using a key instrument for this project, a spirometer, to measure project participants' lung function. Spirometry is typically performed by trained healthcare providers. Community researchers were also interviewed to explore what their experiences were like working as a researcher with their own at-risk community. Although the researchers felt that the training was sufficient, more research is needed to evaluate training effectiveness among community researchers in delivering acceptable quality lung function testing using a spirometer. Upon analyzing the small group discussion and survey results, we found that the community researchers had an overall positive experience with both the project, and the training that was provided to equip them with the knowledge, tools, and resources they needed to successfully work in a research project of this kind. They also faced challenges that are common in such community-based projects, such as the power differential between the researchers with a healthcare background and themselves who have lived experience with the issue at hand. ABSTRACT Background The Ottawa Citizen Engagement and Action Model (OCEAM) used a Community Based Participatory Action Research (CBPAR) approach by involving the most at-risk urban population. Community (peer) researchers participated in every step of the study despite the multiple challenges. Objective To assess the community researchers' training and experiences in a CBPAR project, PROMPT: Participatory Research in Ottawa: Management and Point-of-care for Tobacco Dependence. Method Four community researchers were recruited, representative of the PROMPT project's target population with current or past poly-substance use; smoking tobacco; and/or being homeless or at-risk for homelessness. The community researchers participated in all phases of PROMPT, including study design, development of questionnaires, participant recruitment, administering consent forms and questionnaires, as well as hand-held spirometry after rigorous training. To assess their knowledge and comfort level with spirometry testing after standardized training, questionnaires were administered pre- and post-training. In turn, to assess their overall experience, interviews were conducted at the end of study completion. Results All community researchers underwent small-group training sessions including presentations, discussions and hands-on practice adapted from standardized training material prepared for health care professionals. Spirometry training was included in all sessions. Self-perceived knowledge and confidence in administering spirometry, as well as skill-testing score averages improved between the pre- and post-training questionnaires. Overall, all the community researchers had a fulfilling experience participating in the project. Conclusion Despite challenges, involving community researchers with lived experience is feasible, satisfying and productive even in the most marginalized populations. Standardized spirometry training of community researchers' representative of the PROMPT target population, with no healthcare educational background, was feasible and effective in improving knowledge, confidence and readiness to administer spirometry.
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Affiliation(s)
| | | | - Tina Kaur
- University of Toronto, Toronto, Canada
| | | | | | - Sadia Jama
- The Bridge Engagement Centre, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Smita Pakhalé
- Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Respiratory Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, K1H 8L6 Canada
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419
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Gremyr I, Elg M, Smith F, Gustavsson S. Exploring the phase for highest impact on radicality: a cross-sectional study of patient involvement in quality improvement in Swedish healthcare. BMJ Open 2018; 8:e021958. [PMID: 30413500 PMCID: PMC6231560 DOI: 10.1136/bmjopen-2018-021958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Involving patients in quality improvement is often suggested as a critical step for improving healthcare processes. However, this comes with challenges related to resources, tokenism, validity and competence. Therefore, to optimise the use of available resources, there is a need to understand at what stage in the improvement cycle patient involvement is most beneficial. Thus, the purpose of this study was to identify the phase of an improvement cycle in which patient involvement had the highest impact on radicality of improvement. DESIGN An exploratory cross-sectional survey was used. SETTING AND METHODS A questionnaire was completed by 155 Swedish healthcare professionals (response rate 34%) who had trained and had experience in patient involvement in quality improvement. Based on their replies, the impact of patient involvement on radicality in various phases of the improvement cycle was modelled using the partial least squares method. RESULTS Patient involvement in quality improvement might help to identify and realise innovative solutions; however, there is variation in the impact of patient involvement on perceived radicality depending on the phase in which patients become involved. The highest impact on radicality was observed in the phases of capture experiences and taking action, while a moderate impact was observed in the evaluate phase. The lowest impact was observed in the identify and prioritise phase. CONCLUSIONS Involving patients in improvement projects can enhance the quality of care and help to identify radically new ways of delivering care. This study shows that it is possible to suggest at what point in an improvement cycle patient involvement has the highest impact, which will enable more efficient use of the resources available for patient involvement.
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Affiliation(s)
- Ida Gremyr
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Mattias Elg
- Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Frida Smith
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
- Research and Development, Regional Cancer Centre West, Gothenburg, Sweden
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420
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Patterson P, Allison KR, Hornyak N, Woodward K, Johnson RH, Walczak A. Advancing consumer engagement: Supporting, developing and empowering youth leadership in cancer care. Eur J Cancer Care (Engl) 2018; 27:e12958. [DOI: 10.1111/ecc.12958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Pandora Patterson
- CanTeen Australia; Sydney New South Wales Australia
- Cancer Nursing Research Unit; The University of Sydney; Sydney New South Wales Australia
| | | | | | - Kathryn Woodward
- CanTeen Australia; Sydney New South Wales Australia
- Youth Advisory Group; Queensland Youth Cancer Service; Lady Cilento Children’s Hospital; Brisbane Queensland Australia
| | - Rebecca H. Johnson
- Mary Bridge Children’s Hematology/Oncology Clinic; Mary Bridge Children’s Health Centre; Tacoma Washington
| | - Adam Walczak
- CanTeen Australia; Sydney New South Wales Australia
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421
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Rapaport P, Webster L, Horsley R, Kyle SD, Kinnunen KM, Hallam B, Pickett J, Cooper C, Espie CA, Livingston G. An intervention to improve sleep for people living with dementia: Reflections on the development and co-production of DREAMS:START (Dementia RElAted Manual for Sleep: STrAtegies for RelaTives). DEMENTIA 2018; 17:976-989. [DOI: 10.1177/1471301218789559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many people living with dementia experience sleep disturbances yet there are currently no known effective, safe and acceptable treatments. Working with those affected by dementia to co-produce interventions is increasingly promoted to ensure that approaches are fit for purpose and meet the specific needs of target groups. Our aim here is to outline and reflect upon the co-production of Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS:START), an intervention to improve sleep for people living with dementia. Our co-production team brought together experts in the development and testing of manualised interventions in dementia care and cognitive behavioural interventions for sleep disorders, with Alzheimer’s Society research network volunteers (ASRNVs) whose lives had been affected by dementia. Here we present the process of intervention development. We worked with (ASRNVs) at each stage of the process bringing together ‘experts by training’ and ‘experts by experience’. (ASRNVs)shared their experiences of sleep disturbances in dementia and how they had managed these difficulties, as well as suggestions for how to overcome barriers to putting the intervention into practice; making (DREAMS:START) more accessible and usable for those in need. In this paper we discuss both the benefits and challenges to this process and what we can learn for future work. Collaborating with ‘experts by experience’ caring for a relative with sleep difficulties helped us to develop a complex intervention in an accessible and engaging way which we have tested and found to be feasible and acceptable in a randomised controlled trial.
