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Castillo GF, Salas E. Can team coaching provide healthcare the remedy it needs? J Interprof Care 2024; 38:377-387. [PMID: 38019103 PMCID: PMC10922443 DOI: 10.1080/13561820.2023.2285030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
The healthcare industry is inadvertently a teamwork industry - and yet - little time is devoted to improving teamwork on the field. As a response to this issue, team development intervention (TDI) tools have flourished. Findings suggest the capability for TDIs to better team competencies, and potentially mitigate prominent healthcare problems. However, team coaching has been excluded as a potential TDI for healthcare. For this reason, we seek to 1) discuss existing team coaching models, integrating findings across the literature, 2) highlight the advantages of Hackman and Wageman (2005)'s model over others, 3) display its empirically-corroborated propositions, and finally, 4) provide general guidance on how to move forward. We move beyond extant literature by providing an outline on what outcomes team coaching can and cannot yield, accumulating evidence from fields outside of healthcare and incorporating team coaching into the TDI literature. By doing so, we hope empirical research on team coaching is incentivized, resulting in an efficient and accessible TDI for healthcare professionals and the field of interprofessional care.
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Affiliation(s)
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University
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2
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Lim ELP, Ong RHS, Thor J, Allgurin M, Gäre BA, Thumboo J. An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes. Int J Integr Care 2023; 23:11. [PMID: 38020415 PMCID: PMC10668878 DOI: 10.5334/ijic.7564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners' PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of "caring about the service user as a whole person" and the "sharing of power, control and information". Methods A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points - before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time. Results A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to "care" than to "share power" with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3). Conclusion Training as a specific intervention, appeared to have potential to increase health practitioners' person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.
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Affiliation(s)
- Esther Li Ping Lim
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Allied Health Division, Singapore General Hospital, Singapore
- Centre for Person-centred Care, Singapore Health Services, Singapore
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore
| | | | - Johan Thor
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Monika Allgurin
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Boel Andersson Gäre
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Julian Thumboo
- SingHealth Office of Regional Health, Singapore Health Services, Singapore
- SingHealth Centre for Population Health Research and Implementation, Singapore Health Services, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
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Rushton S, Lewinski AA, Hwang S, Zullig LL, Ball Ricks KA, Ramos K, Gordon A, Ear B, Ballengee LA, Brahmajothi MV, Moore T, Blalock DV, Williams JW, Cantrell SE, Gierisch JM, Goldstein KM. Barriers and facilitators to the implementation and adoption of improvement coaching: A qualitative evidence synthesis. J Clin Nurs 2023; 32:3-30. [PMID: 35403322 PMCID: PMC11309122 DOI: 10.1111/jocn.16247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/15/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Healthcare organisations and teams perform improvement activities to facilitate high-quality healthcare. The use of an improvement coach who provides support and guidance to the healthcare team may facilitate improvement activities; however, no systematic review exists on the facilitators and barriers to implementing an improvement coach. AIMS We conducted a qualitative evidence synthesis to examine the facilitators and barriers to the implementation of improvement coaching. METHODS We searched MEDLINE® , Embase and CINAHL. The final search was in March 2021. The screening eligibility criteria included the following: interdisciplinary team receiving the coaching, improvement coaching, designs with a qualitative component and primary purpose of evaluating practice facilitation in OECD countries. An ecologically-informed consolidated framework for implementation research (CFIR) served as the framework for coding. Patterns of barriers and facilitators across domains were identified through matrix analysis. Risk of bias was assessed using Critical Appraisal Skills Program. PRISMA reporting guidelines served as a guide for reporting this review. RESULTS Nineteen studies with a qualitative component met the inclusion criteria. Four themes of barriers and facilitators crossed multiple CFIR domains: adaptability (e.g. making adjustments to the project; process, or approach); knowledge and skills (e.g. understanding of content and process for the project); engagement (e.g. willingness to be involved in the process) and resources (e.g. assets required to complete the improvement process). CONCLUSION Improvement coaching is a complex intervention that influences the context, healthcare team being coached and improvement activities. Improvement coaches should understand how to minimise barriers and promote facilitators that are unique to each improvement project across the domains. Limitations of the study are related to the nature of the intervention including potential publication bias given quality improvement focus; the variety of terms similar to improvement coaching or selection of framework.
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Affiliation(s)
- Sharron Rushton
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Allison A. Lewinski
- School of Nursing, Duke University, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Soohyun Hwang
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leah L. Zullig
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Katharine A. Ball Ricks
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine Ramos
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Adelaide Gordon
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Belinda Ear
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Lindsay A. Ballengee
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Mulugu V. Brahmajothi
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomasena Moore
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Dan V. Blalock
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Williams
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Sarah E. Cantrell
- School of Medicine, Duke University Medical Center Library & Archives, Duke University, Durham, North Carolina, USA
| | - Jennifer M. Gierisch
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Karen M. Goldstein
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
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Robinson LJ, Butler HV, Hackett KL. Identifying and prioritising the key components of a Quality Improvement Network for allied health professionals and psychological therapists: a group concept mapping project. BMJ Open Qual 2023; 12:bmjoq-2022-002039. [PMID: 36717182 PMCID: PMC9887700 DOI: 10.1136/bmjoq-2022-002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Despite growing enthusiasm for quality improvement (QI), the complexities of modern healthcare continue to create gaps in our ability to consistently deliver the most effective and efficient care for patients, and improvement activities often fail to achieve widespread uptake even when there is robust evidence of their benefits. METHODS We undertook a novel, mixed methods evaluation and planning project using group concept mapping (GCM) methodology to identify and prioritise the ways in which our recently established Quality Improvement Network (QIN) could support allied health professionals, psychological therapists and administrative staff in their daily work to improve patient outcomes and experience. Mid-level leaders across our therapy services department contributed towards a statement generation activity and individually sorted these statements into themes. Each statement was rated for perceived importance and current success. Multidimensional scaling and hierarchical cluster analysis were applied to the sorted data to produce themed clusters of ideas within concept maps. Priority values were applied to these maps to identify key areas for future QIN activity. RESULTS Overall, 34 participants took part in ideas generation, 20 in sorting and 30 in the rating activity. A five-item cluster map was agreed on, containing the following named clusters: data support; practical skills and training; time and resources; embedding a QI culture; and sharing ideas and working together. Statements contained within each of the five clusters highlight the importance of supporting a range of activities spanning the technical and human aspects of QI at an individual, group/team, organisation and wider systems level. CONCLUSION GCM provided a structured and systematic approach for identifying the perceived support needs of allied health professionals, psychological therapists and administrative support staff in relation to QI. The findings from this project provide a useful benchmark from which to track targeted QI support in an applied healthcare setting.
