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Waraksa-Deutsch TL. Leading medical laboratory professionals toward change readiness: a correlational study. Lab Med 2024; 55:255-266. [PMID: 37788447 PMCID: PMC11064098 DOI: 10.1093/labmed/lmad091] [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] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND To remain effective in the dynamic health care landscape, the laboratory must embrace the continuous improvement mindset to support a culture of change, and leadership must facilitate the change process, mitigating perceived barriers of change readiness in followers. METHODS This quantitative study was designed to determine whether there is an association between leadership style (Multifactor Leadership Questionnaire [MLQ]) and change readiness (3-component model [TCM] commitment to change/Employee Commitment Survey, and whether leadership style predicts change readiness. Laboratory professionals (n = 718) were recruited through national societies to complete a combined MLQ-TCM survey instrument. Multivariate analysis of variance, Pearson correlations, and multiple regression analyses were performed. RESULTS A significant correlation between leadership style and change readiness (transformational leadership [TL] and affective commitment to change, r(716) = .12, P = .002; passive-avoidant behavior and continuance commitment to change, r(716) = .25, P < .001) and between leadership style and leadership outcomes (TL and effectiveness, r(716) = .90, P < .001) was identified. Transformational leadership was a significant predictor of change readiness (β = .17, P < .05). CONCLUSION It is recommended that laboratory leaders use transformational leadership or situational leadership to improve followers' affective commitment to change and reduce followers' continuance commitment to change, thus improving commitment to continuous improvement. Leaders should also limit passive-avoidant behavior.
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Affiliation(s)
- Taryn L Waraksa-Deutsch
- Division of Cytopathology, Fox Chase Cancer Center, Philadelphia, PA, US
- Department of Health Science, Bay Path University, Longmeadow, MA, US
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Kenis I, Kinnaer LM, Delombaerde C, Van Rompay V, Van Vlierberghe M, Foulon V, Van Hecke A. A self-directed co-creation process for developing a care pathway for patients on oral anticancer therapy: A qualitative process evaluation. Eur J Oncol Nurs 2023; 65:102353. [PMID: 37321129 DOI: 10.1016/j.ejon.2023.102353] [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: 02/22/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To provide in-depth insight in stakeholders' experiences with the self-directed co-creation of a care pathway for patients treated with oral anticancer drugs, and to identify influencing factors for the success of the co-creation process that are persistent throughout the prior pilot phase and the scale-up phase. METHODS This qualitative process evaluation was performed in 11 Belgian oncology departments participating in a scale-up project. Semi-structured interviews with local coordinators (n = 13) and members of the project teams (n = 19), responsible for the co-creation of the care pathway, were conducted. Data were thematically analyzed. RESULTS Despite the external support (including group-level coaching and the use of well-defined supportive tools) to promote self-directedness, the co-creation process was perceived burdensome. Three influencing factors were persistent throughout the pilot and scale-up phase: a) shared leadership among the coordinator, physician and hospital management, b) an intrinsically motivated team driven by additional extrinsic factors, and c) a balance between external support and self-directedness. CONCLUSION This study shows that the self-directed co-creation of a care pathway is feasible on the condition that important prerequisites are met, including shared leadership and team motivation. More concrete tools, such as a model care pathway, seem needed to increase feasibility of the self-directed co-creation of the care pathway. Yet, these tools should allow tailoring to the specific hospital context. The findings of this study can be useful for further scale-up to other oncology centers, but can also be extrapolated to other healthcare settings.
