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Svensson I, Bridges J, Ellis J, Brady N, Dello S, Hooft J, Kleine J, Kohnen D, Lehane E, Lindqvist R, Maier CB, Mc Carthy VJC, Strømseng Sjetne I, Eriksson LE, Smeds Alenius L. Laying the foundations for implementing Magnet principles in hospitals in Europe: A qualitative analysis. Int J Nurs Stud 2024; 154:104754. [PMID: 38522183 DOI: 10.1016/j.ijnurstu.2024.104754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Magnet hospitals, a concept developed in the U.S., have been associated with improved nurse recruitment and retention, and better patient outcomes. Magnet principles may be useful to address workforce challenges in European hospitals, but they have not been implemented or evaluated on a large scale in the European hospital context. OBJECTIVE This study aims to explore the initial phase of implementing Magnet principles in 11 acute care hospitals in six European countries. The specific objectives of the study were to investigate the type of work that characterises the early phase of implementation and how implementation leaders engage with their context. METHODS A multinational qualitative study was conducted, with data from 23 semi-structured, one-to-one interviews with implementation leaders in 11 acute care hospitals in six European countries. Thematic analyses guided the analysis of data. FINDINGS Three themes of core work processes during the early phase of implementing Magnet principles in European hospitals were identified. The first theme, 'Creating space for Magnet', describes how work was directed towards creating both political and organisational space for the project. The second theme, 'Framing to fit: understanding and interpreting Magnet principles', describes the translational work to understand what the Magnet model entails and how it relates to the local hospital context. Finally, the third theme, 'Calibrating speed and dose', describes the strategic work of considering internal and external factors to adjust the process of implementation. CONCLUSIONS The first phase of implementation was characterised by conceptual and relational work; translating the Magnet concepts, considering the fit into existing structures and practices and making space for Magnet in the local context. Understanding the local context played an important role in shaping and guiding the navigation of professional and organisational tensions. Hospitals employed diverse strategies to either emphasise or downplay the role of nurses and nursing to facilitate progress in the implementation.
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Affiliation(s)
- Ingrid Svensson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Jackie Bridges
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Jaimie Ellis
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Noeleen Brady
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Simon Dello
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Jonathan Hooft
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Joan Kleine
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Dorothea Kohnen
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium; Occupational & Organisational Psychology and Professional Learning, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Elaine Lehane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rikard Lindqvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claudia B Maier
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | | | - Ingeborg Strømseng Sjetne
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Lovisenberg Diakonale Sykehus, Oslo, Norway
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; School of Health and Psychological Sciences, City, University of London, London, United Kingdom; Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Lisa Smeds Alenius
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Brown A, Edelman A, Pain T, Larkins S, Harvey G. "We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research": A Research Impact Evaluation at a Regional Australian Hospital and Health Service. Int J Health Policy Manag 2022; 11:3000-3011. [PMID: 35643418 PMCID: PMC10105178 DOI: 10.34172/ijhpm.2022.6529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Research is central to high functioning health services alongside clinical care and health professional training. The impact of embedded research includes delivery of high-quality care and improved patient outcomes. Evaluations of research impact help health service leadership ensure investments lead to the greatest healthcare benefits for patients. This study aimed to retrospectively evaluate the impact of research investment from 2008 to 2018 at Townsville Hospital and Health Service (THHS), a regional Hospital and Health Service (HHS) in Queensland, Australia. The evaluation also sought to identify contextual conditions that enable or hinder intended impacts. METHODS A mixed-methods realist-informed evaluation was conducted using documentation, interviews with 15 staff and available databases to identify and measure research investments, impacts and contextual conditions influencing impact outcomes. RESULTS Between 2008 and 2018, THHS increased resources for research by funding research projects, employing research personnel, building research-enabling facilities, hosting research events, and providing research education and training. Clinical practice, policy and workforce impacts were successful in isolated pockets, championed by individual researchers and facilitated by their policy and community-of-practice networks. However, there was little organisational-level support for continuity of research and implementation into practice and policy. Availability of research supports varied geographically across THHS, and across disciplines. CONCLUSION Definitive steps in the development of THHS as a credible and productive research centre and leading hospital research centre in Northern Australia are evident. Continuing investments should address support for the research continuum through to translation and establish ongoing, systematic processes for evaluating research investment and impact.