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Affiliation(s)
- Lisa J Robinson
- Rehabilitation Department, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Hannah V Butler
- Rehabilitation Department, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Kate L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
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Lim ELP, Khee GY, Thor J, Andersson Gäre B, Thumboo J, Allgurin M. How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation. BMJ Open 2022; 12:e059794. [PMID: 36564117 PMCID: PMC9791430 DOI: 10.1136/bmjopen-2021-059794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation aimed to explain its adoption and adaptation in Singapore. DESIGN An organisational case study using a realist evaluation approach drawing on Greenhalgh et al (2004)'s Diffusion of Innovations in Service Organisations to guide data collection and analysis. Data collection included interviews with seven individuals and three focus groups (including stakeholders from the macrosystem, mesosystem and microsystem levels) about their experiences of EN in Singapore, and field notes from participant observations of EN activities. SETTING SingHealth, a healthcare cluster serving a population of 1.37 million residents in Eastern Singapore. PARTICIPANTS Policy makers (n=4), EN programme implementers (n=3), practitioners (n=6) and service users (n=7) participated in individual interviews or focus group discussions. PRIMARY AND SECONDARY OUTCOME MEASURES Outcome data from healthcare institutions (n=13) and community agencies (n=59) were included in document analysis. RESULTS Singapore's ageing population and need to transition from a hospital-based model to a more sustainable community-based model provided an opportunity for change. The personalised nature and logic of the EN model resonated with leaders and led to collective adoption. Embedded cultural influences such as the need for order and hierarchical structures were both barriers to, and facilitators of, change. Coproduction between service users and practitioners in making care improvements deepened the relationships and commitments that held the network together. CONCLUSIONS The enabling role of leaders (macrosystem level), the bridging role of practitioners (mesosystem level) and the unifying role of service users (microsystem level) all contributed to EN's success in Singapore. Understanding these roles helps us understand how staff at various levels can contribute to the adoption and adaptation of EN and similar complex innovations systemwide.
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Affiliation(s)
- Esther Li Ping Lim
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- SingHealth Office of Regional Health, Singapore Health Services, Singapore
| | - Giat Yeng Khee
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Johan Thor
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Boel Andersson Gäre
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Julian Thumboo
- SingHealth Office of Regional Health, Singapore Health Services, Singapore
- SingHealth Centre for Population Health Research and Implementation, Singapore Health Services, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Monika Allgurin
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Gilmartin HM, Hess E, Mueller C, Connelly B, Plomondon ME, Waldo SW, Battaglia C. Learning environments, reliability enhancing work practices, employee engagement, and safety climate in VA cardiac catheterization laboratories. Health Serv Res 2022; 57:385-391. [PMID: 35297037 PMCID: PMC8928023 DOI: 10.1111/1475-6773.13907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To characterize the relationship between learning environments (the educational approaches, cultural context, and settings in which teaching and learning happen) and reliability enhancing work practices (hiring, training, decision making) with employee engagement, retention, and safety climate. DATA SOURCE We collected data using the Learning Environment and High Reliability Practices Survey (LEHRs) from 231 physicians, nurses, and technicians at 67 Veterans Affairs cardiac catheterization laboratories who care for high-risk Veterans. STUDY DESIGN The association between the average LEHRs score and employee job satisfaction, burnout, intent to leave, turnover, and safety climate were modeled in separate linear mixed effect models adjusting for other covariates. DATA COLLECTION Participants responded to a web-only survey from August through September 2020. PRINCIPAL FINDINGS There was a significant association between higher average LEHRs scores and (1) higher job satisfaction (2) lower burnout, (3) lower intent to leave, (4) lower cath lab turnover in the previous 12 months, and (5) higher perceived safety climate. CONCLUSIONS Learning environments and use of reliability enhancing work practices are potential new avenues to support satisfaction and safety climate while lowering burnout, intent to leave, and turnover in a diverse US health care workforce that serves a vulnerable and marginalized population.
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Affiliation(s)
- Heather M. Gilmartin
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
- Department of Health Systems, Management and PolicyUniversity of Colorado, School of Public HealthAuroraColoradoUSA
| | - Edward Hess
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
| | - Candice Mueller
- CART Program, Office of Quality and Patient SafetyVeterans Health AdministrationWashingtonDistrict of ColumbiaUSA
| | - Brigid Connelly
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
| | - Mary E. Plomondon
- CART Program, Office of Quality and Patient SafetyVeterans Health AdministrationWashingtonDistrict of ColumbiaUSA
| | - Stephen W. Waldo
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
- CART Program, Office of Quality and Patient SafetyVeterans Health AdministrationWashingtonDistrict of ColumbiaUSA
- Department of Medicine, Cardiology SectionRocky Mountain Regional VA Medical CenterAuroraColoradoUSA
- Department of Medicine, Division of CardiologyUniversity of ColoradoAuroraColoradoUSA
| | - Catherine Battaglia
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
- Department of Health Systems, Management and PolicyUniversity of Colorado, School of Public HealthAuroraColoradoUSA
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Loper AC, Jensen TM, Farley AB, Morgan JD, Metz AJ. A Systematic Review of Approaches for Continuous Quality Improvement Capacity-Building. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E354-E361. [PMID: 34520447 PMCID: PMC8781219 DOI: 10.1097/phh.0000000000001412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Continuous quality improvement (CQI) has become prominent in public health settings; yet, little consolidated guidance exists for building CQI capacity of community-based organizations. OBJECTIVE To synthesize relevant literature to identify guiding principles and core components critical to building the capacity of organizations to adopt and use CQI. DESIGN We employed a systematic review approach to assess guiding principles and core components for CQI capacity-building as outlined in the literature. ELIGIBILITY CRITERIA Studies meeting the following criteria were eligible for review: (1) empirical, peer-reviewed journal article, evaluation study, review, or systematic review; (2) published in 2010 or later; and (3) capacity-building activities were described in enough detail to be replicable. Studies not including human subjects, published in a language other than English, or for which full text was not available were excluded. STUDY SELECTION The initial return of records included 6557 articles, of which 1455 were duplicates. The research team single-screened titles and abstracts of 5102 studies, resulting in the exclusion of 4842 studies. Two hundred sixty-two studies were double-screened during full-text review, yielding a final sample of 61 studies from which data were extracted. MAIN OUTCOME MEASURES Outcome measures of interest were operationalized descriptions of guiding principles and core components of the CQI capacity-building approach. RESULTS Results yielded articles from medical education, health care, and public health settings. Findings included guiding principles and core components of CQI capacity-building identified in current practice, as well as infrastructural and contextual elements needed to build CQI capacity. CONCLUSIONS This consolidation of guiding principles and core components for CQI capacity-building is valuable for public health and related workforces. Despite the uneven distribution of articles from health care, medical education, and public health settings, our findings can be used to guide public health organizations in building CQI capacity in a well-informed, systematic manner.
