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Subramanian L, Elam M, Healey AJ, Paquette E, Henrich N. Context Matters-But What Aspects? The Need for Evidence on Essential Aspects of Context to Better Inform Implementation of Quality Improvement Initiatives. Jt Comm J Qual Patient Saf 2021; 47:748-752. [PMID: 34493446 DOI: 10.1016/j.jcjq.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
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Rogers L, De Brún A, McAuliffe E. Defining and assessing context in healthcare implementation studies: a systematic review. BMC Health Serv Res 2020; 20:591. [PMID: 32600396 PMCID: PMC7322847 DOI: 10.1186/s12913-020-05212-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The implementation of evidence-based healthcare interventions is challenging, with a 17-year gap identified between the generation of evidence and its implementation in routine practice. Although contextual factors such as culture and leadership are strong influences for successful implementation, context remains poorly understood, with a lack of consensus regarding how it should be defined and captured within research. This study addresses this issue by providing insight into how context is defined and assessed within healthcare implementation science literature and develops a definition to enable effective measurement of context. METHODS Medline, PsychInfo, CINAHL and EMBASE were searched. Articles were included if studies were empirical and evaluated context during the implementation of a healthcare initiative. These English language articles were published in the previous 10 years and included a definition and assessment of context. Results were synthesised using a narrative approach. RESULTS Three thousand and twenty-one search records were obtained of which 64 met the eligibility criteria and were included in the review. Studies used a variety of definitions in terms of the level of detail and explanation provided. Some listed contextual factors (n = 19) while others documented sub-elements of a framework that included context (n = 19). The remaining studies provide a rich definition of general context (n = 11) or aspects of context (n = 15). The Alberta Context Tool was the most frequently used quantitative measure (n = 4), while qualitative papers used a range of frameworks to evaluate context. Mixed methods studies used diverse approaches; some used frameworks to inform the methods chosen while others used quantitative measures to inform qualitative data collection. Most studies (n = 50) applied the chosen measure to all aspects of study design with a majority analysing context at an individual level (n = 29). CONCLUSIONS This review highlighted inconsistencies in defining and measuring context which emphasised the need to develop an operational definition. By providing this consensus, improvements in implementation processes may result, as a common understanding will help researchers to appropriately account for context in research.
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Affiliation(s)
- L. Rogers
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
| | - A. De Brún
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
| | - E. McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
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Roussel S, Frenay M. Links Between Perceptions and Practices in Patient Education: A Systematic Review. HEALTH EDUCATION & BEHAVIOR 2019; 46:1001-1011. [PMID: 31426684 DOI: 10.1177/1090198119868273] [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] [Indexed: 11/16/2022]
Abstract
Background. Two decades after "patient education" was defined by the World Health Organization, its integration in health care practices remains a challenge. Perceptions might shed light on these implementation difficulties. This systematic review aims to investigate links between perceptions and patient education practices among health care professionals, paying particular attention to the quality of practices in order to highlight any associated perception. Method. PubMed, PsycINFO, and Scopus were searched using the following search terms: "perceptions," "patient education," "health care professionals," and "professional practices." PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used. Results. Twenty studies were included. Overall findings supported the existence of links between some perceptions and practices. Links were either correlational or "causal" (generally in a single direction: perceptions affecting practices). Four types of perceptions (perceptions of the task including patient education, perceptions about the patient, perceptions of oneself as a health care professional, and perceptions of the context) were identified as being linked with educational practices. Links can although be mediated by other factors. Results concerning links should, however, be considered with caution as practices were mostly assessed by prevalence measurements, were self-reported and concerned exclusively individual education. When analyzing the quality of practices, the two retained studies highlighted their changing nature and the central role of perceptions with respect to the individual patient. Conclusions. This literature review led us to specify the quality criteria for further research: covering the entire spectrum of patient education, operationalizing variables, exploring specific practices, measuring the quality of practices, developing designs that facilitate causation findings, and considering a bidirectional perspective.