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422
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Hampshaw S, Cooke J, Mott L. What is a research derived actionable tool, and what factors should be considered in their development? A Delphi study. BMC Health Serv Res 2018; 18:740. [PMID: 30261925 PMCID: PMC6161350 DOI: 10.1186/s12913-018-3551-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 09/20/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Research findings should be disseminated appropriately to generate maximum impact. The development of research derived 'actionable' tools (RDAT) as research outputs may contribute to impact in health services and health systems research. However there is little agreement on what is meant by actionable tool or what can make them useful. We set out to develop a consensus definition of what is meant by a RDAT and to identify characteristics of a RDAT that would support its use across the research-practice boundary. METHODS A modified Delphi method was used with a panel of 33 experts comprising of researchers, research funders, policy makers and practitioners. Three rounds were administered including an initial workshop, followed by two online surveys comprising of Likert scales supplemented with open-ended questions. Consensus was defined at 75% agreement. RESULTS Consensus was reached for the definition and characteristics of RDATs, and on considerations that might maximize their use. The panel also agreed how RDATs could become integral to primary research methods, conduct and reporting. A typology of RDATs did not reach consensus. CONCLUSIONS A group of experts agreed a definition and characteristics of RDATs that are complementary to peer reviewed publications. The importance of end users shaping such tools was seen as of paramount importance. The findings have implications for research funders to resource such outputs in funding calls. The research community might consider developing and applying skills to coproduce RDATs with end users as part of the research process. Further research is needed on tracking the impact of RDATs, and defining a typology with a range of end-users.
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Affiliation(s)
- Susan Hampshaw
- School of Health Related Research, The University of Sheffield, Sheffield, UK
- Doncaster Metropolitan Borough Council, Doncaster, UK
| | - Jo Cooke
- Health and Social Care Research, Collaborations for Leadership in Applied Health Research and Care Yorkshire and Humber (CLAHRC YH), Sheffield Hallam University, Sheffield, UK
| | - Laurie Mott
- Doncaster Metropolitan Borough Council, Doncaster, UK
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Cations M, Crotty M, Fitzgerald JA, Kurrle S, Cameron ID, Whitehead C, Thompson J, Kaambwa B, Hayes K, de la Perrelle L, Radisic G, Laver KE. Agents of change: establishing quality improvement collaboratives to improve adherence to Australian clinical guidelines for dementia care. Implement Sci 2018; 13:123. [PMID: 30249276 PMCID: PMC6154830 DOI: 10.1186/s13012-018-0820-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/12/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Dissemination of clinical practice guidelines alone is insufficient to create meaningful change in clinical practice. Quality improvement collaborative models have potential to address the evidence-practice gap in dementia care because they capitalise on known knowledge translation enablers and incorporate optimal approaches to implementation. Non-pharmacological interventions focused on promoting independence are effective and favoured by people with dementia and their carers but are not routinely implemented. The objective of this translational project is to assess the impact of quality improvement collaboratives (QICs) on adherence to non-pharmacological recommendations from the Clinical Practice Guidelines for Dementia in Australia. METHODS This project will employ an interrupted time-series design with process evaluation to assess the impact, uptake, feasibility, accessibility, cost, and sustainability of the QICs over 18 months. Thirty clinicians from across Australia will be invited to join the QICs to build their capacity in leading innovation in dementia care. Clinicians will participate in a training program and be supported to develop and implement a quality improvement project unique to their service context using plan-do-study-act cycles. Regular online meetings with their peers in the QIC will facilitate benchmarking and problem-solving. Clinicians will describe their practice via monthly checklists, and guideline adherence will be determined against a set of defined criteria. Phone interviews with up to 180 client dyads will be used to assess satisfaction with care and client outcomes. Clinician interviews and field note data will be used to explore implementation and costs. Involvement of people with dementia and carers will be embedded in the study design, conduct, and reporting, in addition to clinical and industry expertise. DISCUSSION The quality of dementia care in Australia is largely dependent on the clinician involved and the extent to which they apply best available evidence in their practice. This study will determine the elements of this multifaceted implementation strategy that contributed to guideline adherence and client outcomes. The findings will inform future translational approaches to improving care and outcomes for people with dementia and their carers. TRIAL REGISTRATION Registered with the Australian New Zealand Clinical Trials Registry 21 February 2018 ( ACTRN12618000268246 ).
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Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Janna Anneke Fitzgerald
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- Griffith Business School, Griffith University, Gold Coast, Queensland Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- Northern Clinical School, The University of Sydney, Camperdown, New South Wales Australia
| | - Ian D. Cameron
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Jane Thompson
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
| | - Kate Hayes
- Griffith Business School, Griffith University, Gold Coast, Queensland Australia
- Healthcare and Hospital Process Improvement, Brisbane, Queensland Australia
| | - Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Kate E. Laver
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
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Gillespie BM, Bull C, Walker R, Lin F, Roberts S, Chaboyer W. Quality appraisal of clinical guidelines for surgical site infection prevention: A systematic review. PLoS One 2018; 13:e0203354. [PMID: 30212487 PMCID: PMC6136720 DOI: 10.1371/journal.pone.0203354] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Surgical site infections (SSI) occur in up to 10% of surgeries. Wound care practices to prevent infections are guided by Clinical Practice Guidelines (CPGs), yet their contribution to improving patient outcomes relies on their quality and adoption in practice. We critically evaluated the quality of CPGs for SSI prevention during pre-, intra- and post-operative phases of care. Methods We systematically reviewed the literature from 1990–2018 using the Cochrane Library, CINAHL, EMBASE, MEDLINE, ProQuest databases and five guidelines repositories. We extracted characteristics of each guideline using purposely-developed data collection tools. We assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results Combined searches of databases and repositories yielded 5,910 citations. Of these, we reviewed 215 full text documents. The final sample included 15 documents: 6 complete CPGs, 3 CPG updates, and 6 supplementary documents. The overall %mean scores across AGREE II domains for CPGs were: 1) scope and purpose (%mean ± SD = 86.3±23.5); 2) stakeholder involvement (%mean ± SD = 64±31.0); 3) rigour of development (%mean ± SD = 68.7±30.6); 4) clarity and presentation (%mean ± SD = 88.5±16.7); 5) applicability (%mean ± SD = 44±30.2); and, 5) editorial independence (%mean ± SD = 61±37.6). Based on individual AGREE II domains and overall scores, we appraised 4 out of 6 CPGs (inclusive of updates) as “recommended” for use in practice. Overall agreement among appraisers was excellent (ICC 0.86 [95%CI 0.73–0.94] - 0.98 [95%CI 0.96–0.99]; p <0.001). Discussion International interest in CPG development has resulted in refinements to methodologies, which has led to improvements in the overall quality of the product. Implications for translation Given the domains that received the lowest scores, it is clear that we need more consumer involvement and better consideration of the implementation challenges with CPG uptake and sustainability.
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Affiliation(s)
- Brigid M. Gillespie
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
- Optimising Health Outcomes (OHO) group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- * E-mail:
| | - Claudia Bull
- Optimising Health Outcomes (OHO) group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Rachel Walker
- Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, QLD, Australia
| | - Frances Lin
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD, Australia
| | - Shelley Roberts
- Optimising Health Outcomes (OHO) group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Wendy Chaboyer
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD, Australia
- Optimising Health Outcomes (OHO) group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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425
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Sahlström M, Partanen P, Azimirad M, Selander T, Turunen H. Patient participation in patient safety-An exploration of promoting factors. J Nurs Manag 2018; 27:84-92. [PMID: 30129073 DOI: 10.1111/jonm.12651] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 04/02/2018] [Accepted: 04/14/2018] [Indexed: 12/11/2022]
Abstract
AIMS To study how internal medicine patients experienced patient safety during their recent periods of care and to identify explanatory factors for patient participation. BACKGROUND Patient participation is recognized as one of the main factors promoting quality and safety and the identification of effective interventions that encourage safe care. METHODS A cross-sectional survey of patients (n = 462) in the internal medicine wards (n = 18) of all five Finnish university hospitals. Data were analysed using principal component analysis and multiple linear regression. RESULTS Most patients (78%) assessed the level of patient safety on their ward as "very good" or "excellent," 20% of patients assessed it as acceptable or worse. The following were considered to be the most important factors explaining higher patient participation: informing patients about the research and encouraging them to participate (β = 0.378, p < 0.001), providing necessary information promptly and comprehensibly (β = 0.393, p < 0.001), and enhancing patients' ability to identify patient safety incident(s) (β = 0.186, p < 0.001). CONCLUSIONS Healthcare workers must improve by encouraging patient participation and providing relevant information to patients. IMPLICATION FOR NURSING MANAGEMENT Nursing leaders must be competent to support, lead, and allocate resources for the creation of an environment where patient participation can occur and is valued by health care workers.