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Affiliation(s)
- Ilyse Kenis
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium; Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | | | | | | | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium
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Marco-Franco JE, Reis-Santos M, Barrachina-Martinez I, Jurewicz A, Camaño-Puig R. Telenursing: The view of care professionals in selected EU countries. A pilot study. Heliyon 2023; 9:e16760. [PMID: 37313150 PMCID: PMC10258424 DOI: 10.1016/j.heliyon.2023.e16760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/15/2023] Open
Abstract
Background With the growth of digital nursing, several studies have focused on recording patients' views on remote care, or specialised nurse staffing aspects. This is the first international survey on telenursing focused exclusively on clinical nurses that analyses the dimensions of usefulness, acceptability, and appropriateness of telenursing from the staff point of view. Methods A previously validated structured questionnaire including demographic variables, 18 responses with a Likert-5 scale, three dichotomous questions, and one overall percentual estimation of holistic nursing care susceptible to being undertaken by telenursing, was administered (from 1 September to 30 November 2022) to 225 clinical and community nurses from three selected EU countries. Data analysis: descriptive data, classical and Rasch testing. Results The results show adequacy of the model for measurement of the domains of usefulness, acceptability, and appropriateness of telenursing (overall Cronbach's alpha 0.945, Kaiser-Meyer-Olkin 0.952 and Bartlett's p < 0.001). Answers in favour of telenursing ranked 4 out of 5 in Likert scale, both globally and by the three domains. Rasch: reliability coefficient 0.94, Warm's main weighted likelihood estimate reliability 0.95. In the ANOVA analysis, the results for Portugal were significantly higher than those for Spain and Poland, both overall and for each of the dimensions. Respondents with bachelor's, master's and doctoral degrees score significantly higher than those with certificates or diplomas. Multiple regression did not yield additional data of interest. Conclusions The tested model proved to be valid, but although the majority of nurses are in favour of telenursing, given the nature of the care, which is mainly face-to-face, according to the respondents, the chances of carrying out their activities by telenursing is only 35.3%. The survey provides useful information on what can be expected from the implementation of telenursing and the questionnaire proves to be a useful tool to be applied in other countries.
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Affiliation(s)
- Julio Emilio Marco-Franco
- Faculty of Nursing and Podiatry, Valencia University, Spain
- Centre of Economic Engineering (INECO), Unit of Investigation in Economy and Healthcare Management (CIEGS), Department of Economy and Social Sciences, Faculty of Business Administration and Management, Polytechnic University of Valencia, Spain
| | - Margarida Reis-Santos
- Center for Health Technology and Services Research, Higher School of Nursing Porto, Portugal
- Abel Salazar Biomedical Sciences Institute - University of Porto, Portugal
| | - Isabel Barrachina-Martinez
- Centre of Economic Engineering (INECO), Unit of Investigation in Economy and Healthcare Management (CIEGS), Department of Economy and Social Sciences, Faculty of Business Administration and Management, Polytechnic University of Valencia, Spain
| | - Alina Jurewicz
- Department of Specialized Nursing, Faculty of Health Sciences, Pomeranian Medical University of Szczecin, Poland
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Leadership program with skills training for general practitioners was highly accepted without improving job satisfaction: the cluster randomized IMPROVEjob study. Sci Rep 2022; 12:17869. [PMID: 36284216 PMCID: PMC9595077 DOI: 10.1038/s41598-022-22357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/13/2022] [Indexed: 01/20/2023] Open
Abstract
Leadership has become an increasingly important issue in medicine as leadership skills, job satisfaction and patient outcomes correlate positively. Various leadership training and physician psychological well-being programmes have been developed internationally, yet no standard is established in primary care. The IMPROVEjob leadership program was developed to improve job satisfaction among German general practitioners and practice personnel. Its acceptance and effectiveness were evaluated. The IMPROVEjob intervention is a participatory, interdisciplinary and multimodal leadership intervention that targets leadership, workflows and communication in general practices using three elements: (1) two leadership workshops with skills training; (2) a toolbox with printed and online material, and (3) a 9-month implementation phase supported by facilitators. A cluster-randomised trial with a waiting-list control evaluated the effectiveness on the primary outcome job satisfaction assessed by the Copenhagen Psychosocial Questionnaire (range 0-100). A mixed-methods approach with questionnaires and participant interviews evaluated the acceptance of the intervention and factors influencing the implementation of intervention content. Statistical analyses respected the clustered data structure. The COVID-19 pandemic necessitated intervention adjustments: online instead of on-site workshops, online material instead of facilitator practice visits. Overall, 52 of 60 practices completed the study, with altogether 70 practice leaders, 16 employed physicians, and 182 practice assistants. According to an intention-to-treat analysis, job satisfaction decreased between baseline and follow-up (not significantly) in the total study population and in both study arms, while the subgroup of practice leaders showed a non-significant increase. A mixed multilevel regression model showed no effect of the intervention on job satisfaction (b = - 0.36, p > 0.86), which was influenced significantly by a greater sense of community (b = 0.14, p < 0.05). The acceptance of the IMPROVEjob workshops was high, especially among practice leaders compared to assistants (1 = best to 5 = worst): skills training 1.78 vs. 2.46, discussions within the practice team 1.87 vs. 2.28, group discussions 1.96 vs. 2.21. The process evaluation revealed that the COVID-19 pandemic complicated change processes and delayed the implementation of intervention content in practice routines. The workshops within the participatory IMPROVEjob intervention were rated very positively but the multimodal intervention did not improve job satisfaction 9 months into the pandemic. Qualitative data showed an impairment of implementation processes by the unforeseeable COVID pandemic.Trial registration Registration number: DRKS00012677 on 16/10/2019.
