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Carstensen K, Goldman J, Kjeldsen AM, Lou S, Nielsen CP. Engaging health care professionals in quality improvement: A qualitative study exploring the synergies between projects of professionalisation and institutionalisation in quality improvement collaborative implementation in Denmark. J Health Serv Res Policy 2024; 29:163-172. [PMID: 38308439 PMCID: PMC11151708 DOI: 10.1177/13558196241231169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To examine the projects of professionalisation and institutionalisation forming health care professions' engagement in quality improvement collaborative (QIC) implementation in Denmark, and to analyse the synergies and tensions between the two projects given the opportunities afforded by the QICs. METHODS This was a cross-sectional interview study with professionals involved in the implementation of two national QICs in Denmark involving 23 individual interviews and focus group discussions with 75 people representing different professional groups. We conducted a reflexive thematic analysis of the data, drawing on institutional contributions to organisational studies of professions. RESULTS Study participants engaged widely in QIC implementation. This engagement was formed by a constructive interplay between the professions' projects of professionalisation and institutionalisation, with only few tensions identified. The project of professionalisation relates to a self-oriented agenda of contributing professional expertise and promoting professional recognition and development, while the project of institutionalisation focuses on improving health care processes and outcomes and advancing quality improvement. Both projects were largely similar across professional groups. The interplay between the two projects was enabled by the bottom-up approach to implementation, participation of QI specialists, and a clear focus on developing and delivering high-quality patient care. CONCLUSIONS Future strategies for QIC implementation should position QICs as a framework that promotes the integration of professions' projects of professionalisation and institutionalisation to successfully engage professionals in the implementation process, and thereby optimise the effectiveness of QICs in health care.
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Affiliation(s)
- Kathrine Carstensen
- PhD Student, DEFACTUM, Public Health Research, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Joanne Goldman
- Assistant Professor, Centre for Quality Improvement and Patient Safety and Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne Mette Kjeldsen
- Associate Professor, Department of Political Science, Aarhus University, Aarhus, Denmark
| | - Stina Lou
- Senior Researcher and Associate Professor, DEFACTUM, Public Health Research, Central Denmark Region, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- Research Director and Associate Professor, DEFACTUM, Public Health Research, Central Denmark Region and Department of Public Health, Aarhus University, Aarhus, Denmark
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Murphy C, French H, McCarthy G, Cunningham C. 'Look up from the waiting list and see the bigger picture': a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland. Physiotherapy 2024; 123:133-141. [PMID: 38479069 DOI: 10.1016/j.physio.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/13/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Healthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective orthopaedic/ rheumatology consultant clinics. Specialist physiotherapists have expertise to inform health service improvement and reform, but their perspectives of LBP healthcare delivery have received scant attention. OBJECTIVES To explore specialist physiotherapists' perspectives on LBP care in Ireland, the barriers and facilitators to quality LBP care and the development of MSK interface services in primary care settings. DESIGN Cross-sectional observational study using an anonymous electronic survey with thematic framework analysis of response data from open-ended questions. PARTICIPANTS Thirty-four clinical specialist physiotherapists in Irish MSK triage services. RESULTS Thematic analysis resulted in six overarching themes, grouped into two categories. One category pertained to LBP healthcare in Ireland with the following three themes: 1) Inadequate health services for patients with LBP; 2) Need for defined LBP clinical pathways; 3) Need for a multisectoral approach to spine health. Themes in the second category, pertaining to the development of community-based MSK interface services, were: 4) Concern regarding isolation from secondary care services; 5) Unrealistic expectations of MSK triage; 6) Improved communication and collaboration with primary care services. CONCLUSION Specialist physiotherapists have concerns regarding LBP health services and persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care multi-disciplinary teams, enhanced integration across primary and secondary care, development of a national clinical pathway and a multisectoral approach. CONTRIBUTION OF PAPER.
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Affiliation(s)
- Cathriona Murphy
- Physiotherapy Department, University Hospital Kerry, Tralee, Co. Kerry, Ireland.
| | - Helen French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Geraldine McCarthy
- School of Medicine, University College Dublin, Ireland; Department of Rheumatology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
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Birkeli GH, Ballangrud R, Jacobsen HK, Tveter Deilkas EC, Lindahl AK. Green Cross method in a postanaesthesia care unit: a qualitative study of the healthcare professionals' experiences after 3 years, including the COVID-19 pandemic period. BMJ Open Qual 2023; 12:bmjoq-2022-002247. [PMID: 37225257 DOI: 10.1136/bmjoq-2022-002247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/08/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES Unsafe medical care causes morbidity and mortality among the hospital patients. In a postanaesthesia care unit (PACU), increasing patient safety is a joint effort between different professions. The Green Cross (GC) method is a user-friendly incident reporting method that incorporates daily safety briefings to support healthcare professionals in their daily patient safety work. Thus, this study aimed to describe healthcare professionals' experiences with the GC method in a PACU setting 3 years after its implementation, including the period of the coronavirus disease 2019 pandemic's three waves. DESIGN An inductive, descriptive qualitative study was conducted. The data were analysed using qualitative content analysis. SETTING The study was conducted at a PACU of a university hospital in South-Eastern Norway. PARTICIPANTS Five semistructured focus group interviews were conducted in March and April 2022. The informants (n=23) were PACU nurses (n=18) and collaborative healthcare professionals (n=5) including physicians, nurses and a pharmacist. RESULTS The theme 'still active, but in need of revitalisation' was created, describing the healthcare professionals' experiences with the GC method, 3 years post implementation. The following five categories were found: 'continuing to facilitate open communication', 'expressing a desire for more interprofessional collaboration regarding improvements', 'increasing reluctance to report', 'downscaling due to the pandemic' and 'expressing a desire to share more of what went well'. CONCLUSIONS This study offers information regarding the healthcare professionals' experiences with the GC method in a PACU setting; further, it deepens the understanding of the daily patient safety work using this incident reporting method.
