Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations: The ELIAS Performance Management Framework

[Application of scientific knowledge: knowledge translation in an institute of science and technology in public health]

Knowledge translation (KT) aims at the practical use of scientific research results and at the monitoring of the benefits caused to the population's health. In health, the government and especially society expect that investments in research will produce results that go beyond the production and publication of knowledge, provoking outcomes such as public policies, systems, products, and technologies to benefit the health of the population. However, closing the gaps between research and application requires overcoming a number of challenges. This study aimed to propose strategies to foster the process of transforming the scientific knowledge generated in research into actions and products that contribute to improving the population's health based on the identification of barriers and facilitating factors of a health science and technology institute. The reports of interviews conducted with 16 researchers showed 10 categories of barriers, especially: "limited funding to the science and technology institute" and "insufficient technical support for knowledge translation". "Infrastructure and institutional support" was the facilitating factor category participants mentioned the most. Finally, we developed the artifact "strategies and approaches for overcoming barriers to implement research results". Among the strategies, we suggest the inclusion of a knowledge translation discipline in stricto sensu graduate programs and the creation of an instance in the organizational structure of the science and technology institute to technically and managerially support the application of research results.

Validation of the Spanish Version of the Questionnaire on Environmental Awareness in Nursing (NEAT)

Environmental awareness of the ecological problems caused by this climate crisis and its impact on global health has been growing globally. Nurses are health care agents that usually hurt the environment and contribute to the unsustainability of the care system. Such behavior is perpetuated without the nurses’ awareness and is even magnified by the current pandemic, jeopardizing the health systems and the Sustainable Development Goals. However, there is no Spanish version of any survey that measures the awareness of these agents, only the Nurses Environmental Awareness Tool (NEAT) is available. The current research presents a unique investigation based on a mixed method, using the Spanish version of the NEAT, also called NEAT-es. The results of the mixed analysis (N = 376), a cognitive interview, and descriptive analysis indicated perfect consistency (Cronbach’s alpha > 0.80), better than the original. The survey validation achieved higher values and can be used to measure environmental awareness in Spain and Spanish-speaking countries.

The radical and requisite openness of viable systems: Implications for healthcare strategy and practice

This paper addresses an ontological question about the nature of health and challenges some underpinning assumptions in western healthcare. In its analysis, health in its various statuses, is framed as a naturally occurring complex adaptive system made up of dynamically interacting subsystems that include the physiological, psychological, and social realms. Furthermore, openness in complex systems such as health, is necessary for the exchange of energy, information, and resources. Yet, within healthcare much effort is invested in constraining systems' behaviours, whether they be systems of knowledge, health, healthcare, and more. This paper draws on the complexity sciences and Levinasian philosophy to explicate the essential role of system openness in individual, population, and systemic viability. It highlights holism to be "not whole-ism", and system openness to be, not just a reality, but a critical feature of viability. Hence requisite openness is advocated as essential to efficacious and ethical healthcare practice and strategy, and vital for health.

Applying Complexity Theory to a Hospital Complex Patient Care Program

Increasingly, complexity science concepts are informing health care design and practice. The present paper describes the implementation of early complexity science principles in a Complex Care Program with the aim of strengthening the provision of integrated care. Grounded in cybernetic network theory, Stafford Beers Viable Systems Model [1] provided the guiding principles for the programs redesign. The Viable Systems Model with its broadly applicable principles [1], is now the conceptual model of information management in the program. Beers framework has enabled a relatively small number of clinicians to coordinate care for a large cohort of patients with significant clinical complexity, and a multitude of providers, in the community setting.