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Kenis I, Theys S, Hermie E, Foulon V, Van Hecke A. Impact of COVID-19 on the Organization of Cancer Care in Belgium: Lessons Learned for the (Post-)Pandemic Future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12456. [PMID: 36231756 PMCID: PMC9566094 DOI: 10.3390/ijerph191912456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has posed tremendous challenges to healthcare systems. Care for oncology patients, a vulnerable population during the pandemic, was disrupted and drastically changed. A multicenter qualitative study was conducted in 11 Belgian hospitals with the aim to provide an overview of the most important changes that were made in the care of oncology patients in Belgium. In each hospital, a nurse or physician was interviewed by telephone. Two rounds of structured interviews-during the first and second waves of the pandemic-were conducted. The data were analyzed using content analysis. The impact of COVID-19 on care practices for patients with cancer was enormous during the first wave. Major changes, including good but also less patient-centered practices, were implemented with unprecedented speed. After the initial wave, regular care was resumed and only limited new care practices were maintained. In only a few hospitals, healthcare teams reflected on lessons learned and on the maintenance of good practices that came from the COVID-19 experience. As a result, opportunities for healthcare innovation and quality improvement seemed to be missed. Our recommendations aim to support policymakers, hospital managers, and healthcare professionals to learn from the COVID-19 pandemic and to drive patient-centered initiatives in future cancer care.
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Affiliation(s)
- Ilyse Kenis
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Sofie Theys
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Ella Hermie
- Science in Nursing and Midwifery, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
- Nursing Department, Ghent University Hospital, 9000 Ghent, Belgium
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Validation of a New Telenursing Questionnaire: Testing the Test. MATHEMATICS 2022. [DOI: 10.3390/math10142463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Existing surveys on telenursing refer to specific areas of nursing after the implementation of a programme, but telenursing in general has not been fully evaluated from a prospective approach. Aim: Design and statistical validation of a telenursing questionnaire. Methods: A new questionnaire was designed with 18 paired (to avoid leading) questions (Likert-5) plus three dichotomous questions (randomly ordered, inspired by existing validated tests) to analyse the dimensions of: acceptance, usefulness and appropriateness of telenursing from the nursing point of view (7 min test). The questionnaire was validated by classical tests and item response tests (Rasch) using six computer-generated databases with different response profiles (tendency to be positioned against, neutral and positioned in favour) with two degrees of agreement between each pair of responses for each option. Results: Classical testing: Cronbach’s alphas (from 0.8 to 0.95), Kaiser–Meyer–Olkin (KMO) (0.93 to 0.95) and a significant p < 0.0001 for Bartlett’s test of sphericity were obtained. Rasch analysis: Reliability coefficients (0.94). Warm’s mean weighted likelihood estimates (0.94). Extreme infit-t and outfit-t values (+1.61 to −1.98). Conclusions: Both the classical test and the Rasch approaches confirm the usefulness of the new test for assessing nurses’ positioning in relation to telenursing.
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Bode K, Whittaker P, Dressler M, Bauer Y, Ali H. Pain Management Program in Cardiology: A Template for Application of Normalization Process Theory and Social Marketing to Implement a Change in Practice Quality Improvement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095251. [PMID: 35564643 PMCID: PMC9104749 DOI: 10.3390/ijerph19095251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/28/2022] [Accepted: 04/24/2022] [Indexed: 12/04/2022]
Abstract
Quality improvement plays a major role in healthcare, and numerous approaches have been developed to implement changes. However, the reasons for success or failure of the methods applied often remains obscure. Normalization process theory, recently developed in sociology, provides a flexible framework upon which to construct quality improvement. We sought to determine if examination of a successful quality improvement project, using normalization process theory and social marketing, provided insight into implementation. We performed a retrospective analysis of the steps taken to implement a pain management program in an electrophysiology clinic. We mapped these steps, and the corresponding social marketing tools used, to elements of normalization process theory. The combination of mapping implementation steps and marketing approaches to the theory provided insight into the quality-improvement process. Specifically, examination of the steps in the context of normalization process theory highlighted barriers to implementation at individual, group, and organizational levels. Importantly, the mapping also highlighted how facilitators were able to overcome the barriers with marketing techniques. Furthermore, integration with social marketing revealed how promotion of tangibility of benefits aided communication and how process co-creation between stakeholders enhanced value. Our implementation of a pain-management program was successful in a challenging environment composed of several stakeholder groups with entrenched initial positions. Therefore, we propose that the behavior change elements of normalization process theory combined with social marketing provide a flexible framework to initiate quality improvement.