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Affiliation(s)
- Gørill Helen Birkeli
- Institute of Health and Society, Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Surgery, Akershus University Hospital, Lorenskog, Norway
| | - Randi Ballangrud
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Hilde Kristin Jacobsen
- Institute of Basic Medical Sciences, Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Catharina Tveter Deilkas
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Department of Quality Improvement and Patient Safety, Norwegian Directorate of Health, Oslo, Norway
| | - Anne Karin Lindahl
- Institute of Health and Society, Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Surgery, Akershus University Hospital, Lorenskog, Norway
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Wolfstadt JI, Cohen-Rosenblum A. 'You can't do quality between surgical cases and tea time': barriers to surgeon engagement in quality improvement. BMJ Qual Saf 2023; 32:10-12. [PMID: 36549699 DOI: 10.1136/bmjqs-2022-015083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Jesse Isaac Wolfstadt
- Surgery, Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada .,Division of Orthopaedics, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
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McDermott J. Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement. AACN Adv Crit Care 2022; 33:376-381. [PMID: 36477838 DOI: 10.4037/aacnacc2022419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jaime McDermott
- Jaime McDermott is an Advanced Practice Provider, Division of Cardiology, Duke University Hospital, 2301 Erwin Rd, Box 3677, Durham, NC 27710
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Marks BE, Mungmode A, Neyman A, Levin L, Rioles N, Eng D, Lee JM, Basina M, Hawah-Jones N, Mann E, O’Malley G, Wilkes M, Steenkamp D, Aleppo G, Accacha S, Ebekozien O. Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2022; 41:35-44. [PMID: 36714248 PMCID: PMC9845085 DOI: 10.2337/cd22-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes.
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Affiliation(s)
- Brynn E. Marks
- Children’s National Hospital, Washington, DC
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Corresponding author: Brynn E. Marks,
| | | | - Anna Neyman
- Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Laura Levin
- Ann and Robert H. Lurie Children Hospital, Chicago, IL
| | | | - Donna Eng
- Helen DeVos Children’s Hospital, Grand Rapids, MI
| | - Joyce M. Lee
- C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | | | | | - Elizabeth Mann
- UW Health Kids, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Antonio MG, Davis S, Smith M, Burgener P, Price M, Lavallee DC, Fletcher S, Lau F. Advancing digital patient-centered measurement methods for team-based care. Digit Health 2022; 8:20552076221145420. [PMID: 36601284 PMCID: PMC9806437 DOI: 10.1177/20552076221145420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 11/21/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives To conceptualize new methods for integrating patient-centered measurement into team-based care. Methods A standalone portal was introduced into a rural clinic to support conceptualization of new methods for integration of patient-centered measurement in team-based care. The portal housed mental health-related online resources, three patient-reported measures and a self-action plan. Six providers and four patients used the portal for four months. Our data collection techniques included clinic discussions, one-on-one interviews, workflow diagrams and data generated through the portal. Analysis was supported through coding interview transcripts, looking across multiple sources of research data and research team discussions. Results Our research team conceptualized five team-based patient-centered measurement methods through this study. Patient-centered measurement Team Mapping offfers a technique to provide greater clarity of care-team roles and responsibilities in data collected through patient-centered measurement. Longitudinal Care Alignment can guide the care-team on incorporating patient-centered measurement into ongoing provider-patient interactions. Digital Tool Exploration can be used to evaluate a team's readiness toward digital tool adoption, and the impact of these tools. Team-based quality improvement serves as a framework for engaging teams in patient-centered quality improvement. Shared learning is a method that promotes patientprovider interactions that validate patient's perspectives of their care. Conclusion The portal illuminated new methods for the integration of patient-centered measurement in team-based care. The first three proposed patient-centered measurement methods provides ways to assess how a clinic can incorporate patient-centered measurement methods into team-based care. The latter two methods focus on the aim of patient-generated data in which patient's values and perspectives are represented and quality of patient-centered care can be evaluated. Further testing is needed to assess the utility of these patient-centered measurement methods across different clinical settings and domains.