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Affiliation(s)
| | - Mariane Frenay
- Université catholique de Louvain, Louvain-la-neuve, Belgium
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Leonardsen ACL, Del Busso L, Grøndahl VA, Ghanima W, Jelsness-Jørgensen LP. General practitioners' perspectives on referring patients to decentralized acute health care. Fam Pract 2016; 33:709-714. [PMID: 27543796 DOI: 10.1093/fampra/cmw087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Municipality acute wards (MAWs) have recently been introduced in Norway. Their mandate is to provide treatment for patients who otherwise would have been hospitalized. Even though GPs are key stakeholders, little is known about how they perceive referring patients to these wards. The aim of this study was to investigate GPs' perspectives on factors relevant for their decision-making when referring patients to MAWs. METHODS We used a qualitative approach, conducting semi-structured interviews with 23 GPs from five different MAW catchment areas in the southeastern part of Norway. The data were analysed using thematic analysis. RESULTS The GPs experienced challenges in deciding which patients were suitable for treatment at a MAW, including whether patients could be regarded as medically clarified, and whether these services were sufficient and safe. GPs were also under pressure from several other stakeholders when deciding where to refer their patients. Moreover, the MAWs were viewed not merely as an alternative to hospitals, but also as a service in addition to hospitals. CONCLUSION This study improves our understanding of how GPs experience decentralized acute health care services, by identifying factors that influence and challenge their referral decisions. For these services to be used as intended in the collaboration reform, integrating the perspectives of GPs in the development and implementation of these services may be beneficial.
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Affiliation(s)
| | - Lilliana Del Busso
- Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and
| | - Vigdis A Grøndahl
- Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and
| | - Waleed Ghanima
- Department of Research, Østfold Hospital Trust, Sarpsborg, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Research, Østfold Hospital Trust, Sarpsborg, Norway.,Faculty of Health and Social Studies, Østfold University College, Fredrikstad, Norway and
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Øvretveit J, Ramsay P, Shortell SM, Brommels M. Comparing and improving chronic illness primary care in Sweden and the USA. Int J Health Care Qual Assur 2016; 29:582-95. [PMID: 27256779 DOI: 10.1108/ijhcqa-02-2016-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - The purpose of this paper is to identify opportunities for improving primary care services for people with chronic illnesses by comparing how Sweden and US services use evidence-based practices (EBPs), including digital health technologies (DHTs). Design/methodology/approach - A national primary healthcare center (PHCC) heads surveys in 2012-2013 carried out in both countries in 2006. Findings - There are large variations between the two countries. The largest, regarding effective DHT use in primary care centers, were that few Swedish primary healthcare compared to US heads reported having reminders or prompts at the point of care (38 percent Sweden vs 84 percent USA), despite Sweden's established electronic medical records (EMR). Swedish heads also reported 30 percent fewer centers receiving laboratory results (67 percent Sweden vs 97 percent USA). Regarding following other EBPs, 70 percent of Swedish center heads reported their physicians had easy access to diabetic patient lists compared to 14 percent in the USA. Most Swedish PHCC heads (96 percent) said they offered same day appointment compared to 36 percent in equivalent US practices. Practical implications - There are opportunities for improvement based on significant differences in effective practices between the countries, which demonstrates to primary care leaders that their peers elsewhere potentially provide better care for people with chronic illnesses. Some improvements are under primary care center control and can be made quickly. There is evidence that people with chronic illnesses in these two countries are suffering unnecessarily owing to primary care staff failing to provide proven EBP, which would better meet patient needs. Public finance has been invested in DHT, which are not being used to their full potential. Originality/value - The study shows the gaps between current and potential proven effective EBPs for services to patients with chronic conditions. Findings suggest possible explanations for differences and practical improvements by comparing the two countries. Many enhancements are low cost and the proportionate reduction in suffering and costs they bring is high.