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Affiliation(s)
- Audrey C. Loper
- School of Social Work (Mss Loper and Farley, Drs Jensen and Metz), Frank Porter Graham Child Development Institute (Ms Morgan), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Todd M. Jensen
- School of Social Work (Mss Loper and Farley, Drs Jensen and Metz), Frank Porter Graham Child Development Institute (Ms Morgan), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda B. Farley
- School of Social Work (Mss Loper and Farley, Drs Jensen and Metz), Frank Porter Graham Child Development Institute (Ms Morgan), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jenille D. Morgan
- School of Social Work (Mss Loper and Farley, Drs Jensen and Metz), Frank Porter Graham Child Development Institute (Ms Morgan), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison J. Metz
- School of Social Work (Mss Loper and Farley, Drs Jensen and Metz), Frank Porter Graham Child Development Institute (Ms Morgan), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
BACKGROUND AND OBJECTIVES Health care organizations track patient experience data, identify areas of improvement, monitor provider performance, and assist providers in improving their interactions with patients. Some practices use one-on-one provider counseling ("shadow coaching") to identify and modify provider behaviors. A recent evaluation of a large shadow coaching program found statistically significant improvements in coached providers' patient experience scores immediately after being coached. This study aimed to examine the content of the recommendations given to those providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability. METHODS Providers at a large, urban federally qualified health center were selected for coaching based on Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) patient experience scores (92 of 320 providers), shadowed by a trained peer coach for a half to full day and received recommendations on how to improve interactions with their patients. We coded 1082 recommendations found in the 92 coaching reports. RESULTS Reports contained an average of 12 recommendations. About half encouraged consistency of existing behaviors and half encouraged new behaviors. Most recommendations related to behaviors of the provider rather than support staff and targeted actions within the examination room rather than other spaces (eg, waiting room). The most common recommendations mapped to behavioral aspects of provider communication. Most recommendations targeted verbal rather than nonverbal communication behaviors. Most recommendations were actionable (ie, specific, descriptive), with recommendations that encouraged new behaviors being more actionable than those that encouraged existing actions. CONCLUSIONS Patient experience surveys are effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback. Recommendations to providers aimed at improving their interactions with patients need to not only suggest the exact behaviors defined within patient experience survey items but also include recommended behaviors indirectly associated with those measured behaviors. Attention needs to be paid to supplementing patient experience data with explicit, tangible, and descriptive (ie, actionable) recommendations associated with the targeted, measured behaviors. Research is needed to understand how recommendations are put into practice by providers and what motivates and supports them to sustain changed behaviors.
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Quigley DD, Elliott MN, Slaughter ME, Burkhart Q, Chen AY, Talamantes E, Hays RD. Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later. Med Care 2021; 59:950-960. [PMID: 34387621 PMCID: PMC8516705 DOI: 10.1097/mlr.0000000000001629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Health care organizations strive to improve patient care experiences. Some use one-on-one provider counseling (shadow coaching) to identify and target modifiable provider behaviors. OBJECTIVE We examined whether shadow coaching improves patient experience across 44 primary care practices in a large urban Federally Qualified Health Center. RESEARCH DESIGN Seventy-four providers with "medium" (ie, slightly below average) overall provider ratings received coaching and were compared with 246 uncoached providers. We fit mixed-effects regression models with random effects for provider (level of treatment assignment) and fixed effects for time (linear spline with a knot and "jump" at coaching date), patient characteristics and site indicators. By design, coached providers performed worse at selection; models account for the very small (0.2 point) regression-to-the-mean effects. We assessed differential effects by coach. SUBJECTS A total of 46,452 patients (from 320 providers) who completed the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) Visit Survey 2.0. MEASURES CAHPS overall provider rating and provider communication composite (scaled 0-100). RESULTS Providers not chosen for coaching had a nonsignificant change in performance during the period when selected providers were coached. We observed a statistically significant 2-point (small-to-medium) jump among coached providers after coaching on the CAHPS overall provider rating and provider communication score. However, these gains disappeared after 2.5 years; effects differed by coach. CONCLUSIONS Shadow coaching improved providers' overall performance and communication immediately after being coached. Regularly planned shadow coaching "booster" sessions might maintain or even increase the improvement gained in patient experience scores, but research examining additional coaching and optimal implementation is needed.
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Affiliation(s)
| | | | | | - Q Burkhart
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | - Alex Y. Chen
- Health Net, 21650 Oxnard St, Woodland Hills, CA 91367
| | | | - Ron D. Hays
- UCLA David Geffen School of Medicine & Department of Medicine, 1100 Glendon Avenue, Los Angeles, CA 90024-1736
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Stenmarker M, Oldin C, Golsäter M, Blennow M, Enskär K, Nilsson MP, Schollin Ask L. Child health professionals' experiences of the introduction and successful implementation of rotavirus vaccination in Sweden. Acta Paediatr 2021; 110:2833-2841. [PMID: 34297362 DOI: 10.1111/apa.16038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/15/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
AIM To explore child health professionals' experiences of the early implementation of the rotavirus vaccination in the two regions that first introduced this vaccination in Sweden. METHODS A descriptive and repeated cross-sectional study based on a digital study-specific questionnaire with a baseline in 2014 and with a 2-year follow-up in 2016. The study population consisted of nurses and doctors working in child health centres in the health care regions of Stockholm and Jönköping. RESULTS In Stockholm, a larger proportion of the respondents (n = 355) had concerns in 2014, in comparison with the respondents in Jönköping (n = 101), mostly about the vaccination being a new and time-consuming task (60% versus 23%). In 2016, the overall attitude to vaccination was more positive in both regions and the levels of concern about increased workload were reduced (Stockholm, n = 519, 39%, versus Jönköping, n = 96, 10%). Challenges before and after the introduction in both regions were particularly related to how to give information about the vaccine's potential increased risk of intussusception. CONCLUSION The gap between respondents' knowledge, attitudes and concerns pre- and post-vaccination introduction was larger in Stockholm compared to Jönköping. In both regions, overall, the implementation of the rotavirus vaccination was perceived as being easier than expected.