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Affiliation(s)
- Marcy G Antonio
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Selena Davis
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Mindy Smith
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Patient Advisory Committee of the Kootenay-Boundary Collaborative
Services Committee, Cranbrook, Canada
| | | | - Morgan Price
- Department of Family Practice, Innovation and Support Unit, Faculty
of Medicine, University of British
Columbia, Vancouver, Canada
| | - Danielle C Lavallee
- BC SUPPORT Unit, Michael Smith Health Research BC, Vancouver,
Canada
- School of Population and Public Health, University of British
Columbia, Vancouver, Canada
| | - Sarah Fletcher
- Department of Family Practice, Innovation and Support Unit, Faculty
of Medicine, University of British
Columbia, Vancouver, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, Canada
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McCarthy SE, Jabakhanji SB, Martin J, Flynn MA, Sørensen J. Reporting standards, outcomes and costs of quality improvement studies in Ireland: a scoping review. BMJ Open Qual 2021; 10:bmjoq-2020-001319. [PMID: 34341016 PMCID: PMC8330587 DOI: 10.1136/bmjoq-2020-001319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To profile the aims and characteristics of quality improvement (QI) initiatives conducted in Ireland, to review the quality of their reporting and to assess outcomes and costs. DESIGN Scoping review. DATA SOURCES Systematic searches were conducted in PubMed, Web of Science, Embase, Google Scholar, Lenus and rian.ie. Two researchers independently screened abstracts (n=379) and separately reviewed 43 studies identified for inclusion using a 70-item critique tool. The tool was based on the Quality Improvement Minimum Quality Criteria Set (QI-MQCS), an appraisal instrument for QI intervention publications, and health economics reporting criteria. After reaching consensus, the final dataset was analysed using descriptive statistics. To support interpretations, findings were presented at a national stakeholder workshop. ELIGIBILITY CRITERIA QI studies implemented and evaluated in Ireland and published between January 2015 and April 2020. RESULTS The 43 studies represented various QI interventions. Most studies were peer-reviewed publications (n=37), conducted in hospitals (n=38). Studies mainly aimed to improve the 'effectiveness' (65%), 'efficiency' (53%), 'timeliness' (47%) and 'safety' (44%) of care. Fewer aimed to improve 'patient-centredness' (30%), 'value for money' (23%) or 'staff well-being' (9%). No study aimed to increase 'equity'. Seventy per cent of studies described 14 of 16 QI-MQCS dimensions. Least often studies reported the 'penetration/reach' of an initiative and only 35% reported health outcomes. While 53% of studies expressed awareness of costs, only eight provided at least one quantifiable figure for costs or savings. No studies assessed the cost-effectiveness of the QI. CONCLUSION Irish QI studies included in our review demonstrate varied aims and high reporting standards. Strategies are needed to support greater stimulation and dissemination of QI beyond the hospital sector and awareness of equity issues as QI work. Systematic measurement and reporting of costs and outcomes can be facilitated by integrating principles of health economics in QI education and guidelines.
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Affiliation(s)
- Siobhán Eithne McCarthy
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Samira Barbara Jabakhanji
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer Martin
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland
| | - Maureen Alice Flynn
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland
| | - Jan Sørensen
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Harrison R, Fischer S, Walpola RL, Chauhan A, Babalola T, Mears S, Le-Dao H. Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. J Healthc Leadersh 2021; 13:85-108. [PMID: 33737854 PMCID: PMC7966357 DOI: 10.2147/jhl.s289176] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing prioritisation of healthcare quality across the six domains of efficiency, safety, patient-centredness, effectiveness, timeliness and accessibility has given rise to accelerated change both in the uptake of initiatives and the realisation of their outcomes to meet external targets. Whilst a multitude of change management methodologies exist, their application in complex healthcare contexts remains unclear. Our review sought to establish the methodologies applied, and the nature and effectiveness of their application in the context of healthcare. METHODS A systematic review and narrative synthesis was undertaken. Two reviewers independently screened the titles and abstracts followed by the full-text articles that were potentially relevant against the inclusion criteria. An appraisal of methodological and reporting quality of the included studies was also conducted by two further reviewers. RESULTS Thirty-eight studies were included that reported the use of 12 change management methodologies in healthcare contexts across 10 countries. The most commonly applied methodologies were Kotter's Model (19 studies) and Lewin's Model (11 studies). Change management methodologies were applied in projects at local ward or unit level (14), institutional level (12) and system or multi-system (6) levels. The remainder of the studies provided commentary on the success of change efforts that had not utilised a change methodology with reference to change management approaches. CONCLUSION Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts. The lack of prescription application of the change management methodologies was identified. Change management methodologies were valued for providing guiding principles for change that are well suited to enable methodologies to be applied in the context of complex and unique healthcare contexts, and to be used in synergy with implementation and improvement methodologies.
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Affiliation(s)
- Reema Harrison
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Fischer
- Clinical Excellence Commission, New South Wales Health, Sydney, NSW, Australia
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ramesh L Walpola
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Ashfaq Chauhan
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Temitope Babalola
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, NSW, Australia
| | - Huong Le-Dao
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Kieran K. EDITORIAL COMMENT. Urology 2020; 145:88-89. [DOI: 10.1016/j.urology.2020.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
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