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Affiliation(s)
| | - Patricia Ramsay
- Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Stephen M Shortell
- Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, University of California Berkeley, Berkeley, California, USA
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Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Factors influencing the implementation of chronic care models: A systematic literature review. BMC FAMILY PRACTICE 2015; 16:102. [PMID: 26286614 PMCID: PMC4545323 DOI: 10.1186/s12875-015-0319-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/07/2015] [Indexed: 12/16/2022]
Abstract
Background The increasing prevalence of chronic disease faced by both developed and developing countries is of considerable concern to a number of international organisations. Many of the interventions to address this concern within primary healthcare settings are based on the chronic care model (CCM). The implementation of complex interventions such as CCMs requires careful consideration and planning. Success depends on a number of factors at the healthcare provider, team, organisation and system levels. Methods The aim of this systematic review was to systematically examine the scientific literature in order to understand the facilitators and barriers to implementing CCMs within a primary healthcare setting. This review focused on both quantitative and qualitative studies which included patients with chronic disease (cardiovascular disease, chronic kidney disease, chronic respiratory disease, type 2 diabetes mellitus, depression and HIV/AIDS) receiving care in primary healthcare settings, as well as primary healthcare providers such as doctors, nurses and administrators. Papers were limited to those published in English between 1998 and 2013. Results The search returned 3492 articles. The majority of these studies were subsequently excluded based on their title or abstract because they clearly did not meet the inclusion criteria for this review. A total of 226 full text articles were obtained and a further 188 were excluded as they did not meet the criteria. Thirty eight published peer-reviewed articles were ultimately included in this review. Five primary themes emerged. In addition to ensuring appropriate resources to support implementation and sustainability, the acceptability of the intervention for both patients and healthcare providers contributed to the success of the intervention. There was also a need to prepare healthcare providers for the implementation of a CCM, and to support patients as the way in which they receive care changes. Conclusion This systematic review demonstrated the importance of considering human factors including the influence that different stakeholders have on the success or otherwise of the implementing a CCM. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0319-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol Davy
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
| | - Jonathan Bleasel
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Hueiming Liu
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Maria Tchan
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Sharon Ponniah
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Alex Brown
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
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Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review. BMC Health Serv Res 2015; 15:194. [PMID: 25958128 PMCID: PMC4448852 DOI: 10.1186/s12913-015-0854-8] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background The increasing prevalence of chronic disease and even multiple chronic diseases faced by both developed and developing countries is of considerable concern. Many of the interventions to address this within primary healthcare settings are based on a chronic care model first developed by MacColl Institute for Healthcare Innovation at Group Health Cooperative. Methods This systematic literature review aimed to identify and synthesise international evidence on the effectiveness of elements that have been included in a chronic care model for improving healthcare practices and health outcomes within primary healthcare settings. The review broadens the work of other similar reviews by focusing on effectiveness of healthcare practice as well as health outcomes associated with implementing a chronic care model. In addition, relevant case series and case studies were also included. Results Of the 77 papers which met the inclusion criteria, all but two reported improvements to healthcare practice or health outcomes for people living with chronic disease. While the most commonly used elements of a chronic care model were self-management support and delivery system design, there were considerable variations between studies regarding what combination of elements were included as well as the way in which chronic care model elements were implemented. This meant that it was impossible to clearly identify any optimal combination of chronic care model elements that led to the reported improvements. Conclusions While the main argument for excluding papers reporting case studies and case series in systematic literature reviews is that they are not of sufficient quality or generalizability, we found that they provided a more detailed account of how various chronic care models were developed and implemented. In particular, these papers suggested that several factors including supporting reflective healthcare practice, sending clear messages about the importance of chronic disease care and ensuring that leaders support the implementation and sustainability of interventions may have been just as important as a chronic care model’s elements in contributing to the improvements in healthcare practice or health outcomes for people living with chronic disease. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0854-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol Davy
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
| | - Jonathan Bleasel
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Hueiming Liu
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Maria Tchan
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Sharon Ponniah
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Alex Brown
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