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Affiliation(s)
- Margaretha Stenmarker
- Futurum – Academy of Health and Care/Department of Paediatrics Jönköping Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Carin Oldin
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- Child Health ServicesRegion Jönköping County Jönköping Sweden
| | - Marie Golsäter
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- Child Health ServicesRegion Jönköping County Jönköping Sweden
- School of Health and Welfare CHILD ‐ Research Group Jönköping University Jönköping Sweden
| | - Margareta Blennow
- Division of South General Hospital Department of Clinical Sciences and Education Karolinska Institutet Stockholm Sweden
| | - Karin Enskär
- Department of Care Science Faculty of Health and Society Malmö University Malmö Sweden
| | - Mats P. Nilsson
- Futurum – Academy of Health and Care Jönköping Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Lina Schollin Ask
- Public Health Agency of Sweden Solna Sweden
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Stockholm Sweden
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11
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Olmos-Ochoa TT, Ganz DA, Barnard JM, Penney L, Finley EP, Hamilton AB, Chawla N. Sustaining implementation facilitation: a model for facilitator resilience. Implement Sci Commun 2021; 2:65. [PMID: 34154670 PMCID: PMC8218441 DOI: 10.1186/s43058-021-00171-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Implementation facilitators enable healthcare staff to effectively implement change, yet little is known about their affective (e.g., emotional, mental, physical) experiences of facilitation. We propose an expansion to the Integrated Promoting Action on Research in Health Services (i-PARIHS) framework that introduces facilitation intensity and facilitator resilience to better assess facilitators' affective experiences. METHODS We used an instrumental case study and facilitator data (logged reflections and debrief session notes) from the Coordination Toolkit and Coaching initiative to conceptualize facilitation intensity and facilitator resilience and to better understand the psychological impact of the facilitation process on facilitator effectiveness and implementation success. RESULTS We define facilitation intensity as both the quantitative and/or qualitative measure of the volume of tasks and activities needed to engage and motivate recipients in implementation, and the psychological impact on the facilitator of conducting facilitation tasks and activities. We define facilitator resilience as the ability to cope with and adapt to the complexities of facilitation in order to effectively engage and motivate staff, while nurturing and sustaining hope, self-efficacy, and adaptive coping behaviors in oneself. CONCLUSIONS Facilitators' affective experience may help to identify potential relationships between the facilitation factors we propose (facilitation intensity and facilitator resilience). Future studies should test ways of reliably measuring facilitation intensity and facilitator resilience and specify their relationships in greater detail. By supporting facilitator resilience, healthcare delivery systems may help sustain the skilled facilitator workforce necessary for continued practice improvement. TRIAL REGISTRATION The project was registered with ClinicalTrials.gov ( NCT03063294 ) on February 24, 2017.
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Affiliation(s)
- Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.
| | - David A Ganz
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jenny M Barnard
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA
| | - Lauren Penney
- Veterans Evidence-based Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Erin P Finley
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Veterans Evidence-based Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Neetu Chawla
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA
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Thies K, Schiessl A, Khalid N, Hess AM, Harding K, Ward D. Evaluation of a learning collaborative to advance team-based care in Federally Qualified Health Centers. BMJ Open Qual 2021; 9:bmjoq-2019-000794. [PMID: 32611596 PMCID: PMC7332191 DOI: 10.1136/bmjoq-2019-000794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 04/28/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022] Open
Abstract
Practising team-based primary care allows Federally Qualified Health Centers (FQHC) in the USA to be accredited as patient-centred medical homes, positioning them for value-based models of shared savings in healthcare costs. Team-based care (TBC) involves redesign of staff roles and care delivery processes to improve efficiency and effectiveness, which requires a systematic and supportive approach to practice change over time. Thirteen FQHC primary care teams participated in an 8-month learning collaborative with a goal of providing teams with the knowledge, skills and coaching support needed to advance TBC in their organisations. The primary aim was to evaluate self-reported changes in FQHC teams’ assessment of their practice relative to key concepts of TBC. The secondary aim was to evaluate how teams used the collaborative to develop new skills to advance TBC, and the implementation, service and patient outcomes they achieved. Site visits were conducted with three teams 6 months postcollaborative. Results: Two teams withdrew. The remaining teams embarked on 15 TBC improvement initiatives. Nine teams submitted a total of 11 playbooks to guide other staff in changes to their practice. Three teams reported improved efficiencies at the service level (screening and scheduling), and one improved outcomes in patients with diabetes. The nine teams that completed precollaborative and postcollaborative self-assessments reported improvements in their practice and in coach and team skills. Site visits revealed that actionable data were a barrier to improvement, coaching support from the collaborative was highly valued and FQHC leadership support was critical to improvement. Leadership investment in developing their primary care teams’ quality improvement, coaching and data analytical skills can advance TBC in their organisations.
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Affiliation(s)
- Kathleen Thies
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Amanda Schiessl
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Nashwa Khalid
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Anne Marie Hess
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Kasey Harding
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Deborah Ward
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
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13
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Arvidsson E, Dahlin S, Anell A. Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care. BMC FAMILY PRACTICE 2021; 22:113. [PMID: 34126935 PMCID: PMC8201899 DOI: 10.1186/s12875-021-01462-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/18/2021] [Indexed: 12/24/2022]
Abstract
Background High quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully designed audit and feedback practices, barriers related to contextual conditions may prevent quality improvement efforts. The purpose of this study was to explore how professionals and health centre managers in Swedish primary care experience existing forms of audit and feedback, and conditions and barriers for quality improvement, and to explore views on the future use of clinical performance data for quality improvement. Methods We used an explorative qualitative design. Focus groups were conducted with health centre managers, physicians and other health professionals at seven health centres. The interviews were audio recorded, transcribed and analysed using qualitative content analysis. Results Four different types of audit and feedback that regularly occurred at the health centres were identified. The main part of the audit and feedback was “external”, from the regional purchasers and funders, and from the owners of the health centres. This audit and feedback focused on non-clinical measures such as revenues, utilisation of resources, and the volume of production. The participants in our study did not perceive that existing audit and feedback practices contributed to improved quality in general. This, along with lack of time for quality improvement, lack of autonomy and lack of quality improvement initiatives at the system (macro) level, were considered barriers to quality improvement at the health centres. Conclusions Professionals and health centre managers did not experience audit and feedback practices and existing conditions in Swedish primary care as supportive of quality improvement work. From a professional perspective, audit and feedback with a focus on clinical measures, as well as autonomy for professionals, are necessary to create motivation and space for quality improvement work. Such initiatives also need to be supported by quality improvement efforts at the system (macro) level, which favour transformation to a primary care based system.
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Affiliation(s)
- Eva Arvidsson
- Futurum, Region Jönköping County, Sweden; School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Sofia Dahlin
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Anders Anell
- Lund University School of Economics & Management, Lund, Sweden
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Küllenberg JK, Becker S, Körner M. The team leader coaching programme (TLCP) - a programme to implement team coaching in rehabilitation clinics - a feasibility study. Leadersh Health Serv (Bradf Engl) 2021; ahead-of-print. [PMID: 34043895 DOI: 10.1108/lhs-08-2020-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Team coaching is a promising way to advance a shift from the classical leader to a coach who leads his/her interprofessional colleagues. It is acknowledged as an effective instrument to reinforce leaders' roles but is rarely used in the health-care sector. This paper aims to present the team leader coaching programme (TLCP), designed to strengthen team leaders by implementing coaching tools into their work routine. DESIGN/METHODOLOGY/APPROACH The TLCP was designed based on the evaluated intervention on patient-centred team development, an expert workshop and a literature search. It addresses leadership styles, self-reflection, role clarity, attitude, moderation techniques and coaching tools with a focus on systemic questions. It was implemented as a train-the-trainer concept, in two training groups including 27 participants from 12 clinics ("multi-clinic" group) and another in-house training group ("single-clinic" group) including 15 participants from one clinic. FINDINGS There were differences in the evaluation of the training between the group that received an inhouse training ("single-clinic" group) and the group that received a workshop in a group of professions from different clinics ("multi-clinic" group) with a tendency for a more positive evaluation by the "multi-clinic" group. ORIGINALITY/VALUE The TLCP is a promising programme to potentially improve teamwork in rehabilitation clinics, as it provides team leaders with coaching tools they can use in their work routine without being dependent on external coaches. It is characterized by a reflective stance, which seems to be highly necessary to optimally fulfil the role of a team leader.