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Affiliation(s)
- Kerstin Bode
- Department of Electrophysiology, Heart Center Leipzig, Struempellstr. 39, 04289 Leipzig, Germany;
- Department of Cardiology, Asklepios Clinic Weißenfels, Naumburger Str. 76, 06667 Weissenfels, Germany
- Correspondence: ; Tel.: +49-3443-401921
| | - Peter Whittaker
- The University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YL, UK;
| | - Miriam Dressler
- Medical Faculty, University of Leipzig, Liebigstr. 21, 04109 Leipzig, Germany;
| | - Yvonne Bauer
- Department of Electrophysiology, Heart Center Leipzig, Struempellstr. 39, 04289 Leipzig, Germany;
| | - Haider Ali
- Business School, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK;
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Flint SW, Brown A, Sanders G, Tahrani AA. Exploring the awareness, attitudes, and actions (AAA) of UK adults at high risk of severe illness from COVID-19. PLoS One 2021; 16:e0259376. [PMID: 34762659 PMCID: PMC8584659 DOI: 10.1371/journal.pone.0259376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background People at high risk of severe illness from COVID-19 have experienced greater restrictions during the pandemic, yet there is a paucity of research exploring their lived experience. Objectives This study explored the impact of COVID-19 on people identified as at high risk of severe illness by UK Government, and in particular, the impact of the first lockdown on access to healthcare, medications and use of technological platforms. Methods 1038 UK adults who identified as at high risk of severe illness from COVID-19 in line with UK Government guidance or self-identified with acute or other chronic health conditions, completed the Awareness, Attitudes and Actions survey which explored the impact of COVID-19 on access to healthcare, management of long-term health condition, mental health, and health behaviours. Results Most participants reported feelings of vulnerability, anxiety and isolation, noticed that other people changed their behaviour towards them including a feeling of being stigmatised by people not categorised as high risk. Participants described the largely negative impact that the COVID-19 lockdown had on to health-related behaviours and access to healthcare, which had resulted in large declines in mental health and wellbeing. Participants also indicated disappointment at the UK Governments response and handling of the COVID-19 lockdown. Implications This study provides novel evidence of the lived experience of the first COVID-19 lockdown for people identified as at high risk of severe illness. In the context of behavioural health interventions, the ubiquity of digital technologies and their adoption into day-to-day life translates into greater potential reach than traditional interventions, and consequently, greater potential for positive public health impact. Findings should be considered by policymakers and healthcare professionals to support people now and as we transition through the recovery phase with a particular emphasis on supporting mental health and changes to the management of long-term health conditions.
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Affiliation(s)
- Stuart W. Flint
- School of Psychology, University of Leeds, Leeds, United Kingdom
- Scaled Insights, Nexus, University of Leeds, Leeds, United Kingdom
| | - Adrian Brown
- Centre for Obesity Research, University College London, London, United Kingdom
- National Institute of Health Research, University College London, London, United Kingdom
- * E-mail:
| | - George Sanders
- School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Abd A. Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
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Palumbo R. Engaging to innovate: an investigation into the implications of engagement at work on innovative behaviors in healthcare organizations. J Health Organ Manag 2021; ahead-of-print. [PMID: 34170095 DOI: 10.1108/jhom-02-2021-0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Organizational innovation relies on the employees' active participation in improving extant processes and practices. In particular, it has been argued that employees' engagement triggers innovation-oriented behaviors at work. Nevertheless, there is a paucity of evidence of the implications of work engagement on the health professionals' innovation propensity. The article intends to push forward what we currently know about this issue, providing some food for thought to scholars and practitioners. DESIGN/METHODOLOGY/APPROACH A path analysis based on ordinary least square (OLS) regression and 10,000 bootstrap samples was designed to investigate the direct and indirect implications of employees' engagement on innovative behaviors at work in a large sample of health professionals operating in Europe. The quality of employee-manager relationships and the organizational climate were included as mediating variables affecting the relationship between work engagement and propensity to innovation-oriented behaviors. FINDINGS The research findings highlighted that being engaged at work fosters the willingness of health professionals to partake in the improvement of organizational processes and practices. The positive implications of employees' engagement on innovative behaviors at work are catalyzed by good employee-manager relationships and a positive organizational climate. PRACTICAL IMPLICATIONS Healthcare organizations should uphold the health professional's engagement to enhance their innovation potential. Targeted interventions are needed to merge work engagement with the enhancement of the organizational environment in which health professionals accomplish their activities. A positive organizational climate enacts an empowering work environment, which further incentivizes innovation. ORIGINALITY/VALUE The article adopts a micro-level perspective to investigate the triggers of innovative behaviors among healthcare professionals, providing evidence which is relevant for theory and practice.