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Powell M, Dawson J, Topakas A, Durose J, Fewtrell C. Staff satisfaction and organisational performance: evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe search for causal links between human resource management (HRM) and organisational performance has dominated academic and practitioner debates for many years. However, much of this work comes from contexts outside health care and/or the UK.ObjectivesThis study tested the later stages of a well-established HRM model, testing whether or not there was evidence of causal links between staff experience and intermediate (staff) and final (patient and organisational) outcomes, and whether or not these differed in parts of the NHS. We used large-scale longitudinal secondary data sets in order to answer these questions in a thorough way.Data sourcesSearches were conducted using Health Management Information Consortium, MEDLINE, PsycINFO, Social Sciences Citation Index and EBSCOhost(from inception to May 2012).MethodsStaff experience data came from the national NHS staff surveys of 2009, 2010 and 2011, with trust-level measures of staff absenteeism, turnover, patient satisfaction, mortality and infection rates gathered from the same NHS years. Several analytical methods were used, including multilevel analysis, mediated regression, latent growth curve modelling and cross-lagged correlation analysis.ResultsIn general, the pattern was that better staff experiences are associated with better outcomes for employees and patients. Multilevel analysis found that the positive effects of staff perceiving equal opportunities on employee outcomes were especially strong, as were the negative effects of aggression and discrimination. Organisational-level analysis showed that better staff experiences (particularly those associated with better well-being and better job design, and more positive attitudes about the organisation generally) were linked to lower levels of absenteeism and greater patient satisfaction. There was some evidence that the relationship with absenteeism is causal, although the causal link with patient satisfaction was less clear-cut. Some relationships between staff experience and turnover, and some between staff experience and patient mortality, were also found (and a few with infection rates), with longitudinal analysis comparatively unclear about the direction of causality. Although many staff experiences were associated with absenteeism and patient satisfaction, these effects were not mediated and the reason staff experiences are linked to patient satisfaction appears to be separate from the link with absenteeism. In general, there is no single group of staff (or geographical region) for which staff experiences are the most important. However, nurses’ experiences generally had the strongest effects on absenteeism, followed by medical/dental staff. Few clear or explainable patterns for other staff group effects were found. Absenteeism was most readily predicted by staff experience in the West Midlands. Two Action Learning Sets of managers, and patient and public involvement representatives broadly supported the emerging findings of the factors that seemed to be important indicators of staff satisfaction and organisational outcomes.LimitationsThe relatively blunt nature of the data used meant that conclusions about the direction of causality were less clear. More specific limitations included that we had to limit outcome variables to those that were available already, that many variables were available for acute trusts, and that we could not break down data further within trusts or years.ConclusionsOverall, the research confirmed many expected links between staff experiences and outcomes, providing support for that part of the overall HRM model in the NHS. However, conclusions about the direction of causality were less clear (except for absenteeism). This is probably due in part to the relatively blunt nature of the data used. Future research may involve the careful evaluation of interventions designed to improve staff experience on more specific groups of staff, and the continued use of secondary data sources, such as those used in this report, to answer more specific, theoretically driven questions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Martin Powell
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jeremy Dawson
- Institute of Work Psychology, Sheffield University Management School, Sheffield, UK
| | - Anna Topakas
- Institute of Work Psychology, Sheffield University Management School, Sheffield, UK
| | - Joan Durose
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Chris Fewtrell
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Mc Hugh SM, O'Mullane M, Perry IJ, Bradley C. 'It sounds like a great idea but…': a qualitative study of GPs' attitudes towards the development of a national diabetes register. BMJ Qual Saf 2014; 23:910-7. [PMID: 25038038 DOI: 10.1136/bmjqs-2013-002626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the attitudes of general practitioners (GPs) to the development of a national diabetes register as a way of improving the quality of care. DESIGN Qualitative study using semistructured interviews. SETTING General practice, Ireland. PARTICIPANTS Purposive sample of 29 GPs and two practice nurses. Participants' practices varied by (a) location (rural/urban), (b) size (single-handed/group practice) and (c) extent of computerisation. METHODS The semistructured topic guide focused on experiences of change in the health system at a local and national level and attitudes towards the development of a national diabetes register. Analysis was conducted using the Framework approach. RESULTS Participants were sceptical about the development of a national diabetes register. The main advantage was 'knowing the numbers' for epidemiological and policy purposes. However, participants questioned the benefits for their practice and patients. There were concerns that it would drain resources from other priorities and distract from patient management. These attitudes were strongly influenced by previous experience of change in the health system. Participants felt that remuneration would be necessary to ensure full engagement, reflecting wider frustrations with payment structures for general practice. There was a sense of wariness towards health service administration which was not specific to diabetes care but which coloured some participants' attitudes towards a national register. In contrast, participants referred to positive experiences of change at a local level, facilitated by a 'practice ethos' and professional leadership. CONCLUSIONS This study highlights the growing sense of scepticism and inertia towards change within the health system. This inertia stems from previous experience and the competing demands of maintaining versus improving care in a system with dwindling resources.