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Affiliation(s)
- Janna Katharina Küllenberg
- Medizinische Psychologie und Medizinische Soziologie, Albert-Ludwigs-Universitat Freiburg, Freiburg im Breisgau, Germany and Institut für Medizinische Psychologie im Zentrum für Psychosoziale Medizin, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Sonja Becker
- Medizinische Psychologie und Medizinische Soziologie, Albert-Ludwigs-Universitat Freiburg, Freiburg im Breisgau, Germany
| | - Mirjam Körner
- Medizinische Psychologie und Medizinische Soziologie, Albert-Ludwigs-Universitat Freiburg, Freiburg im Breisgau, Germany
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15
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Gremyr I, Elg M, Eriksson E, Halldórsson Á, Smith F, Gustavsson S. Exploring power shifts as an enabler for a strengthened patient role in quality improvements: a Swedish survey study. BMJ Open Qual 2021; 10:bmjoq-2020-001185. [PMID: 33648954 PMCID: PMC7925245 DOI: 10.1136/bmjoq-2020-001185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives This study examined the relationship between professionals’ perceptions of a strengthened role for the patient and of patient involvement in quality improvement (QI) and whether professionals’ experiences in improvement science were a moderator on such a relationship. Design From a predominantly close-ended, 44-item questionnaire, 4 questions specifically concerning professionals′ perception on patient involvement in QI were analysed. Setting Three Swedish regions. Participants 155 healthcare professionals who had previously participated in courses in improvement science. Results The covariate patient involvement was significantly related to a perceived strengthened patient role. There was also a significant interaction effect between degree of patient involvement and professionals’ experience in the area of improvement science on a strengthened patient role. The result shows that there is a relationship between the perceived level of patient involvement in improvements and professionals’ perceptions of a strengthened patient role. In this study, the covariate, perceived patient involvement, was significantly related to experiences of more equal relationships between patients and healthcare professionals. There was also a significant interaction effect between the degree of patient involvement and professionals’ experience in the area of improvement science, for a more equal relationship between patients and healthcare professionals. Conclusion Increased patient involvement in QI is a means of strengthening the patient role and supporting a more equal relation between patients and healthcare professionals. Furthermore, empirical evidence shows that the healthcare professionals’ experiences in the area of improvement science support a strengthened patient role and a more equal power relationship, but for this to happen, the mindset of professionals is key. Future research is needed to capture and investigate the experiences from patients and relatives about being involved in QI in healthcare, and to study the effects on quality in care processes.
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Affiliation(s)
- Ida Gremyr
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Mattias Elg
- Department of Management and Engineering, Linköpings Universitet, Linkoping, Sweden
| | - Erik Eriksson
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Árni Halldórsson
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Frida Smith
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden.,Department of Care Development, Regional Cancer Centre West, Goteborg, Sweden
| | - Susanne Gustavsson
- Hospital Administration Management, Skaraborg Hospital Skövde, Skovde, Sweden
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Hlongwa P, Rispel LC. Interprofessional collaboration among health professionals in cleft lip and palate treatment and care in the public health sector of South Africa. HUMAN RESOURCES FOR HEALTH 2021; 19:25. [PMID: 33639981 PMCID: PMC7912817 DOI: 10.1186/s12960-021-00566-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Collaboration among different categories of health professionals is essential for quality patient care, especially for individuals with cleft lip and palate (CLP). This study examined interprofessional collaboration (IPC) among health professionals in all CLP specialised centres in South Africa's public health sector. METHODS During 2017, a survey was conducted among health professionals at all the specialised CLP centres in South Africa's public health sector. Following informed consent, each member of the CLP team completed a self-administered questionnaire on IPC, using the Interprofessional Competency Framework Self-Assessment Tool. The IPC questionnaire consists of seven domains with 51 items: care expertise (8 items); shared power (4 items); collaborative leadership (10 items); shared decision-making (2 items); optimising professional role and scope (10 items); effective group function (9 items); and competent communication (8 items). STATA®13 was used to analyse the data. Descriptive analysis of participants and overall mean scores were computed for each domain and analysed using ANOVA. All statistical tests were conducted at 5% significance level. RESULTS We obtained an 87% response rate, and 52 participants completed the questionnaire. The majority of participants were female 52% (n = 27); with a mean age of 41.9 years (range 22-72). Plastic surgeons accounted for 38.5% of all study participants, followed by speech therapists (23.1%), and professional nurses (9.6%). The lowest mean score of 2.55 was obtained for effective group function (SD + -0.50), and the highest mean score of 2.92 for care expertise (SD + -0.37). Explanatory factor analysis showed that gender did not influence IPC, but category of health professional predicted scores on the five categories of shared power (p = 0.01), collaborative leadership (p = 0.04), optimising professional role and scope (p = 0.03), effective group function (p = 0.01) and effective communication (p = 0.04). CONCLUSION The seven IPC categories could be used as a guide to develop specific strategies to enhance IPC among CLP teams. Institutional support and leadership combined with patient-centred, continuing professional development in multi-disciplinary meetings will also enrich IPC.
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Affiliation(s)
- Phumzile Hlongwa
- School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laetitia C. Rispel
- Centre for Health Policy & SARChI Chair, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Patterson J, Worku B, Jones D, Clary A, Ramaswamy R, Bose C. Ethiopian Pediatric Society Quality Improvement Initiative: a pragmatic approach to facility-based quality improvement in low-resource settings. BMJ Open Qual 2021; 10:bmjoq-2020-000927. [PMID: 33436379 PMCID: PMC7805350 DOI: 10.1136/bmjoq-2020-000927] [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] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives To describe critical features of the Ethiopian Pediatric Society (EPS) Quality Improvement (QI) Initiative and to present formative research on mentor models. Setting General and referral hospitals in the Addis Ababa area of Ethiopia. Participants Eighteen hospitals selected for proximity to the EPS headquarters, prior participation in a recent newborn care training cascade and minimal experience with QI. Interventions Education in QI in a 2-hour workshop setting followed by implementation of a facility-based QI project with the support of virtual mentorship or in-person mentorship. Primary and secondary outcome measures Primary outcome—QI progress, measured using an adapted Institute for Healthcare Improvement Scale; secondary outcome—contextual factors affecting QI success as measured by the Model for Understanding Success in Quality. Results The dose and nature of mentoring encounters differed based on a virtual versus in-person mentoring approach. All QI teams conducted at least one large-scale change. Education of staff was the most common change implemented in both groups. We did not identify contextual factors that predicted greater QI progress. Conclusions The EPS QI Initiative demonstrates that education in QI paired with external mentorship can support implementation of QI in low-resource settings. This pragmatic approach to facility-based QI may be a scalable strategy for improving newborn care and outcomes. Further research is needed on the most appropriate instruments for measuring contextual factors in low/middle-income country settings.