Setting the standard for healthy eating: Continuous quality improvement for health promotion at Nova Scotia Health

Healthcare organizations engage in continuous quality improvement to improve performance and value-for-performance, but the pathway to change is often rooted in challenging the way things are "normally" done. In an effort to propel system-wide change to support healthy eating, Nova Scotia Health developed and implemented a healthy eating policy as a benchmark to create a food environment supportive of health. This article describes the healthy eating policy and its role as a benchmark in the quality improvement process. The policy, rooted in health promotion, sets a standard for healthy eating and applies to stakeholders both inside and outside of health. We explain how the policy offers nutrition but also cultural benchmarks around healthy eating, bringing practitioners throughout Nova Scotia Health together and sustaining collaborative efforts to improve upon the status quo.

The ELIAS framework: A prescription for innovation and change

Healthcare is a complex adaptive system with multiple stakeholders and dynamic environments. Therefore, healthcare organizations must continuously learn, innovate, adapt, and co-evolve to be successful. This article describes a systematic, comprehensive, and holistic performance management framework that healthcare managers can use to achieve these goals. The framework involves the ongoing assessment, modification, or replacement of current programs or services aimed at adapting successfully to achieve the organization's strategic objectives. This is engendered by the presence of a culture that is premised on continuous learning and innovation. The foundation of the framework is based on accountability, the organization's strategy, and its culture. This then acts as the basis for an ongoing process of measurement, disconfirmation, contextualization, implementation, and routinization that enhances learning, innovation, adaptation, and sustainability within the healthcare organization.

The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature

BACKGROUND

The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework.

METHODS

This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail.

RESULTS

The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated.

CONCLUSIONS

In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

Effective Project Management of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the Prostate (MADCaP)

Purpose

Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostate cancer in Africa, focusing on building strategic and operational capacity.

Methods

Applying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical center-specific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics.

Results

The PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local center project managers. A specific evaluation was conducted 1 year after study initiation to obtain enrollment data, evaluate individual quality control management plans, and undertake risk log assessments and follow-up. Pilot data obtained identified areas in which centers required mentoring, strengthening, and capacity development. Strategies were implemented to improve project goals and operational capacity through local problem solving, conducting quality control checks and following compliancy with study aims. Moving forward, centers will perform quarterly evaluations and initiate strengthening measures as required.

Conclusion

The PMT has fostered the development of both strategic and operational capacity across project centers. Investment in project management resources is essential to ensuring high-quality, impactful health research in low- and middle-income countries.

Leadership for Innovation in Healthcare: An Exploration

Although leadership has been studied extensively, most research has focused on the political and military spheres. More recent work has also examined the role of leadership in sectors such as manufacturing and technology, both areas where it is essential to encourage and nurture innovation. Yet, in the health sector, where innovation is now high on the policy agenda in many countries, there is a paucity of research on how leadership can foster a culture of innovation. In this perspective, written for those seeking to foster innovation in the health sector, we offer a narrative synthesis approach of eight theories and concepts that have been empirically shown to support innovation through all phases of the innovation process.

Designing a Performance Measurement System for Accountability, Quality Improvement, and Innovation

The purpose of this article is to detail a system for the design of performance measures that will be used to assess the achievement of a health care organization's strategic goals and its need for change. The article begins by emphasizing the importance of accountability and the need for the presence of a dynamic learning culture that is premised on a foundation of accountability, continuous improvement, learning, and innovation. This is followed by describing the importance of utilizing an interdisciplinary team with physician and patient involvement to guide the design and implementation of the performance measurement system. The goals of the system are then outlined and followed by a description of the process for the determination of the framework, scope, domains, measures, and reporting mechanisms for displaying the performance measures. Lastly, guidelines for the design of valid, reliable, and cost-effective performance measures are discussed with the aim of maximizing their utility by health care professionals, managers, and administrators.

Organizational Culture at a Tertiary Care Center in Saudi Arabia: A Mixed Approach Study

Objective

To explore the prevailing culture among leaders at the King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia, as well as to evaluate the impact of organizational culture from the perspective of employees.

Subjects and methods

Utilizing a convenient sampling method, data were collected at the KFMC, Saudi Arabia, using two research approaches (focus group and cross-sectional). A total of 446 employees participated in this questionnaire-based study, and all questionnaires were analyzed to obtain the final data.