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Affiliation(s)
- Sheena M Mc Hugh
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Monica O'Mullane
- Faculty of Health Care and Social Work, Department of Public Health, Trnava University, Trnava, Slovakia
| | - Ivan J Perry
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
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Lauvergeon S, Burnand B, Peytremann-Bridevaux I. [Implementation of a diabetes disease management program in Switzerland: patients' and healthcare professionals' point of view]. Rev Epidemiol Sante Publique 2013; 61:475-84. [PMID: 24035386 DOI: 10.1016/j.respe.2013.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 09/18/2012] [Accepted: 05/10/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND A reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the "Diabetes Cantonal Program", within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate. METHODS We organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis. RESULTS Patients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients' and professionals' needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem. CONCLUSION The identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.
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Affiliation(s)
- S Lauvergeon
- Institut universitaire de médecine sociale et préventive (IUMSP), centre hospitalier universitaire Vaudois et université de Lausanne, Biopôle 2, route de la Corniche 10, 1010 Lausanne, Suisse
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Vedel I, Ghadi V, De Stampa M, Routelous C, Bergman H, Ankri J, Lapointe L. Diffusion of a collaborative care model in primary care: a longitudinal qualitative study. BMC FAMILY PRACTICE 2013; 14:3. [PMID: 23289966 PMCID: PMC3558442 DOI: 10.1186/1471-2296-14-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process. METHODS We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. RESULTS Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices). Opinion leaders played a key role in the diffusion of the CTM among PCPs. CONCLUSION CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians.
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Affiliation(s)
- Isabelle Vedel
- Solidage, McGill University - Université de Montréal Research Group on Frailty and Aging - Lady Davis Institute, Jewish General Hospital, H466, 3755, Ch. Côte Ste Catherine, Montreal, Québec H3T 1E2, Canada
| | - Veronique Ghadi
- Santé Vieillissement research group, Versailles St Quentin University, 49 rue Mirabeau, Paris, 75016, France
| | - Matthieu De Stampa
- Santé Vieillissement research group, Versailles St Quentin University, 49 rue Mirabeau, Paris, 75016, France
| | - Christelle Routelous
- Management Institute, Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon-Bernard - CS 74312, Rennes cedex, 35043, France
| | - Howard Bergman
- Department of Family Medicine, McGill University, 515-517 av. des Pins Ouest, Montreal, Quebec, H2W 1S4, Canada
| | - Joel Ankri
- Santé Vieillissement research group, Versailles St Quentin University, 49 rue Mirabeau, Paris, 75016, France
| | - Liette Lapointe
- Desautels Faculty of Management, McGill University, 1001 Sherbrooke St. West, Montreal, Quebec, H3A 1G5, Canada
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Hartgerink JM, Cramm JM, Bakker TJEM, van Eijsden RAM, Mackenbach JP, Nieboer AP. The importance of relational coordination for integrated care delivery to older patients in the hospital. J Nurs Manag 2012; 22:248-56. [PMID: 24576117 DOI: 10.1111/j.1365-2834.2012.01481.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2012] [Indexed: 12/29/2022]
Abstract
AIM This study investigated relational coordination among professionals providing healthcare to hospitalized older patients and assessed its impact on integrated care delivery. BACKGROUND Previous studies have shown that relational coordination is positively associated with the delivery of acute, emergency and trauma care. The effect of relational coordination in integrated care delivery to hospitalized older patients remains unknown. METHODS This cross-sectional study was part of an examination of integrated care delivery to hospitalized older patients. Data were collected using questionnaires distributed to hospital professionals (192 respondents; 44% response rate). RESULTS After controlling for demographic variables, regression analyses showed that relational coordination was positively related to integrated care delivery (β = 0.20; P ≤ 0.05). Relational coordination was lower among professionals in the same discipline, and higher between nurses and others than between medical specialists and others. Relational coordination and integrated care delivery were significantly higher in geriatrics than in other units (both P ≤ 0.001). CONCLUSIONS The enhancement of relational coordination among healthcare professionals is positively associated with integrated care delivery to older patients. IMPLICATIONS FOR NURSING MANAGEMENT Relational coordination should be improved between medical specialists and others and higher levels of relational coordination and integrated care delivery should be achieved in all hospital units.