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Affiliation(s)
- Rocco Palumbo
- Department of Management and Law, University of Rome Tor Vergata, Roma, Italy
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Milella F, Minelli EA, Strozzi F, Croce D. Change and Innovation in Healthcare: Findings from Literature. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:395-408. [PMID: 34040399 PMCID: PMC8141398 DOI: 10.2147/ceor.s301169] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Change is an ongoing process in any organizations. Over years, healthcare organizations have been exposed to multiple external stimuli to change (eg, ageing population, increasing incidence of chronic diseases, ongoing Sars-Cov-2 pandemic) that pointed out the need to convert the current healthcare organizational model. Nowadays, the topic is extremely relevant, rendering organizational change an urgency. The work is structured on a double level of analysis. In the beginning, the paper collects the overall literature on the topic of organisational change in order to identify, on the basis of the citation network, the main existing theoretical approaches. Secondly, the analysis attempts to isolate the scientific production related to the healthcare context, by analysing the body of literature outside the identified citation network, divided by clusters of related studies. METHODOLOGY This review adopted a quantitative-based method that employs jointly systematic literature review and bibliographic network analysis. Specifically, the study applied a citation network analysis (CNA) and a co-occurrence keywords analysis. The CNA allowed detecting the most relevant papers published over time, identifying the research streams in literature. RESULTS The study showed four main findings. Firstly, consistent with past studies, works reviewed pointed out a convergence on the micro-level perspective for change's analysis. Secondly, an organic viewpoint whereby individual, organization and change's outcome contribute to any organizational change's action has been found in its early stage. Thirdly, works reported change combined with innovation's concept, although the structure of the relationship has not been outlined. Fourth, interestingly, contributions have been limited within the healthcare context. CONCLUSION Human dimension is the primary criticality to be managed to impede failure of the re-organizational path. Individuals are not passive recipients of change: individual change acceptance has been found a key input. Few papers discussed healthcare professionals' behaviour, and those available focused on technology-led changes perspective. In this view, individual acceptance of change within the healthcare context resulted being undeveloped and offers rooms for further analyses.
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Affiliation(s)
| | | | | | - Davide Croce
- School of Public Health, Faculty of Health Science, Witwatersrand University, Johannesburg, South Africa
- Centre for Health Economics, Social and Health Care Management, University Carlo Cattaneo - LIUC, Castellanza, Italy
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Bussu S, Marshall M. Organisational development to support integrated care in East London: the perspective of clinicians and social workers on the ground. J Health Organ Manag 2021; 34:603-619. [PMID: 32681632 DOI: 10.1108/jhom-10-2019-0294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Organisational Development (OD), with its focus on partnership working and distributed leadership, is increasingly advocated as an effective approach to driving change. Our evaluation of the impact of OD on delivery of integrated care in three London boroughs sheds light on how OD is being understood and implemented within health services, and what impact it is having on delivery of care. DESIGN/METHODOLOGY/APPROACH The findings presented here are based on a qualitative and participatory evaluation. The authors looked at how health and social care professionals communicated and coordinated delivery of care and evaluated the impact of current OD activities on the ground to evidence whether and to which degree they are enabling frontline staff to change their working routines towards greater coordination. FINDINGS Our findings highlight the limited reach and scope of a top-down approach to OD based on ad hoc coaching and staff engagement events, often delivered by external consultancies, and mostly focused at the senior management level. This approach fell short of enabling the creation of sustainable, integrated and collaborative organisations. Instead, some of the professionals that participated in our study tried to develop spaces that facilitated ongoing dialogue and mutual support among professionals on the ground. PRACTICAL IMPLICATIONS Initiatives of bottom-up OD such as those described in this paper have greater potential to change working routines as they enable staff to move towards more collaborative and coordinated work. ORIGINALITY/VALUE These findings contribute to the literature on OD in public services and highlight the benefits of a context-sensitive, pragmatic, and long-term approach to OD to help create sustainable collaborative organisations.