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Affiliation(s)
- Merja Sahlström
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Ylä-Savo SOTE Joint Municipal Authority, Iisalmi, Finland
| | - Pirjo Partanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Mina Azimirad
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Selander
- Kuopio University Hospital, Science Service Center, Kuopio, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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426
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Bergs J, Lambrechts F, Desmedt M, Hellings J, Schrooten W, Vlayen A, Vandijck D. Seen through the patients' eyes: surgical safety and checklists. Int J Qual Health Care 2018; 30:118-123. [PMID: 29340625 DOI: 10.1093/intqhc/mzx180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 12/06/2017] [Indexed: 11/15/2022] Open
Abstract
Objective We sought to explore the views patients have towards surgical safety and checklists. As a secondary aim, we explored if previous experience of error or other patient characteristics influence these views. Design A cross-sectional survey study design was applied. Participants The Flemish Patients' Platform network and social media were used to recruit participants. Main outcome measure(s) An 11-item questionnaire was designed to assess the following constructs: perception of surgical safety, attitudes towards the WHO surgical safety checklist and attitudes regarding checklist usage. Results Respondents' view (N = 444) on the risk of an adverse event showed considerable variation. Respondents were positive towards the checklist, strongly agreeing that it would impact positively on their safety. However, this positive perception did not translate into an attitude where patients will actively inform themselves whether a checklist is used. The majority of respondents have no difficulty with repetitive verification of identity, procedure and location of the surgery. Respondents with a clinical background were the least anxious. Views were divided regarding hearing discussions around blood loss or airway problems. Conclusions Patients perceive the checklist as a reliable safety tool. They do not mind repetitive verification of identity and procedure. However, hearing staff discussing specific, explicit, risks could cause anxiousness in some patients. Building a supportive and collaborative environment is needed to involve and empower patients to contribute in the realization of a safe hospital environment.
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Affiliation(s)
- Jochen Bergs
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Frank Lambrechts
- Faculty of Busines Economics, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Melissa Desmedt
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.,AZ Delta Hospital, General Management, Rode-kruisstraat 20, 8800 Roeselare, Belgium
| | - Ward Schrooten
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Annemie Vlayen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Dominique Vandijck
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Gent, Belgium
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427
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Berzins K, Louch G, Brown M, O’Hara JK, Baker J. Service user and carer involvement in mental health care safety: raising concerns and improving the safety of services. BMC Health Serv Res 2018; 18:644. [PMID: 30119632 PMCID: PMC6098618 DOI: 10.1186/s12913-018-3455-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research into improving patient safety has emphasised the importance of responding to and learning from concerns raised by service users and carers. Expertise gained by the experiences of service users and their carers has also been seen as a potential resource to improve patient safety. We know little about the ease of raising concerns within mental health services, and the potential benefits of involving service users and carers in safety interventions. This study aimed to explore service user and carer perceptions of raising safety concerns, and service user, carer and health professional views on the potential for service user and carer involvement in safety interventions. METHODS UK service users, carers and health professionals ( n= 185) were recruited via social media to a cross-sectional survey focussed on raising concerns about safety issues and views on potential service user and carer participation in safety interventions. Data were analysed using descriptive statistics, and free text responses were coded into categories. RESULTS The sample of 185 participants included 90 health professionals, 77 service users and 18 carers. Seventy seven percent of service users and carers reported finding it very difficult or difficult to raise concerns. Their most frequently cited barriers to raising concerns were: services did not listen; concerns about repercussions; and the process of raising concerns, especially while experiencing mental ill health. There was universal support from health professionals for service user and carer involvement in safety interventions and over half the service users and carers supported involvement, primarily due to their expertise from experience. CONCLUSIONS Mental health service users and carers experience difficulties in raising safety concerns meaning that potentially useful information is being missed. All the health professionals and the majority of service users and carers saw potential for service users and carer involvement in interventions to improve safety, to ensure their experiences are taken into consideration. The results provide guidance for future research about the most effective ways of ensuring that concerns about safety can be both raised and responded to, and how service user and carer involvement in improving safety in mental health care can be further developed.
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Affiliation(s)
- Kathryn Berzins
- School of Healthcare, University of Leeds, Baines Wing, Woodhouse Lane, Leeds, LS29JT UK
| | - Gemma Louch
- Yorkshire Quality and Safety Research Group, Yorkshire & Humber Patient Safety Translational Research Centre, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Mark Brown
- Social Spider CIC, The Mill, 7-11 Coppermill Lane, Walthamstow, London, E17 7HA UK
| | - Jane K. O’Hara
- Yorkshire Quality and Safety Research Group, Yorkshire & Humber Patient Safety Translational Research Centre, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
- Leeds Institute of Medical Education, University of Leeds, Worsley Building, Leeds, LS2 9JT UK
| | - John Baker
- School of Healthcare, University of Leeds, Baines Wing, Woodhouse Lane, Leeds, LS29JT UK
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428
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Jørgensen CR, Eskildsen NB, Johnsen AT. User involvement in a Danish project on the empowerment of cancer patients - experiences and early recommendations for further practice. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:26. [PMID: 30123531 PMCID: PMC6088427 DOI: 10.1186/s40900-018-0105-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/29/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND This paper reports on the process of involving former and current cancer patients and carers as co-researchers in a Danish mixed methods research project on patient empowerment of cancer patients in follow up (The Empowerment study 2015-2019). User-Involvement in health care research is a relatively new practice in Denmark and the Empowerment project was one of the first to systematically involve patients and carers in its research design, conduct and reporting. The paper has two aims: first, it provides a detailed account of the process of involving co-researchers in the Empowerment project and second, it presents findings from a workshop held with academic researchers and co-researchers on the project to discuss their experiences and recommendations for user-involvement in the Danish context. METHODS The Empowerment project adopted a consultative and collaborative approach to user involvement and co-researchers were involved from the early stages and all through the project. Users gave feedback on the proposal, helped develop project documents and research tools, acted as peer interviewers in qualitative interviews, participated in data analysis and development of questionnaires, and co-authored journal articles. The workshop held with the academic researchers and co-researchers consisted of two parallel focus groups and a joint group discussion, following an interactive and informal format to facilitate discussion and exchange of ideas. FINDINGS The focus group resulted in eleven recommendations for the further development of user-involvement in Denmark. Key issues encountered were the general lack of guidelines on user-involvement in the Danish context and the need for more organisational support. Particular issues, such as payment, recruitment and training, need to be carefully considered within individual projects and within the national context in which projects are carried out. CONCLUSION The paper adds to the current very limited knowledge base on user-involvement in the Danish context and provides a set of early recommendations for the further development of the practice in Danish Health Research. User-involvement needs to be developed with consideration to the local context, but common challenges also emphasise the usefulness of cross-country comparisons and knowledge exchange.