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Affiliation(s)
- Jacquelyn Patterson
- Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bogale Worku
- School of Medicine, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Denise Jones
- Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alecia Clary
- Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rohit Ramaswamy
- Department of Maternal and Child Health, and the Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carl Bose
- Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Carney PA, Dickinson WP, Fetter J, Warm EJ, Zierler B, Patton J, Kirschner G, Crane SD, Shrader S, Eiff MP. An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice. J Prim Care Community Health 2021; 12:21501327211023716. [PMID: 34109864 PMCID: PMC8202267 DOI: 10.1177/21501327211023716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. METHODS This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. RESULTS The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach's alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach's expertise with the team's needs. CONCLUSIONS While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.
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Affiliation(s)
| | | | - Jay Fetter
- American Academy of Family Physicians, Leawood, KS, USA
| | - Eric J. Warm
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Brenda Zierler
- University of Washington, School of Nursing, Seattle, WA, USA
| | - Jill Patton
- Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | | | - Steven D. Crane
- University of North Carolina Health Science Center at Mountain Area Health Education Center, Asheville, NC, USA
| | - Sarah Shrader
- University of Missouri, School of Pharmacy, Kansas City, MO, USA
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Shimazaki K, Ota K, Niimi Y. Developing a self-checklist of staff development behavior for associate nurse unit managers using the Delphi method. Nurs Health Sci 2020; 23:195-207. [PMID: 33295081 DOI: 10.1111/nhs.12798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
The most significant influence on nurses' professional growth is through work under direct guidance in clinical settings. Associate nurse unit managers perform direct patient care with the staff, as well as assist management work of nurse unit managers. They can be excellent role models for the staff. We examined their behaviors that help promote staff development, aimed to identify effective behaviors, and created a self-checklist to evaluate them. We created 53 items to assess staff development behaviors, which were evaluated via a Delphi survey with 252 experts and a questionnaire survey with 124 associate nurse unit managers in Japan to evaluate whether the created item was appropriate. The results of the Delphi survey showed an agreement rate of over 90%, and associate nurse unit managers showed an acceptance rate of 82.6-99.2% for 40 of 53 items. Consequently, we created 40-item self-checklist of staff development behaviors for associate nurse unit managers with adequate validity. This checklist would be helpful for them to promote staff development while working in clinical settings and would contribute to enhancing the quality of nursing.
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Affiliation(s)
- Kazuyo Shimazaki
- Department of Nursing, College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Katsumasa Ota
- Opening Preparation Office of Numazu Human Care Department, Toho University, Numazu, Japan
| | - Yukari Niimi
- Department of Nursing Faculty of Health and Science, Nagoya Women's University, Nagoya, Japan
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Organizational Support in Healthcare Redesign Education: A Mixed-Methods Exploratory Study of Expert Coach and Executive Sponsor Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155308. [PMID: 32717993 PMCID: PMC7432300 DOI: 10.3390/ijerph17155308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
Healthcare organizations must continue to improve services to meet the rising demand and patient expectations. For this to occur, the health workforce needs to have knowledge and skills to design, implement, and evaluate service improvement interventions. Studies have shown that effective training in health service improvement and redesign combines didactic education with experiential project-based learning and on-the-ground coaching. Project-based learning requires organizational support and oversight, generally through executive sponsorship. A mixed-methods approach, comprising online surveys and semi-structured interviews, was used to explore the experiences of expert coaches and executive sponsors as key facilitators of workplace-based projects undertaken during an Australian postgraduate healthcare redesign course. Fifteen (54%) expert coaches and 37 (20%) executive sponsors completed the online survey. Ten expert coaches and six executive sponsors participated in interviews. The survey data revealed overall positive experiences for coaches and mixed experiences for sponsors. Interview participants expressed a sense of fulfillment that came from working with project teams to deliver a successful project and educational outcomes. However, concerns were raised about adequate resourcing, organizational recognition, competing priorities, and the skills required to effectively coach and sponsor. Expert coaches and executive sponsors sometimes felt under-valued and may benefit from cohort-tailored and evidence-based professional development.
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21
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Okpala P. Addressing power dynamics in interprofessional health care teams. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1758894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gan GC, Chong CW, Yuen YY, Yen Teoh WM, Rahman MS. Executive coaching effectiveness: towards sustainable business excellence. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2020. [DOI: 10.1080/14783363.2020.1724507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Geok Chew Gan
- Talent Consultancy & Services, Putra Heights, Selangor, Malaysia
| | - Chin Wei Chong
- Faculty of Management, Multimedia University, Cyberjaya, Selangor, Malaysia
| | - Yee Yen Yuen
- Faculty of Business, Multimedia University, Melaka, Malaysia
| | | | - Muhammad Sabbir Rahman
- Department of Marketing and International Business, North South University, Dhaka, Bangladesh
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VA Quality Scholars Quality Improvement Coach Model to Facilitate Learning and Success. Qual Manag Health Care 2019; 27:87-92. [PMID: 29596269 DOI: 10.1097/qmh.0000000000000164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the increase in quality improvement (QI) education both in practice and in health professions' education, gaps exist in the usefulness and success of QI projects. Barriers to successful QI are a result of delays in implementation, teamwork issues, and lack of QI knowledge. These barriers can be addressed using a QI Coach. A QI Coach is an expert in QI principles who has excellent communication and collaboration skills, and is experienced with organizational policies. The purpose of this article is to (a) describe the VA Quality Scholars (VAQS) QI Coach Model that includes the role of a coach and effective coaching strategies and (b) discuss lessons learned from the application of the VAQS QI Coach Model. The QI Coach facilitates success by providing novice QI teams with practical skills, encouragement, and support.
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Fernholm R, Arvidsson E, Wettermark B. Financial incentives linked to quality improvement projects in Swedish primary care: a model for improving quality of care. BMJ Open Qual 2019; 8:e000402. [PMID: 31259276 PMCID: PMC6567957 DOI: 10.1136/bmjoq-2018-000402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/17/2022] Open
Abstract
Background Quality improvement (QI) is necessary in all healthcare, but quality of healthcare is hard to measure. To use financial incentives to improve care is difficult and may even be harmful. However, conducting QI projects is a well-established way to increase quality in healthcare. Problem In 2015, there were few QI projects conducted in primary care in the Stockholm Region, Sweden. There was no structured support or way to share the QI projects with other general practitioner (GP) practices. To use financial incentives could increase the number of projects performed and could possibly improve the quality of care. The aim was to increase the number of GP practices performing QI projects in the Stockholm Region through financial incentives. Method To study QI projects performed during 2016 and 2017 in the Region Stockholm. This was compared with 2015 in Stockholm and with the Region Jönköping in Sweden during 2016 and 2017. Interventions First, the healthcare administration started to reimburse GP practices for conducting and reporting QI projects in 2016. Second, a 4-hour course in QI was offered. Third, feedback on plans for QI projects was given. The year after the projects were prerformed, they were published online to stimulate sharing and inspiration between the GP practices. Results For 2016, there were 166 (80%) of the GP practices that presented a QI project and in 2017, 164 (79%) did so. The number of projects in Stockholm increased almost by 100 per years compared with 2015. Conclusion QI work has increased in Stockholm since 2016, probably because of the financial incentives from the Stockholm Region.