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Affiliation(s)
- Sonia Bussu
- Department of History, Politics, and Philosophy, Manchester Metropolitan University, Manchester, UK
| | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
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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: 29] [Impact Index Per Article: 9.7] [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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Elliott AL, Watson S, Dodgson G, Cohen-Tovée E, Ling J. Changing practice: assessing attitudes toward a NICE-informed collaborative treatment pathway for bipolar disorder. BJPsych Open 2021; 7:e64. [PMID: 33678215 PMCID: PMC8058910 DOI: 10.1192/bjo.2021.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/01/2021] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bipolar disorder is a chronic mental health condition, which can result in functional impairment despite medication. A large evidence base supports use of psychological therapies and structured care in the treatment of mood disorders, but these are rarely implemented. e-Pathways are digital structures that inform and record patient progress through a healthcare system, although these have not yet been used for bipolar disorder. AIMS To assess the perceived benefits and costs associated with implementing a collaborative NICE-informed e-pathway for bipolar disorder. METHOD Healthcare professionals and people with bipolar disorder attended a workshop to share feedback on e-pathways. Data were collected through questionnaires (n = 26) and transcription of a focus group, analysed qualitatively by a framework analysis. RESULTS Patients and healthcare professionals welcomed the development of an e-pathway for bipolar disorder. There were five elements to the framework: quality and delivery of care, patient-clinician collaboration, flexibility and adaptability, impact on staff and impact on healthcare services. CONCLUSIONS Identification of benefits and costs ensures that future development of e-pathways addresses concerns of healthcare professionals and people with bipolar disorder, which would be essential for successful implementation. Recommendations for this development include making e-pathways less complicated for patients, ensuring sufficient training and ensuring clinicians do not feel their skills become invalidated. Limitations of the study, and directions for future research, are discussed.
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Affiliation(s)
| | - Stuart Watson
- Translational and Clinical Research Institute, Newcastle University, UK; and North Locality, Central Business Unit, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Guy Dodgson
- Translational and Clinical Research Institute, Newcastle University, UK; and North Locality, Central Business Unit, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Esther Cohen-Tovée
- North Locality, Central Business Unit, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, UK
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14
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Virdun C, Luckett T, Davidson PM, Phillips J. Strengthening palliative care in the hospital setting: a codesign study. BMJ Support Palliat Care 2020:bmjspcare-2020-002645. [PMID: 33115832 DOI: 10.1136/bmjspcare-2020-002645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify actions required to strengthen the delivery of person and family centred hospital-based palliative care so that it addressed the domains of care identified as important for inpatients with palliative care needs and their families. METHODS A codesign study involving a workshop with palliative care and acute hospital policy, consumer and clinical representatives in Australia. A modified nominal group process generated a series of actions, which were thematically analysed and refined, before being circulated to participants to gain consensus. RESULTS More than half (n=30, 58%) of the invited representatives (n=52) participated in the codesign process. Nine actions were identified as required to strengthen inpatient palliative care provision being: (a) evidence-informed practice and national benchmarking; (b) funding reforms; (c) securing executive level support; (d) mandatory clinical and ancillary education; (e) fostering greater community awareness; (f) policy reviews of care of the dying; (g) better integration of advance care planning; (h) strengthen nursing leadership; and (i) develop communities of practice for improving palliative care. CONCLUSIONS Changes to policy, practice, education and further research are required to optimise palliative care within hospital settings, in accordance with the domains inpatients with palliative care needs and their families consider to be important. Achieving these changes will require a whole of sector approach and significant national and jurisdictional leadership.
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Affiliation(s)
- Claudia Virdun
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Patricia M Davidson
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
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15
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Komulainen H, Mertaniemi E, Lunkka N, Jansson N, Meriläinen M, Wiik H, Suhonen M. Persuasive speech in multi-professional change facilitation meetings. J Health Organ Manag 2019; 33:396-412. [DOI: 10.1108/jhom-12-2018-0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to describe persuasive speech and discourses in multi-professional organizational change facilitation meetings at a hospital through rhetorical discourse analysis. Previous research has often considered organizational change to be a managerial issue, with other employees given the rather passive role of implementators. This study takes an alternative approach in assuming that organizational change could benefit by involving those who are most familiar with the tasks to be changed.