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Affiliation(s)
- Clara R. Jørgensen
- Department for Disability Inclusion and Special Needs, School of Education, University of Birmingham, B15 2TT, Edgbaston, Birmingham UK
| | - Nanna B. Eskildsen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Anna T. Johnsen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
- Department of Palliative Medicine, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
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429
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Farmer J, Bigby C, Davis H, Carlisle K, Kenny A, Huysmans R. The state of health services partnering with consumers: evidence from an online survey of Australian health services. BMC Health Serv Res 2018; 18:628. [PMID: 30097008 PMCID: PMC6086055 DOI: 10.1186/s12913-018-3433-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background Involving consumers in producing health services is mandated in many countries. Evidence indicates consumer partnerships lead to improved service design, quality and innovation. Involving participants from minority groups is crucial because poor understanding of distinctive needs affects individuals’ service experiences and outcomes. Few studies consider service compliance with consumer partnering requirements or inclusion of minority group participants. Methods An online survey structured by domains of the Australian National Safety and Quality in Health Service Standards (NSQHS, 2013), was conducted. Questions covered consumer partnering in service planning, management and evaluation plus patient care design and inclusion of consumers from minority groups. Approximately 1200 Australian hospital and day surgery services were identified and 447 individual email addresses were identified for staff leading consumer partnerships. Quantitative data were analysed using SPSS. Qualitative responses, managed in NVivo, were analysed thematically. Frequencies were produced to indicate common activities and range of activities within question domains. Results Comprehensive responses were received from 115 services (25.7%), including metropolitan and non-metropolitan, private and public service settings. Most respondents (95.6%) “partnered with consumers to develop or provide feedback on patient information”. Regarding inclusion of participants from minority groups, respondents were least likely to specifically include those from socially disadvantaged backgrounds (23.6%). Public health services were more likely than private services to engage with consumers. Conclusions The survey is the first to include responses about consumer partnering from across Australia. While many respondents partner with consumers, it is clear that more easily-organised activity such as involvement in existing committees or commenting on patient information occurs more commonly than involvement in strategy or governance. This raises questions over whether strategic-level involvement is too difficult or unrealistic; or whether services simply lack tools. Minority views may be missed where there is a lack of specific action to include diversity. Future work might address why services choose the activities we found and probe emerging opportunities, such as using social media or online engagement. Electronic supplementary material The online version of this article (10.1186/s12913-018-3433-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jane Farmer
- Social Innovation Research Institute, Swinburne University of Technology, John Street, Hawthorn, Melbourne, Australia.
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University, Bundoora, Melbourne, Australia
| | - Hilary Davis
- Living with Disability Research Centre, La Trobe University, Bundoora, Melbourne, Australia.,Centre for Social Impact, Swinburne University of Technology, John Street, Hawthorn, Melbourne, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, QLD, Townsville, Australia
| | - Amanda Kenny
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Richard Huysmans
- Raven Consulting Group, Unit 4, 62 Wattletree Road, Armadale Vic, Melbourne, 3143, Australia
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430
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Frost J, Gibson A, Harris-Golesworthy F, Harris J, Britten N. Patient involvement in qualitative data analysis in a trial of a patient-centred intervention: Reconciling lay knowledge and scientific method. Health Expect 2018; 21:1111-1121. [PMID: 30073734 PMCID: PMC6250869 DOI: 10.1111/hex.12814] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We conducted a pilot study of an intervention to facilitate patients' agenda setting in clinical consultations. The primary aim of the study was to test the feasibility of running the randomized controlled trial. A secondary objective was to assess the extent to which patient and public involvement (PPI) could contribute to the process of qualitative data analysis (QDA). AIMS To describe a novel approach to including patient partners in QDA; to illustrate the kinds of contribution that patient partners made to QDA in this context; and to propose a characterization of a process by which patient involvement can contribute to knowledge production. METHODS Six patient and public representatives were supported to contribute to data analysis via a range of modalities. During a series of QDA workshops, experienced research staff role-played consultations and interviews, and provided vignettes. Workshop data and PPI diaries were analysed using thematic discourse analysis. RESULTS We characterized a process of thesis, antithesis and synthesis. This PPI group contributed to the rigour and validity of the study findings by challenging their own and the researchers' assumptions, and by testing the emerging hypotheses. By training PPI representatives to undertake qualitative data analysis, we transformed our understanding of doctor-patient consultations. CONCLUSIONS This research required changes to our usual research practices but was in keeping with the objective of establishing meaningful patient involvement for a future definitive trial. This work was informed by concepts of critical humility, and a process of knowledge production enabled via the construction of a knowledge space.
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Affiliation(s)
- Julia Frost
- University of Exeter Medical School, Exeter, UK
| | - Andy Gibson
- Department of Health and Social Sciences, University of West England, Bristol, UK
| | | | - Jim Harris
- PenCLAHRC Patient and Public Involvement Team, University of Exeter Medical School, Exeter, UK
| | - Nicky Britten
- University of Exeter Medical School, University of Exeter, Exeter, UK
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431
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Bishop AC, Elliott MJ, Cassidy C. Moving patient-oriented research forward: thoughts from the next generation of knowledge translation researchers. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:23. [PMID: 30083391 PMCID: PMC6069714 DOI: 10.1186/s40900-018-0110-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Abstract
PLAIN ENGLISH SUMMARY As knowledge translation trainee participants, we report on the discussions that took place during the 2017 Knowledge Translation Canada Summer Institute. The theme of the institute was patient-oriented research and patient engagement in research. Trying to move knowledge into health care practice can be difficult. Including patients and families as members of the research team can help to overcome some of these challenges by producing more relevant research designs and results. However, in the absence of guidelines and best practices, it can be difficult for trainees and researchers to effectively engage patients and families in designing and conducting research. We detail how trainees and early career researchers are currently engaging patients in their research, the strengths and challenges of engaging patients in research, and lessons learned. These discussions have helped us to identify important areas where future training and guidance is needed to support trainees as patient-oriented researchers. ABSTRACT Background Moving knowledge into health care practice can present a number of challenges for researchers. Including patients and families as members of the research team can help to overcome some of these challenges by producing more relevant research designs and results. However, many trainees and researchers experience difficulty in engaging patients and families in research effectively. Main body We report on the discussions that took place at the 2017 Knowledge Translation (KT) Canada Summer Institute (KTCSI). The theme of the KTCSI was patient-oriented research and patient engagement in research. We provide an important viewpoint on how trainees and early career researchers are currently engaging patients in their research, the strengths and challenges of engaging patients in research, and lessons learned. As the target audience of the KTCSI, we provide our thoughts on what is needed to support trainees and researchers to more effectively engage patients and families in research. Conclusion While many of the participants at the KTCSI are conducting patient-oriented research, practical guidance, resources and tools are needed to ensure the effective engagement of patients in research. These discussions have helped us to identify how to move forward as patient-oriented researchers and where future work and support is needed to achieve effective engagement.