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Affiliation(s)
- Rita Fernholm
- Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden.,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Eva Arvidsson
- Research and Development unit for Primary Care, Futurum, Jönköping, Sweden.,Jönköping Academy for Improvements of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Björn Wettermark
- Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden.,Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
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25
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Petty GM, Lingham T. Coaching Teamwork in the Classroom Using an Innovative Team-Coaching Process. Nurs Educ Perspect 2019; 40:118-120. [PMID: 29677042 DOI: 10.1097/01.nep.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The importance of health professionals working in teams was first acknowledged by the Institute of Medicine more than 15 years ago. Since then, teaching students to function in teams continues to present challenges in nursing education. This article presents an innovative process, using faculty as coaches in the classroom, to enhance student learning through experiential teamwork.
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Affiliation(s)
- Gayle M Petty
- About the Authors Gayle M. Petty, DNP, RN, is a faculty member, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Tony Lingham, PhD, is a professor of organizational behavior and leadership, PhD, in Leadership and Change program Antioch University, Yellow Springs, Ohio. For more information, contact Dr. Petty at
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Mackinson LG, Corey J, Kelly V, O'Reilly KP, Stevens JP, Desanto-Madeya S, Williams D, O'Donoghue SC, Foley J. Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety. Crit Care Nurse 2018; 38:54-66. [PMID: 29858196 DOI: 10.4037/ccn2018838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants' responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign.
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Affiliation(s)
- Lynn G Mackinson
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts. .,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center. .,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center. .,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center. .,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center. .,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center. .,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center. .,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center. .,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center.
| | - Juliann Corey
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center.,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center.,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center.,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center.,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center.,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center.,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center
| | - Veronica Kelly
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center.,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center.,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center.,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center.,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center.,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center.,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center
| | - Kristin P O'Reilly
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center.,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center.,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center.,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center.,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center.,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center.,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center
| | - Jennifer P Stevens
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center.,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center.,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center.,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center.,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center.,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center.,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center
| | - Susan Desanto-Madeya
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center.,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center.,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center.,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center.,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center.,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center.,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center
| | - Donna Williams
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center.,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center.,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center.,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center.,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center.,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center.,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center
| | - Sharon C O'Donoghue
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center.,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center.,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center.,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center.,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center.,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center.,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center
| | - Jane Foley
- Lynn G. Mackinson is a nurse specialist in Cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Juliann Corey is a direct care nurse in the medical intensive care unit at Beth Israel Deaconess Medical Center.,Veronica Kelly is a surgical intensive care nurse at Beth Israel Deaconess Medical Center.,Kristin P. O'Reilly is the director of project management and process improvement at Beth Israel Deaconess Medical Center.,Jennifer P. Stevens is a pulmonary and critical care physician, health services researcher, and the associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center.,Susan Desanto-Madeya is an associate clinical professor in the William F. Connell School of Nursing at Boston College, Chestnut Hill, Massachusetts; and the Beth Israel Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.,Donna Williams is the nurse specialist for the cardiac intensive care unit and cardiac step-down unit at Beth Israel Deaconess Medical Center.,Sharon C. O'Donoghue is a nurse specialist in the medical intensive care units at Beth Israel Deaconess Medical Center.,Jane Foley is associate chief nurse for critical care and medical-surgical nursing at Beth Israel Deaconess Medical Center
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Dyess SM, Sherman R, Opalinski A, Eggenberger T. Structured Coaching Programs to Develop Staff. J Contin Educ Nurs 2018; 48:373-378. [PMID: 28759696 DOI: 10.3928/00220124-20170712-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/20/2017] [Indexed: 11/20/2022]
Abstract
Health care environments are complex and chaotic, therein challenging patients and professionals to attain satisfaction, well-being, and exceptional outcomes. These chaotic environments increase the stress and burnout of professionals and reduce the likelihood of optimizing success in many dimensions. Coaching is evolving as a professional skill that may influence the optimization of the health care environment. This article reflects on three coaching programs: Gallup Strengths-Based Coaching, Dartmouth Microsystem Coaching, and Health and Wellness Nurse Coaching. Each approach is presented, processes and outcomes are considered, and implications for educators are offered. Continuing education departments may recognize various coaching approaches as opportunities to support staff professionals achieve not only the triple aim, but also the quadruple aim. J Contin Educ Nurs. 2017;48(8):373-378.
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Sabadosa KA, Godfrey MM, Marshall BC. Trans-Atlantic collaboration: applying lessons learned from the US CF Foundation quality improvement initiative. Orphanet J Rare Dis 2018; 13:13. [PMID: 29799379 PMCID: PMC6225611 DOI: 10.1186/s13023-017-0744-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Between 2002 and 2006 France launched a national cystic fibrois (CF) newborn screening program; organized a network of specialized CF care centers; and issued CF diagnostic and treatment standards. To continue to build on this success in 2007 the Cystic Fibrosis Center of Expertise for Rare Diseases (CF CERD) of Nantes-Roscoff in partnership with the French CF Society, the French CF Association (Vaincre la Mucoviscidose), and all CF center leaders from across the country agreed to pursue center-level improvement in medical outcomes for people with CF by adapting the U.S. Cystic Fibrosis Foundation’s (US CFF) national initiative, Accelerating the Rate of Improvement in CF Care. To launch the Program to Improve Results and Expertise in CF (le Programme d’Amélioration des Résultats et de l’Expertise en Mucoviscidose - PHARE-M), French leaders pursued mentorship and guidance from leaders at the US CFF, the Dartmouth Institute (TDI), and clinical care teams at CF centers across the U.S. Methods The following activities enabled the Nantes-Roscoff CF CERD team members and a parent, involved with the French CF Association board and a quality engineer by training, to gain the leadership and quality improvement knowledge and skills necessary to implement the PHARE-M program: 1) regularly attending national meetings, tracking publications, and leveraging existing partnerships; 2) completing two sabbaticals to visit U.S. CF centers and enrolling in academic and professional training courses; and, 3) inviting US CFF and TDI leaders to France to meet key opinion leaders and frontline teams. Conclusions The Nantes-Roscoff CF CERD team successfully adapted the US CFF’s initiative to accelerate improvement in CF care by establishing a partnership with U.S. leaders to communicate and exchange strategies and lessons learned; intentionally studying and adapting the Clinical Microsystems approach to quality improvement; and learning directly from the experience of frontline teams in the U.S. They continue to partner with U.S. leaders and are seeking to collaborate with European colleagues to continue to improve care for individuals with CF and their families across Europe.