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Affiliation(s)
- Amy Brown
- Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Alexandra Edelman
- Townsville Hospital and Health Service, Townsville, QLD, Australia
- James Cook University, Townsville, QLD, Australia
| | - Tilley Pain
- Townsville Hospital and Health Service, Townsville, QLD, Australia
- James Cook University, Townsville, QLD, Australia
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An implementation study of electronic assessment of patient-reported outcomes in inpatient radiation oncology. J Patient Rep Outcomes 2022; 6:77. [PMID: 35852715 PMCID: PMC9296709 DOI: 10.1186/s41687-022-00478-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/08/2022] [Indexed: 12/20/2022] Open
Abstract
Purpose Despite evidence for clinical benefits, recommendations in guidelines, and options for electronic data collection, routine assessment of patient-reported outcomes (PROs) is mostly not implemented in clinical practice. This study aimed to plan, conduct and evaluate the implementation of electronic PRO (e-PRO) assessment in the clinical routine of an inpatient radiation oncology clinic. Methods The guideline- and evidence-based, stepwise approach of this single-center implementation study comprised preparatory analyses of current practice, selection of assessment instruments and times, development of staff training, and evidence-based recommendations regarding the use of the e-PRO assessment, as well as on-site support of the implementation. Process evaluation focused on potential clinical benefit (number of documented symptoms and supportive measures), feasibility and acceptance (patient contacts resulting in completion/non-completion of the e-PRO assessment, reasons for non-completion, preconditions, facilitators and barriers of implementation), and required resources (duration of patient contacts to explain/support the completion). Results Selection of instruments and assessment times resulted in initial assessment at admission (EORTC QLQ-C30, QSR 10), daily symptom monitoring (EORTC single items), and assessment at discharge (EORTC QLQ-C30). Recommendations for PRO-based clinical action and self-management advice for patients concerning nine core symptoms were developed. Staff training comprised group and face-to-face meetings and an additional e-learning course was developed. Analyses of clinical records showed that e-PRO assessment identified more symptoms followed by a higher number of supportive measures compared to records of patients without e-PRO assessment. Analysis of n = 1597 patient contacts resulted in n = 1355 (84.9%) completed e-PROs (initial assessment: n = 355, monitoring: n = 967, final assessment: n = 44) and n = 242 (15.2%) non-completions. Instructions or support to complete e-PROs took on average 5.5 ± 5.3 min per patient contact. The most challenging issue was the integration of the results in clinical practice. Conclusion E-PRO assessment in oncologic inpatient settings is acceptable for patients and can support symptom identification and the initiation of supportive measures. The challenge of making the “data actionable” within the clinical workflow and motivating clinical staff to use the results became evident. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00478-3. Cancer patients’ perceptions regarding their symptoms and functioning are important as they can differ from a professional assessment. Patients’ perceptions and self-assessment can be collected via electronic devices. Thus, the clinical staff can see a graphic overview of individual disease-related burden. Despite studies indicating the benefit of this assessment for care and symptom management, it is not integrated into routine care so far. The aim of our study was, to plan, conduct and evaluate the implementation of electronic patient-reported assessment in a radio-oncology inpatient clinic under “real-life” clinical conditions instead of study conditions. Patients could complete an electronic assessment at the beginning/end and during their treatment. Results indicate that electronic self-assessment can identify more symptoms than the assessment of physicians and nurses. Patients completing a self-assessment are more likely to receive supportive measures. The majority of 80–90% of patients were willing to complete a self-assessment. On average 5–6 min were needed to explain or support the completion. While the intervention was feasible and acceptable for patients, motivating clinical staff using its results was most challenging. The importance of technical support became evident.
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Singleton G, Dowrick A, Manby L, Fillmore H, Syverson A, Lewis-Jackson S, Uddin I, Sumray K, Bautista-González E, Johnson G, Vindrola-Padros C. UK Healthcare Workers' Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation. Int J Health Policy Manag 2022; 11:2072-2082. [PMID: 34523860 PMCID: PMC9808275 DOI: 10.34172/ijhpm.2021.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic disrupted the delivery of elective surgery in the United Kingdom. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the United Kingdom, with the aim of developing lessons for future major systems change (MSC). METHODS Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. Framework analysis was used to organise and interpret findings. RESULTS Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision-making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. CONCLUSION Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of MSC is essential for the sustainability of change processes.
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Affiliation(s)
- Georgina Singleton
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Anna Dowrick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louisa Manby
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | | | - Aron Syverson
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Sasha Lewis-Jackson
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Inayah Uddin
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Kirsi Sumray
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Elysse Bautista-González
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Ginger Johnson
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
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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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