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Affiliation(s)
- Andrea C. Bishop
- Strengthening Transitions in Pediatric Care, IWK Health Centre, 5850/5980 University Avenue, Halifax, NS B3K 6R8 Canada
| | - Meghan J. Elliott
- Department of Medicine, University of Calgary, 1403 29 Street NW, Calgary, AB T2N 2T9 Canada
| | - Christine Cassidy
- School of Nursing, Dalhousie University, 5896 University Avenue, Halifax, NS B3H 4R2 Canada
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432
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“Not an afterthought”: Power imbalances in systemic partnerships between health service providers and consumers in a hospital setting. Health Policy 2018; 122:922-928. [DOI: 10.1016/j.healthpol.2018.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 11/20/2022]
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433
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Staniszewska S, Denegri S, Matthews R, Minogue V. Reviewing progress in public involvement in NIHR research: developing and implementing a new vision for the future. BMJ Open 2018; 8:e017124. [PMID: 30061427 PMCID: PMC6067369 DOI: 10.1136/bmjopen-2017-017124] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To review the progress of public involvement (PPI) in NIHR (National Institute for Health Research) research, identify barriers and enablers, reflect on the influence of PPI on the wider health research system in the UK and internationally and develop a vision for public involvement in research for 2025. The developing evidence base, growing institutional commitment and public involvement activity highlight its growth as a significant international social movement. DESIGN The 'Breaking Boundaries Review' was commissioned by the Department of Health. An expert advisory panel was convened. Data sources included: an online survey, international evidence sessions, workshop events, open submission of documents and supporting materials and existing systematic reviews. Thematic analysis identified key themes. NVivo was used for data management. The themes informed the report's vision, mission and recommendations, published as 'Going the Extra Mile-Improving the health and the wealth of the nation through public involvement in research'. The Review is now being implemented across the NIHR. RESULTS This paper reports the Review findings, the first of its type internationally. A range of barriers and enablers to progress were identified, including attitudes, resources, infrastructure, training and support and leadership. The importance of evidence to underpin practice and continuous improvement emerged. Co-production was identified as a concept central to strengthening public involvement in the future. The Vision and Mission are supported by four suggested measures of success, reach, refinement, relevance and relationships. CONCLUSIONS The NIHR is the first funder of its size and importance globally to review its approach to public involvement. While significant progress has been made, there is a need to consolidate progress and accelerate the spread of effective practice, drawing on evidence. The outcomes of the Review are being implemented across the NIHR. The findings and recommendations have transferability for other organisations, countries and individuals.
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Affiliation(s)
- Sophie Staniszewska
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Simon Denegri
- NIHR National Director for Patients, Carers and the Public UCL School of Life and Medical Sciences, London, UK
| | - Rachel Matthews
- National Institute for Health Research (NIHR) Collaboration for Leadership and Applied Health Research and Care (CLAHRC), Northwest London, Imperial College, London, UK
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434
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Abayneh S, Lempp H, Manthorpe J, Hanlon C. Development of programme theory for integration of service user and caregiver involvement in mental health system strengthening: protocol for realist systematic review. Int J Ment Health Syst 2018; 12:41. [PMID: 30061922 PMCID: PMC6057009 DOI: 10.1186/s13033-018-0220-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is international recognition of the need for service user and caregiver involvement in mental health system strengthening. However, little is known about how best to integrate this approach into the mental healthcare system; what works to advance involvement, under what conditions, how and when does involvement bring added value, and how can it work in resource-poor settings in low and middle-income countries. Objective To describe the methodology for a realist systematic review protocol to synthesise the evidence to explain the contexts, outcomes, and underlying mechanisms for involvement of service users with severe mental health problems and their caregivers in mental healthcare policy-making and planning, advocacy, service development, monitoring and improvement. Methods/designs The proposed realist systematic review will involve five steps: (i) clarifying the review scope, (ii) a systematic search for evidence, (iii) evidence appraisal and data extraction, (iv) data analysis, (v) synthesis of evidence and formation of revised programme theory. Inputs from a formative qualitative study, consultative Theory of Change meetings with key stakeholder groups, and scoping reviews will be used to identify candidate theory/theories that will guide the selection, appraisal and analysis of studies, and refine the Theory of Change model that will be piloted and evaluated. Synthesis of data will be undertaken using realist logic, constant comparison and thematic analysis. In a consultative meeting with stakeholders the Theory of Change model will then be situated with respect to relevant programme theories and adapted to incorporate the synthesized evidence of relevance to the local context. The finalized Theory of Change model will be piloted and evaluated in a primary health care setting in rural Ethiopia. Discussion Realist review methodology has not been applied to the area of mental health service user involvement in low- and middle-income country settings. In this protocol, we describe how this contextualized approach will be applied to identify and refine a theory-driven and transferable model of involvement of service users, embedded in ongoing work in Ethiopia.Systematic review registration PROSPERO CRD42018084595.
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Affiliation(s)
- Sisay Abayneh
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- 2Department of Inflammation Biology, Faculty of Life Sciences & Medicine, King's College London, Weston Education Centre, 10, Cutcombe Road, London, SE5 9RJ UK
| | - Jill Manthorpe
- 3Health &Social Care Workforce Research Unit, King's College London, Strand, London, WC2 4LL UK
| | - Charlotte Hanlon
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,4Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciencem, King's College London, 16 De Crespigny Park, London, SE5 8AF UK
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435
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Kok J, Leistikow I, Bal R. Patient and family engagement in incident investigations: exploring hospital manager and incident investigators' experiences and challenges. J Health Serv Res Policy 2018; 23:252-261. [PMID: 30027771 PMCID: PMC6187500 DOI: 10.1177/1355819618788586] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective There is growing recognition among health care providers and policy makers that when things go wrong, the patient or their families should be heard and participate in the incident investigation process. This paper explores how Dutch hospitals organize patient or family engagement in incident investigations, maps out incident investigators' experiences of involving patients or their families in incident investigations and identifies the challenges encountered. Methods Semi-structured interviews were conducted with managers and incident investigators in 13 Dutch hospitals. Study participants (n = 18) were asked about the incident investigation routines and their experiences of involving affected patients or family members. Interview transcripts were coded and analysed using thematic content analysis. Results Our findings reveal that patient or family involvement in incident investigations is typically organized as a one-time interview event. Interviews with patients or their families were considered to be valuable and important in their own right and seen as a way to do justice to the individual needs of the patient or their family. Yet, the usefulness and validity of the patient or family perspective for incident investigations was often seen to be limited, with the professional perspective afforded more weight. This was particularly the case when the patient or their family were unable to provide verifiable details of the incident under investigation. Study participants described challenges when involving patients or family members, including in relation to the available timeframe for incident investigations, legal issues, managing trust and working with intense emotions. Conclusions We propose that by placing patient and family criteria of significance at the centre of incident investigations (i.e. an 'emic' research approach), hospitals may be able to expand their learning potential and improve patient-centeredness following an incident.
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Affiliation(s)
- Josje Kok
- 1 PhD candidate Healthcare Governance, Erasmus School of Health Policy and Management, Erasmus University, the Netherlands
| | - Ian Leistikow
- 2 Professor of Governmental Supervision on Quality and Safety in Health Care, Erasmus School of Health Policy and Management, Erasmus University, the Netherlands.,3 Senior inspector and advisor, Health and Youth Care Inspectorate, the Netherlands
| | - Roland Bal
- 4 Professor of Healthcare Governance, Erasmus School of Health Policy and Management, Erasmus University, the Netherlands
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436
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Leech RD, Eyles J, Batt ME, Hunter DJ. Lower extremity osteoarthritis: optimising musculoskeletal health is a growing global concern: a narrative review. Br J Sports Med 2018; 53:806-811. [PMID: 30030282 DOI: 10.1136/bjsports-2017-098051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 11/03/2022]
Abstract
The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.