Design/methodology/approach
The study employed a qualitative, case study approach and focused on the construction of a hospitalist model within multi-professional change facilitation meetings. Eight videos of these multi-professional change facilitation meetings – which occurred between January and September 2017 – were observed and the material was analyzed by rhetorical discourse analysis. An average of 10–20 actors from different professional groups participated in the meetings. The change actors comprised physicians, nursing staff and nursing managers, along with a secretary and hospitalist. The meetings were conducted by a change facilitator.
Findings
The persuasive speech in the analyzed organizational change meetings occurred within five distinct discourses: constructing the change together, positive feedback, strategic change in speech, patient perspective and driving change. The content of these discourses revealed topics that are relevant to persuading members of healthcare organizations to adopt a planned change.
Originality/value
The presented research provides new knowledge about how persuasive speech is used in organizational change and describes the discourses in which persuasive speech is used in a healthcare context.
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16
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Eljiz K, Greenfield D, Derrett A, Radmore S. Health system redesign: Changing thoughts, values, and behaviours for the co-production of a safety culture. Int J Health Plann Manage 2019; 34:1477-1484. [PMID: 31120155 DOI: 10.1002/hpm.2798] [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: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Simultaneous incremental and revolutionary systems change is a norm for many health care organisations. Organisational redesign, incorporating physical redevelopments and technological innovations, drives revolutionary transformations. Redesigning health facilities provides opportunities for improving and sustaining safe, high-quality patient care. There is a need for the creation of knowledge, based on empirical research, to inform how to effectively plan, implement, and evaluate health organisational redesign, underpinned by co-production principles. FINDINGS Using an Australian case study, we identify and discuss the opportunities and challenges, aligned with safety and quality requirements, to undertake redesign projects. Through an analysis of redesign and governance accountabilities, we identify five key foci for health leaders, and their communities, to plan, implement and evaluate organisational redesign. CONCLUSION By rebuilding and engaging with patients and consumers to organise, manage and deliver care, the redesign process allows us to change thoughts, values, and behaviours to achieve better patient outcomes.
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Affiliation(s)
- Kathy Eljiz
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - Alison Derrett
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simon Radmore
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
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17
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Braithwaite J, Vincent C, Nicklin W, Amalberti R. Coping with more people with more illness. Part 2: new generation of standards for enabling healthcare system transformation and sustainability. Int J Qual Health Care 2018; 31:159-163. [DOI: 10.1093/intqhc/mzy236] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/11/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia
- International Society for Quality in Health Care, 4th Floor, Huguenot House, 35-38 St Stephens Green, Dublin 2, Ireland
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, UK
| | - Wendy Nicklin
- International Society for Quality in Health Care, 4th Floor, Huguenot House, 35-38 St Stephens Green, Dublin 2, Ireland
- Queen’s University, 99 University Ave, Kingston, ON, Canada
- University of Ottawa, 75 Laurier Ave E, Ottawa, ON, Canada
| | - René Amalberti
- Haute Autorité de Santé, 5 Avenue du Stade de France, Saint-Denis, France
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18
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Ersson A, Beckman A, Jarl J, Borell J. Effects of a multifaceted intervention QI program to improve ICU performance. BMC Health Serv Res 2018; 18:838. [PMID: 30404646 PMCID: PMC6223055 DOI: 10.1186/s12913-018-3648-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To benefit from the increasing clinical evidence, organisational changes have been among the main drivers behind the reduction of ICU mortality during the last decade. Increasing demand, costs and complexity, amplifies the need for optimisation of clinical processes and resource utilisation. Thus, multidisciplinary teamwork and critical care processes needs to be adapted to profit from increased availability of human skill and technical resources in a cost-effective manner. Inadequate clinical performance and outcome data compelled us to design a quality improvement project to address current work processes and competence utilisation. METHODS During revision period, clinical processes, professional performance and clinical competence were targeted using "scientific production management methodology" approach. As part of the project, an intensivist training program was instituted, and full time intensivist coverage was obtained in the process of creating multi-professional teams, composed of certified intensivists, critical care nurses, assistant nurses, physiotherapists and social counsellors. The use of staff resources and clinical work-processes were optimised in accordance with the outcome of a "value stream mapping". In this process, efforts to enhance the personal dynamics and performance within the teams were paramount. Clinical and economic outcome data were analysed during a seven year follow up period. RESULTS • Consecutive reduced overall ICU (24%) and long-term (600 days) mortality. The effect on ICU mortality was especially pronounced in the subgroup of patients > 65 years (30%) • Consecutive reduced length of stay (43%, septic patients) and time on ventilator (for septic patients and patients > 65 years of age (23 resp.52%). • Substantial increase in life years gained (13,140 life years) as well as quality-adjusted life-years (9593 QALY: s) over the study period. • High cost-effectiveness as ICU costs were reduced while patient outcomes were improved. Disregarding the cost reduction in ICU, the intervention is highly cost effective with cost- effectiveness ratios of (75€/QALY) and (55€ / life year) CONCLUSIONS: We have shown favourable results of a QI project aiming to improve the clinical performance and quality through the development of multi-professional interaction, teamwork and systematic revisions of work processes. The economic evaluation shows that the intervention is highly cost-effective and potentially dominating.