Results

About 51% of the participants were males and 49% were non-Saudi nationals. On a scale of 5 points, the overall score of the KFMC culture assessment was 3.6 (72%). The strongest recognized factor was the enjoyment (3.9/5; 78%). On the other hand, the factor with the lowest score was innovation (3.3/5; 66%).

Conclusion

The culture within an organization is very important. Communicating organizational strategic plans of change to employees and assuring their acknowledgment of the vision can inspire the behavior and attitude of employees at the workplace. This study strikes a note of challenge in some dimensions and items. Top management leaders are recommended to adjust their leadership behavior to focus on these challenges.

Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare

BACKGROUND

Improvement initiatives offer a valuable mechanism for delivering and testing innovations in healthcare settings. Many of these initiatives deliver meaningful and necessary changes to patient care and outcomes. However, many improvement initiatives fail to sustain to a point where their full benefits can be realised. This has led many researchers and healthcare practitioners to develop frameworks, models and tools to support and monitor sustainability. This work aimed to identify what approaches are available to assess and influence sustainability in healthcare and to describe the different perspectives, applications and constructs within these approaches to guide their future use.

METHODS

A systematic review was carried out following PRISMA guidelines to identify publications that reported approaches to support or influence sustainability in healthcare. Eligibility criteria were defined through an iterative process in which two reviewers independently assessed 20% of articles to test the objectivity of the selection criteria. Data were extracted from the identified articles, and a template analysis was undertaken to identify and assess the sustainability constructs within each reported approach.

RESULTS

The search strategy identified 1748 publications with 227 articles retrieved in full text for full documentary analysis. In total, 62 publications identifying a sustainability approach were included in this review (32 frameworks, 16 models, 8 tools, 4 strategies, 1 checklist and 1 process). Constructs across approaches were compared and 40 individual constructs for sustainability were found. Comparison across approaches demonstrated consistent constructs were seen regardless of proposed interventions, setting or level of application with 6 constructs included in 75% of the approaches. Although similarities were found, no approaches contained the same combination of the constructs nor did any single approach capture all identified constructs. From these results, a consolidated framework for sustainability constructs in healthcare was developed.

CONCLUSIONS

Choosing a sustainability method can pose a challenge because of the diverse approaches reported in the literature. This review provides a valuable resource to researchers, healthcare professionals and improvement practitioners by providing a summary of available sustainability approaches and their characteristics.

TRIAL REGISTRATION

This review was registered on the PROSPERO database: CRD42016040081 in June 2016.

A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury

Exposure to nephrotoxic medication is among the most common causes of acute kidney injury (AKI) in hospitalized patients. Here we conducted a prospective quality improvement project implementing a systematic Electronic Health Record screening and decision support process (trigger) in our quaternary pediatric inpatient hospital. Eligible patients were noncritically ill hospitalized children receiving an intravenous aminoglycoside for more than 3 days or more than 3 nephrotoxins simultaneously (exposure) from September 2011 through March 2015. Pharmacists recommended daily serum creatinine monitoring in exposed patients after appearance on the trigger report and AKI was defined by the Kidney Disease Improving Global Outcomes AKI criteria. A total of 1749 patients accounted for 2358 separate hospital admissions during which a total of 3243 episodes of nephrotoxin exposure were identified with 170 patients (9.7%) experiencing 2 or more exposures. A total of 575 individual AKI episodes occurred over the 43-month study period. Overall, the exposure rate decreased by 38% (11.63-7.24 exposures/1000 patient days), and the AKI rate decreased by 64% (2.96-1.06 episodes/1000 patient days). Assuming initial baseline exposure rates would have persisted without our project implementation, we estimate 633 exposures and 398 AKI episodes were avoided. Thus, systematic surveillance for nephrotoxic medication exposure and near real-time AKI risk can lead to sustained reductions in avoidable harm. These interventions and outcomes are translatable to other pediatric and nonpediatric hospitalized settings.