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Affiliation(s)
- Richard D Leech
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jillian Eyles
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Mark E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.,Centre for Sports Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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437
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Scholz B, Bocking J, Banfield M, Platania-Phung C, Happell B. “Coming from a different place”: Partnerships between consumers and health services for system change. J Clin Nurs 2018; 27:3622-3629. [DOI: 10.1111/jocn.14520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Brett Scholz
- SYNERGY Nursing and Midwifery Research Centre; University of Canberra and ACT Health; The Canberra Hospital; Woden ACT Australia
| | - Julia Bocking
- SYNERGY Nursing and Midwifery Research Centre; University of Canberra and ACT Health; The Canberra Hospital; Woden ACT Australia
| | - Michelle Banfield
- Centre for Mental Health Research; The Australian National University; Canberra ACT Australia
| | - Chris Platania-Phung
- SYNERGY Nursing and Midwifery Research Centre; University of Canberra and ACT Health; The Canberra Hospital; Woden ACT Australia
| | - Brenda Happell
- SYNERGY Nursing and Midwifery Research Centre; University of Canberra and ACT Health; The Canberra Hospital; Woden ACT Australia
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438
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Psychological adaptation after peripartum cardiomyopathy: A qualitative study. Midwifery 2018; 62:52-60. [DOI: 10.1016/j.midw.2018.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/16/2018] [Accepted: 03/15/2018] [Indexed: 11/22/2022]
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439
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Reed JE, Howe C, Doyle C, Bell D. Simple rules for evidence translation in complex systems: A qualitative study. BMC Med 2018; 16:92. [PMID: 29921274 PMCID: PMC6009041 DOI: 10.1186/s12916-018-1076-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/14/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Ensuring patients benefit from the latest medical and technical advances remains a major challenge, with rational-linear and reductionist approaches to translating evidence into practice proving inefficient and ineffective. Complexity thinking, which emphasises interconnectedness and unpredictability, offers insights to inform evidence translation theories and strategies. Drawing on detailed insights into complex micro-systems, this research aimed to advance empirical and theoretical understanding of the reality of making and sustaining improvements in complex healthcare systems. METHODS Using analytical auto-ethnography, including documentary analysis and literature review, we assimilated learning from 5 years of observation of 22 evidence translation projects (UK). We used a grounded theory approach to develop substantive theory and a conceptual framework. Results were interpreted using complexity theory and 'simple rules' were identified reflecting the practical strategies that enhanced project progress. RESULTS The framework for Successful Healthcare Improvement From Translating Evidence in complex systems (SHIFT-Evidence) positions the challenge of evidence translation within the dynamic context of the health system. SHIFT-Evidence is summarised by three strategic principles, namely (1) 'act scientifically and pragmatically' - knowledge of existing evidence needs to be combined with knowledge of the unique initial conditions of a system, and interventions need to adapt as the complex system responds and learning emerges about unpredictable effects; (2) 'embrace complexity' - evidence-based interventions only work if related practices and processes of care within the complex system are functional, and evidence-translation efforts need to identify and address any problems with usual care, recognising that this typically includes a range of interdependent parts of the system; and (3) 'engage and empower' - evidence translation and system navigation requires commitment and insights from staff and patients with experience of the local system, and changes need to align with their motivations and concerns. Twelve associated 'simple rules' are presented to provide actionable guidance to support evidence translation and improvement in complex systems. CONCLUSION By recognising how agency, interconnectedness and unpredictability influences evidence translation in complex systems, SHIFT-Evidence provides a tool to guide practice and research. The 'simple rules' have potential to provide a common platform for academics, practitioners, patients and policymakers to collaborate when intervening to achieve improvements in healthcare.
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Affiliation(s)
- Julie E Reed
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Chelsea, London, UK. .,Westminster Hospital, Imperial College, London, SW10 9NH, UK.
| | - Cathy Howe
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Chelsea, London, UK.,Westminster Hospital, Imperial College, London, SW10 9NH, UK
| | - Cathal Doyle
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Chelsea, London, UK.,Westminster Hospital, Imperial College, London, SW10 9NH, UK
| | - Derek Bell
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Chelsea, London, UK.,Westminster Hospital, Imperial College, London, SW10 9NH, UK
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440
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Hannigan A. Public and patient involvement in quantitative health research: A statistical perspective. Health Expect 2018; 21:939-943. [PMID: 29920877 PMCID: PMC6250860 DOI: 10.1111/hex.12800] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The majority of studies included in recent reviews of impact for public and patient involvement (PPI) in health research had a qualitative design. PPI in solely quantitative designs is underexplored, particularly its impact on statistical analysis. Statisticians in practice have a long history of working in both consultative (indirect) and collaborative (direct) roles in health research, yet their perspective on PPI in quantitative health research has never been explicitly examined. OBJECTIVE To explore the potential and challenges of PPI from a statistical perspective at distinct stages of quantitative research, that is sampling, measurement and statistical analysis, distinguishing between indirect and direct PPI. CONCLUSIONS Statistical analysis is underpinned by having a representative sample, and a collaborative or direct approach to PPI may help achieve that by supporting access to and increasing participation of under-represented groups in the population. Acknowledging and valuing the role of lay knowledge of the context in statistical analysis and in deciding what variables to measure may support collective learning and advance scientific understanding, as evidenced by the use of participatory modelling in other disciplines. A recurring issue for quantitative researchers, which reflects quantitative sampling methods, is the selection and required number of PPI contributors, and this requires further methodological development. Direct approaches to PPI in quantitative health research may potentially increase its impact, but the facilitation and partnership skills required may require further training for all stakeholders, including statisticians.
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Affiliation(s)
- Ailish Hannigan
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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441
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442
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Boudes M, Robinson P, Bertelsen N, Brooke N, Hoos A, Boutin M, Geissler J, Sargeant I. What do stakeholders expect from patient engagement: Are these expectations being met? Health Expect 2018; 21:1035-1045. [PMID: 29858529 PMCID: PMC6250871 DOI: 10.1111/hex.12797] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2018] [Indexed: 11/30/2022] Open
Abstract
Background Meaningful patient engagement (PE) in medicines development and during the life cycle of a product requires all stakeholders have a clear understanding of respective expectations. Objective A qualitative survey was undertaken to understand stakeholder expectations. Design The survey explored 4 themes from the perspective of each stakeholder group: meaning, views, expectations and priorities for PE. Participants were grouped into 7 categories: policymakers/regulators; health‐care professionals (HCPs); research funders; payers/purchasers/HTA; patients/patient representatives; pharmaceutical/life sciences industry; and academic researchers. Results Fifty‐nine interviews were conducted across a range of geographies, PE experience and job seniority/role. There was consensus across stakeholders on meaning of PE; importance of promoting PE to a higher level than currently; need for a more structured process and guidance. There was little consensus on stakeholder expectations and roles. Policymakers/regulators were expected by others to drive PE, create a framework and facilitate PE, provide guidelines of good practice and connect stakeholders, but this expectation was not shared by the policymakers/regulators group. HCPs were seen as the link between patients and other stakeholders, but HCPs did not necessarily share this view. Discussion and conclusions Despite broad stakeholder categories, clear themes emerged: there is no “leader”; no stakeholder has a clear view on how to meaningfully engage with patients; there are educational gaps; and a structure and guidance for PE is urgently required. Given the diversity of stakeholders, there needs to be multistakeholder collaborative leadership. Effective collaboration requires consensus on roles, responsibilities and expectations to synergize efforts to deliver meaningful PE in medicines life cycle.
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Affiliation(s)
| | | | | | | | | | - Marc Boutin
- National Health Council, Washington, DC, USA
| | - Jan Geissler
- European Patients' Academy on Therapeutic Innovation, Brussels, Belgium
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443
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Abstract
AbstractIn recent years, there have been positive changes to the health research landscape, with increasing interest amongst community organisations and university investigators in establishing research partnerships and with more funding opportunities for community-engaged work. However, creating a community–university partnership requires new skills, new types of knowledge, and new ways of creating and maintaining relationships. On both sides of the research equation, people are looking for guidance. The discussion here uses our experience to offer concrete tips in plain language for strategies that can be used to build capacity for community–university partnerships for organisations and researchers in pre-partnership and early partnership stages. We comment on debates about epistemology and knowledge production in research and how anthropologists are well positioned to contribute to this process.