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Affiliation(s)
- Anders Ersson
- Department of Intensive Care and Perioperative medicine, Skåne University Hospital, Malmö, Sweden
| | - Anders Beckman
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - Johan Jarl
- Department of Clinical Sciences Malmö, Health Economics, Lund University, Malmö, Sweden
| | - Jonas Borell
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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19
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Rydenfält C, Borell J, Erlingsdottir G. What do doctors mean when they talk about teamwork? Possible implications for interprofessional care. J Interprof Care 2018; 33:714-723. [PMID: 30362854 DOI: 10.1080/13561820.2018.1538943] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.
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Affiliation(s)
- Christofer Rydenfält
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Jonas Borell
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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20
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Steinmann KE, Lehnick D, Buettcher M, Schwendener-Scholl K, Daetwyler K, Fontana M, Morgillo D, Ganassi K, O'Neill K, Genet P, Burth S, Savoia P, Terheggen U, Berger C, Stocker M. Impact of Empowering Leadership on Antimicrobial Stewardship: A Single Center Study in a Neonatal and Pediatric Intensive Care Unit and a Literature Review. Front Pediatr 2018; 6:294. [PMID: 30370263 PMCID: PMC6194187 DOI: 10.3389/fped.2018.00294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Antimicrobial stewardship (AMS) is an important strategy of quality improvement for every hospital. Leadership is an important factor for implementation of quality improvement and AMS programs. Recent publications show successful AMS programs in children's hospitals, but successful implementation is often difficult to achieve and literature of AMS in neonatal and pediatric intensive care units (NICU/PICU) is scarce. Lack of resources and prescriber opposition are reported barriers. A leadership style focusing on empowering frontline staff to take responsibility is one approach to implement changes in health care institutions. Aim: Literature review regarding empowering leadership and AMS in health care and assessment of the impact of such a leadership style on AMS in a NICU/PICU over 3 years. Methods: Assessment of the impact of a leadership change September 1, 2015 from control-driven to an empowering leadership style on antibiotic use and hospital acquired infections. Prospective analysis and annual comparison of antibiotic use, rate of suspected and confirmed ventilator-associated pneumonia (VAP) and central-line associated blood stream infection (CLABSI) including antibiotic use overall, antibiotic therapy for culture-negative and culture-proven infections including correct initial choice and streamlining of antibiotics in the NICU/PICU of the Children's Hospital of Lucerne between January 1, 2015 and December 31, 2017. Results: Five articles were included in the literature review. All five studies concluded that an empowering leadership style may lead to a higher engagement of physicians. Three out of five studies reported improved AMS as reduced rate in hospital-acquired infections and improved prevention of MRSA infections. From 2015 to 2017, antibiotic days overall and antibiotic days for culture-negative situations (suspected infections and prophylaxis) per 1000 patient days declined significantly from 474.1 to 403.9 and from 418.2 to 309.4 days, respectively. Similar, the use of meropenem and vancomycin declined significantly. Over the 3 years, suspected and proven VAP- and CLABSI-episodes decreased with no confirmed episodes in 2017. Conclusion: An empowering leadership style which focuses on enabling frontline physicians to take direct responsibilities for their patients may be a successful strategy of antimicrobial stewardship allowing to overcome reported barriers of AMS implementation.
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Affiliation(s)
- Karin E Steinmann
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Dirk Lehnick
- Department of Health Sciences and Health Policy, Biostatistics and Methodology, University Lucerne, Lucerne, Switzerland
| | - Michael Buettcher
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Infectious Diseases Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Katharina Schwendener-Scholl
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Karin Daetwyler
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Matteo Fontana
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Davide Morgillo
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Katja Ganassi
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Kathrin O'Neill
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Petra Genet
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Susanne Burth
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Patrizia Savoia
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Ulrich Terheggen
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Christoph Berger
- Department of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
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