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Strating MMH, Broer T, van Rooijen S, Bal RA, Nieboer AP. Quality improvement in long-term mental health: results from four collaboratives. J Psychiatr Ment Health Nurs 2012; 19:379-88. [PMID: 22070667 DOI: 10.1111/j.1365-2850.2011.01802.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This multiple case study evaluates four quality improvement collaboratives (QICs) in long-term mental health care focusing on social psychiatric care, recovery oriented care, social participation and somatic co-morbidity of psychiatric patients. The aim is to explore (1) effectiveness in terms of objective outcome indicators and impact of changes as perceived by team members; and (2) associations between collaborative-, organizational- and team-level factors and perceived effectiveness. Most objective outcomes, such as health, loneliness and clients' problem areas, showed significant improvement. Because of the diversity in content no single measure for objective effectiveness could be computed across the four collaboratives. Perceived effectiveness of team members was used as an indicator of the overall impact. In all, 55 of the 94 participating team leaders and 117 remaining team members completed a written survey at the end of each quality improvement collaborative. Multilevel regression analyses indicated that innovation attributes, appropriate measures, usable data collection tools and an innovative team culture could explain variation in perceived effectiveness. In conclusion, overall positive changes for clients were realized as demonstrated by objective outcomes and team members' perceptions of improvements in care processes. The results supported the notion that a layered approach is necessary to achieve improvements in quality of care.
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Affiliation(s)
- M M H Strating
- Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.
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Strating MMH, Nieboer AP. Explaining variation in perceived team effectiveness: results from eleven quality improvement collaboratives. J Clin Nurs 2012; 22:1692-706. [PMID: 22612406 DOI: 10.1111/j.1365-2702.2012.04120.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. BACKGROUND Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. DESIGN A multiple-case cross-sectional study. METHODS Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. RESULTS Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual-level variance, 57·6% of the team-level variance and 80% of the collaborative-level variance could be explained. CONCLUSION The innovation's attributes, organisational support, an innovative team culture and professionals' commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. RELEVANCE TO CLINICAL PRACTICE Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve breakthrough improvement in care delivery to patients on a wide variety of quality problems.
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Affiliation(s)
- Mathilde M H Strating
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Abstract
Purpose: This article reports on the concept analysis of self-management support (SMS) to provide clarity for systematic implementation in practice. Background: SMS is a concept in its early phase of development. It is increasingly evident in literature on chronic illness care. However, the definition has been simplified or vague leading to variable SMS programs and inconsistent outcomes. Elucidation of SMS is necessary in chronic illness care to facilitate clear understanding and implementation. Method: Rodgers’ evolutionary concept analysis method was used to examine SMS. Data sources included systematic multidisciplinary searches of multiple search engines. Results: SMS refers to comprehensive sustaining approaches toward improving chronic illness outcomes consisting of patient-centered attributes (involving patients as partners; providing diverse, innovative educational modalities specific to patients’ needs; individualizing patient care), provider attributes (possessing adequate knowledge, skills, attitudes in providing care), and organizational attributes (putting an organized system of care in place, having multidisciplinary team approach, using tangible and social support). Implications: A well-clarified SMS concept is important in theory development. The attributes offer necessary components in SMS programs for systematic implementation, evaluation, and research. There is great potential that SMS can help improve outcomes of chronic illness care.
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Seruya FM, Hinojosa J. Professional and organizational commitment in paediatric occupational therapists: the influence of practice setting. Occup Ther Int 2010; 17:125-34. [PMID: 20806287 DOI: 10.1002/oti.293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The professional and organizational commitment of paediatric occupational therapists working in two distinct practice settings, schools and medically based settings, was investigated. A web-based survey program was used to administer a questionnaire to occupational therapists employed in New York, New Jersey and Connecticut. The study employed social identity theory as a guiding perspective in understanding therapists' professional and organizational commitment. One hundred and fifty-seven paediatric therapists responded to the Professional Commitment Questionnaire and the Organizational Commitment Questionnaire to gauge their commitment to both the profession and their employing organizations. Results indicated that paediatric therapists, regardless of employment setting, have high professional commitment. Paediatric occupational therapists employed in medically based settings indicated statistically significant higher organizational commitment than their school-based counterparts. For therapists that work in school settings, the presence of a professional cohort did not influence professional commitment scores. As the study employed a web-based survey methodology, only individuals who were members of associations and had access to a computer and the Internet were able to participate. Further study might include widening the participant pool as well as adding additional instruments to explore both professional and organizational commitment on a more national scale.
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