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444
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Zaman S, Whitelaw A, Richards N, Inbadas H, Clark D. A moment for compassion: emerging rhetorics in end-of-life care. MEDICAL HUMANITIES 2018; 44:140-143. [PMID: 29440385 PMCID: PMC6031266 DOI: 10.1136/medhum-2017-011329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 06/08/2023]
Abstract
Compassion is an emotional response to the suffering of others. Once felt, it entails subsequent action to ameliorate their suffering. Recently, 'compassion' has become the flagship concept to be fostered in the delivery of end-of-life care, and a rallying call for social action and public health intervention. In this paper, we examine the emerging rhetorics of compassion as they relate to end-of-life care and offer a critique of the expanding discourse around it. We argue that, even where individuals 'possess' compassion or are 'trained' in it, there are difficulties for compassion to flow freely, particularly within Western society. This relates to specific sociopolitical structural factors that include the sense of privacy and individualism in modern industrialised countries, highly professionalised closed health systems, anxiety about litigation on health and safety grounds, and a context of suspicion and mistrust within the global political scenario. We must then ask ourselves whether compassion can be created intentionally, without paying attention to the structural aspects of society. One consequence of globalisation is that countries in the global South are rapidly trying to embrace the features of modernity adopted by the global North. We argue that unrealistic assumptions have been made about the role of compassion in end-of-life care and these idealist aspirations must be tempered by a more structural assessment of potential. Compassion that is not tied to to realistic action runs the risk of becoming empty rhetoric.
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Affiliation(s)
- Shahaduz Zaman
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
- Department of Global Health and Infection, Brighton Sussex Medical School, University of Sussex, Brighton, UK
| | - Alexander Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| | - Naomi Richards
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| | - Hamilton Inbadas
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
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445
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Turner A, Mulla A, Booth A, Aldridge S, Stevens S, Begum M, Malik A. The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [PMID: 29972636 DOI: 10.3310/hsdr06250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundThe Multispecialty Community Provider (MCP) model was introduced to the NHS as a primary care-led, community-based integrated care model to provide better quality, experience and value for local populations.ObjectivesThe three main objectives were to (1) articulate the underlying programme theories for the MCP model of care; (2) identify sources of theoretical, empirical and practice evidence to test the programme theories; and (3) explain how mechanisms used in different contexts contribute to outcomes and process variables.DesignThere were three main phases: (1) identification of programme theories from logic models of MCP vanguards, prioritising key theories for investigation; (2) appraisal, extraction and analysis of evidence against a best-fit framework; and (3) realist reviews of prioritised theory components and maps of remaining theory components.Main outcome measuresThe quadruple aim outcomes addressed population health, cost-effectiveness, patient experience and staff experience.Data sourcesSearches of electronic databases with forward- and backward-citation tracking, identifying research-based evidence and practice-derived evidence.Review methodsA realist synthesis was used to identify, test and refine the following programme theory components: (1) community-based, co-ordinated care is more accessible; (2) place-based contracting and payment systems incentivise shared accountability; and (3) fostering relational behaviours builds resilience within communities.ResultsDelivery of a MCP model requires professional and service user engagement, which is dependent on building trust and empowerment. These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. Together, these can facilitate accountability at the individual, community and system levels. The evidence base relating to these theory components was, for the most part, limited by initiatives that are relatively new or not formally evaluated. Support for the programme theory components varies, with moderate support for enhanced primary care and community involvement in care, and relatively weak support for new contracting models.Strengths and limitationsThe project benefited from a close relationship with national and local MCP leads, reflecting the value of the proximity of the research team to decision-makers. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change.ConclusionsMultispecialty Community Providers can be described as complex adaptive systems (CASs) and, as such, connectivity, feedback loops, system learning and adaptation of CASs play a critical role in their design. Implementation can be further reinforced by paying attention to contextual factors that influence behaviour change, in order to support more integrated working.Future workA set of evidence-derived ‘key ingredients’ has been compiled to inform the design and delivery of future iterations of population health-based models of care. Suggested priorities for future research include the impact of enhanced primary care on the workforce, the effects of longer-term contracts on sustainability and capacity, the conditions needed for successful continuous improvement and learning, the role of carers in patient empowerment and how community participation might contribute to community resilience.Study registrationThis study is registered as PROSPERO CRD42016039552.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alison Turner
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Abeda Mulla
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shiona Aldridge
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Sharon Stevens
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Mahmoda Begum
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Anam Malik
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
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446
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Synnot A, Bragge P, Lowe D, Nunn JS, O'Sullivan M, Horvat L, Tong A, Kay D, Ghersi D, McDonald S, Poole N, Bourke N, Lannin N, Vadasz D, Oliver S, Carey K, Hill SJ. Research priorities in health communication and participation: international survey of consumers and other stakeholders. BMJ Open 2018; 8:e019481. [PMID: 29739780 PMCID: PMC5942413 DOI: 10.1136/bmjopen-2017-019481] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify research priorities of consumers and other stakeholders to inform Cochrane Reviews in 'health communication and participation' (including such concepts as patient experience, shared decision-making and health literacy). SETTING International. PARTICIPANTS We included anyone with an interest in health communication and participation. Up to 151 participants (18-80 years; 117 female) across 12 countries took part, including 48 consumers (patients, carers, consumer representatives) and 75 professionals (health professionals, policymakers, researchers) (plus 25 people who identified as both). DESIGN Survey. METHODS We invited people to submit their research ideas via an online survey open for 4 weeks. Using inductive thematic analysis, we generated priority research topics, then classified these into broader themes. RESULTS Participants submitted 200 research ideas, which we grouped into 21 priority topics. Key research priorities included: insufficient consumer involvement in research (19 responses), 'official' health information is contradictory and hard to understand (18 responses), communication/coordination breakdowns in health services (15 responses), health information provision a low priority for health professionals (15 responses), insufficient eliciting of patient preferences (14 responses), health services poorly understand/implement patient-centred care (14 responses), lack of holistic care impacting healthcare quality and safety (13 responses) and inadequate consumer involvement in service design (11 responses). These priorities encompassed acute and community health settings, with implications for policy and research. Priority populations of interest included people from diverse cultural and linguistic backgrounds, carers, and people with low educational attainment, or mental illness. Most frequently suggested interventions focused on training and cultural change activities for health services and health professionals. CONCLUSIONS Consumers and other stakeholders want research addressing structural and cultural challenges in health services (eg, lack of holistic, patient-centred, culturally safe care) and building health professionals' communication skills. Solutions should be devised in partnership with consumers, and focus on the needs of vulnerable groups.
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Affiliation(s)
- Anneliese Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jack S Nunn
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Molly O'Sullivan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lidia Horvat
- Safer Care Victoria, Melbourne, Victoria, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Debra Kay
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Davina Ghersi
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- National Health and Medical Research Council, Canberra, New South Wales, Australia
| | - Steve McDonald
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Naomi Poole
- Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia
| | - Noni Bourke
- Bass Coast Health, Wonthaggi, Victoria, Australia
| | - Natasha Lannin
- Alfred Health, Melbourne, Victoria, Australia
- School of Allied Health (Occupational Therapy), La Trobe University, Melbourne, Victoria, Australia
| | - Danny Vadasz
- Health Issues Centre, Melbourne, Victoria, Australia
| | - Sandy Oliver
- University College London, London, UK
- Universityof Johannesburg, Johannesburg, South Africa
| | - Karen Carey
- Formerly of Consumers Health Forum, Canberra, Australia
| | - Sophie J Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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447
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Anderson de Cuevas R, Nylén L, Burström B, Whitehead M. Involving the public in epidemiological public health research: a qualitative study of public and stakeholder involvement in evaluation of a population-wide natural policy experiment. BMJ Open 2018; 8:e019805. [PMID: 29678973 PMCID: PMC5914713 DOI: 10.1136/bmjopen-2017-019805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Public involvement in research is considered good practice by European funders; however, evidence of its research impact is sparse, particularly in relation to large-scale epidemiological research. OBJECTIVES To explore what difference public and stakeholder involvement made to the interpretation of findings from an evaluation of a natural policy experiment to influence the wider social determinants of health: 'Flexicurity'. SETTING Stockholm County, Sweden. PARTICIPANTS Members of the public from different occupational groups represented by blue-collar and white-collar trade union representatives. Also, members of three stakeholder groups: the Swedish national employment agency; an employers' association and politicians sitting on a national labour market committee. Total: 17 participants. METHODS Qualitative study of process and outcomes of public and stakeholder participation in four focused workshops on the interpretation of initial findings from the flexicurity evaluation. OUTCOME MEASURES New insights from participants benefiting the interpretation of our research findings or conceptualisation of future research. RESULTS Participants sensed more drastic and nuanced change in the Swedish welfare system over recent decades than was evident from our literature reviews and policy analysis. They also elaborated hidden developments in the Swedish labour market that were increasingly leading to 'insiders' and 'outsiders', with differing experiences and consequences for financial and job security. Their explanation of the differential effects of the various collective agreements for different occupational groups was new and raised further potential research questions. Their first-hand experience provided new insights into how changes to the social protection system were contributing to the increasing trends in poverty among unemployed people with limiting long-standing illness. The politicians provided further reasoning behind some of the policy changes and their intended and unintended consequences. These insights fed into subsequent reporting of the flexicurity evaluation results, as well as the conceptualisation of new research that could be pursued in a future programme.
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Affiliation(s)
| | - Lotta Nylén
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Bo Burström
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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448
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Patient Involvement in Healthcare-Associated Infection Research: A Lexical Review. Infect Control Hosp Epidemiol 2018; 39:710-717. [PMID: 29606155 DOI: 10.1017/ice.2018.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVEThis review examines patient involvement in healthcare-associated infection (HAI) research. Healthcare-associated infections represent an intractable issue with considerable implications for patients and staff. Participatory methodologies that involve patients in healthcare research are associated with myriad benefits.DESIGNLexical review.METHODSPubMed was searched to identify all publications on patient involvement in HAI research since 2000; publications were also identified from the cited references. A lexical analysis was conducted of the methods sections of 148 publications.RESULTSThe findings reveal that HAI research that actively involves patients and members of the public is limited.CONCLUSIONSPatient involvement is largely limited to recruitment to HAI studies rather than extended to patient involvement in research design, implementation, analysis, and/or dissemination. As such, there is considerable opportunity to further this important research area via alternative methodologies that award primacy to patient expertise and agency.Infect Control Hosp Epidemiol 2018;39:710-717.
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449
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Dogba MJ, Dipankui MT, Chipenda Dansokho S, Légaré F, Witteman HO. Diabetes-related complications: Which research topics matter to diverse patients and caregivers? Health Expect 2018; 21:549-559. [PMID: 29165920 PMCID: PMC5867328 DOI: 10.1111/hex.12649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Diabetes is a chronic disease with increasing prevalence worldwide. Although research has improved its treatment and management, little is known about which research topics matter to people living with diabetes, particularly among under-represented groups. OBJECTIVES To explore the importance of research topics among a diverse range of people living with any type of diabetes or caring for someone living with any type of diabetes. METHODS We used a convergent mixed-method design with quantitative and qualitative aspects. We surveyed a national sample of people living with diabetes and caregivers of people with diabetes, asking them to rate the importance of 10 predetermined important research topics. We also held three focus groups in two major cities to explore research concerns of people who are under-represented in research. RESULTS 469 adults (57% men, 42% women) in Canada completed the online survey, indicating that all 10 areas of research mattered to them, with the highest ratings accorded to preventing and treating kidney, eye and nerve complications. Fourteen individuals participated in three focus groups and similarly noted the importance of research on those three complications. Additionally, focus group participants also noted the importance of research around daily management. No new topics were identified. CONCLUSIONS This study confirmed the importance of research topics among a population of people living with or caring for someone with diabetes. Findings from this study were used to inform the vision for Diabetes Action Canada-a pan-Canadian Strategy for Patient-Oriented Research (SPOR) Network on diabetes and its complications.
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Affiliation(s)
- Maman Joyce Dogba
- Department of Family and Emergency MedicineFaculty of MedicineLaval UniversityQuebec CityQCCanada
- Office of Education and Professional DevelopmentFaculty of MedicineLaval UniversityQuebec CityQCCanada
| | - Mylène Tantchou Dipankui
- Department of Family and Emergency MedicineFaculty of MedicineLaval UniversityQuebec CityQCCanada
| | - Selma Chipenda Dansokho
- Department of Family and Emergency MedicineFaculty of MedicineLaval UniversityQuebec CityQCCanada
| | - France Légaré
- Department of Family and Emergency MedicineFaculty of MedicineLaval UniversityQuebec CityQCCanada
- Office of Education and Professional DevelopmentFaculty of MedicineLaval UniversityQuebec CityQCCanada
| | - Holly O. Witteman
- Department of Family and Emergency MedicineFaculty of MedicineLaval UniversityQuebec CityQCCanada
- Office of Education and Professional DevelopmentFaculty of MedicineLaval UniversityQuebec CityQCCanada
- Centre Hospitalier Universitaire de Québec (CHU de Québec) Research Centre [Health of populations and best health practices axis]Quebec CityQCCanada
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450
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Burges Watson DL, Lewis S, Bryant V, Patterson J, Kelly C, Edwards-Stuart R, Murtagh MJ, Deary V. Altered eating: a definition and framework for assessment and intervention. BMC Nutr 2018; 4:14. [PMID: 32153878 PMCID: PMC7050903 DOI: 10.1186/s40795-018-0221-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Eating can be a significant challenge for cancer survivors; however, to date there is no systematic way of assessing and addressing food related quality of life in this group. The purpose of our study was to develop a framework for doing so. Methods Over the course of 6 years in participant-led food workshops, we worked alongside 25 head and neck cancer (HNC) survivors and their partners, employing video-reflexive ethnographic (VRE) methods. The current study reports on data from the two summative workshops of this series where we worked with participants to cohere the emergent themes. Video and transcripts were reviewed and coded with participants and stakeholders according to domains of life that were affected by food. Three of the authors, one of whom is both survivor and researcher, arrived at the consensus framework. Results Seven areas of life were identified as affecting, or being affected by, altered eating. Three were physiological: anatomical, functional and sensory. Two captured the cognitive and behavioural labour of eating. Social life and identity were altered. The foregoing had an enduring emotional impact. Conclusions Altered eating has physical, emotional and social consequences. The altered eating framework provides a systematic way of exploring those consequences with individual survivors. This framework has the potential to improve both the assessment and treatment of altered eating, to benefit food-related quality of life.
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Affiliation(s)
- D L Burges Watson
- 1Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - S Lewis
- 2Department of Geography, Durham University, Durham, UK
| | | | - J Patterson
- 4City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - C Kelly
- 5Freeman Hospital Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - M J Murtagh
- 7Newcastle University, Newcastle Upon Tyne, UK
| | - V Deary
- 8School of Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
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