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Affiliation(s)
- Kathryn A Sabadosa
- The Dartmouth Institute for Health Policy & Clinical Practice, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Marjorie M Godfrey
- The Dartmouth Institute for Health Policy & Clinical Practice, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Bruce C Marshall
- Cystic Fibrosis Foundation, 4550 Montgomery Ave. Suite 1100 N, Bethesda, MD, 20814, USA
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Samuelsson U, Åkesson K, Peterson A, Hanas R, Hanberger L. Continued improvement of metabolic control in Swedish pediatric diabetes care. Pediatr Diabetes 2018; 19:150-157. [PMID: 27807917 DOI: 10.1111/pedi.12467] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To prospectively investigate if the grand mean HbA1c and the differences in mean HbA1c between centers in Sweden could be reduced, thereby improving care delivered by pediatric diabetes teams. METHODS We used an 18-month quality improvement collaborative (QIC) together with the Swedish pediatric diabetes quality registry (SWEDIABKIDS). The first program (IQ-1), started in April 2011 and the second (IQ-2) in April 2012; together they encompassed 70% of Swedish children and adolescents with diabetes. RESULTS The proportion of patients in IQ-1 with a mean HbA1c <7.4% (57 mmol/mol) increased from 26.4% before start to 35.9% at 36 months (P < .001), and from 30.2% to 37.2% (P < .001) for IQ-2. Mean HbA1c decreased in both participating and non-participating (NP) centers in Sweden, thereby indicating an improvement by a spatial spill over effect in NP centers. The grand mean HbA1c decreased by 0.45% (4.9 mmol/mol) during 36 months; at the end of 2014 it was 7.43% (57.7 mmol/mol) (P < .001). A linear regression model with the difference in HbA1c before start and second follow-up as dependent variable showed that QIC participation significantly decreased mean HbA1c both for IQ-1 and IQ-2. The proportion of patients with high HbA1c values (>8.7%, 72 mmol/mol) decreased significantly in both QICs, while it increased in the NP group. CONCLUSIONS The grand mean HbA1c has decreased significantly in Sweden from 2010 to 2014, and QICs have contributed significantly to this decrease. There seems to be a spatial spill-over effect in NP centers.
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Affiliation(s)
- Ulf Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.,The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anette Peterson
- School of Health and Science, The Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping University, Jönköping, Sweden
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla Hospital, Uddevalla, Sweden.,The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Lena Hanberger
- Division of Nursing, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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Development of a Customizable Programme for Improving Interprofessional Team Meetings: An Action Research Approach. Int J Integr Care 2018; 18:8. [PMID: 29632457 PMCID: PMC5887069 DOI: 10.5334/ijic.3076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Interprofessional teamwork is increasingly necessary in primary care to meet the needs of people with complex care demands. Needs assessment shows that this requires efficient interprofessional team meetings, focusing on patients’ personal goals. The aim of this study was to develop a programme to improve the efficiency and patient-centredness of such meetings. Methods: Action research approach: a first draft of the programme was developed, and iteratively used and evaluated by three primary care teams. Data were collected using observations, interviews and a focus group, and analysed using directed content analysis. Results: The final programme comprises a framework to reflect on team functioning, and training activities supplemented by a toolbox. Training is intended for the chairperson and a co-chair, and aims at organizing and structuring meetings, and enhancing patient-centredness. Our findings emphasize the essential role of the team’s chairperson, who, in addition to technically structuring meetings, should act as a change agent guiding team development. Conclusion: Findings show that the programme should be customizable to each individual team’s context and participants’ learning objectives. Becoming acquainted with new structures can be considered a growth process, in which teams have to find their way, with the chairperson as change agent.
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31
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Myron R, French C, Sullivan P, Sathyamoorthy G, Barlow J, Pomeroy L. Professionals learning together with patients: An exploratory study of a collaborative learning Fellowship programme for healthcare improvement. J Interprof Care 2017; 32:257-265. [PMID: 29240524 DOI: 10.1080/13561820.2017.1392935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice. Further, though it is recognised that patients play a fundamental role in quality improvement, there are few examples of where they learn together with professionals. To contribute to addressing this gap, we review a collaborative fellowship in Northwest London, designed to build capacity to improve healthcare, which enabled patients and professionals to learn together. Using the lens of collaborative learning, we conducted an exploratory study of six cohorts of the year long programme (71 participants). Data were collected using open text responses from an online survey (n = 31) and semi-structured interviews (n = 34) and analysed using an inductive open coding approach. The collaborative design of the Fellowship, which included bringing multiple perspectives to discussions of real world problems, was valued by participants who reflected on the safe, egalitarian space created by the programme. Participants (healthcare professionals and patients) found this way of learning initially challenging yet ultimately productive. Despite the pedagogical and practical challenges of developing a collaborative programme, this study indicates that opening up previously restricted learning opportunities as widely as possible, to include patients and carers, is an effective mechanism to develop collaborative skills for quality improvement.
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Affiliation(s)
- Rowan Myron
- a CLAHRC NWL , Imperial College London/University of West London , London , UK
| | | | - Paul Sullivan
- c Improvement Science , CLAHRC NWL/Imperial College London , UK
| | | | - James Barlow
- e Business School , Imperial College London , London
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Berian JR, Thomas JM, Minami CA, Farrell PR, O'Leary KJ, Williams MV, Prachand VN, Halverson AL, Bilimoria KY, Johnson JK. Evaluation of a novel mentor program to improve surgical care for US hospitals. Int J Qual Health Care 2017; 29:234-242. [PMID: 28453822 DOI: 10.1093/intqhc/mzx005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/12/2017] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate a novel mentor program for 27 US surgeons, charged with improving quality at their respective hospitals, having been paired 1:1 with 27 surgeon mentors through a state-wide quality improvement (QI) initiative. Design Mixed-methods utilizing quantitative surveys and in-depth semi-structured interviews. Setting The Illinois Surgical Quality Improvement Collaborative (ISQIC) utilized a novel Mentor Program to guide surgeons new to QI. Participants All mentor-mentee pairs received the survey (n = 27). Purposive sampling identified a subset of mentors (n = 8) and mentees (n = 4) for in-depth semi-structured interviews. Intervention Surgeons with expertise in QI mentored surgeons new to QI. Main outcome measures (i) Quantitative: self-reported satisfaction with the mentor program; (ii) Qualitative: key themes suggesting actions and strategies to facilitate mentorship in QI. Results Mentees expressed satisfaction with the mentor program (n = 24, 88.9%) and agreed that mentorship is vital to ISQIC (n = 24, 88.9%). Analysis of interview data revealed four key themes: (i) nuances of data management, (ii) culture of quality and safety, (iii) mentor-mentee relationship and (iv) logistics. Strategies from these key themes include: utilize raw data for in-depth QI understanding, facilitate presentations to build QI support, identify opportunities for in-person meetings and establish scheduled conference calls. The mentor's role required sharing experiences and acting as a resource. The mentee's role required actively bringing questions and identifying barriers. Conclusions Mentorship plays a vital role in advancing surgeon knowledge and engagement with QI in ISQIC. Key themes in mentorship reflect strategies to best facilitate mentorship, which may serve as a guide to other collaboratives.
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Affiliation(s)
- Julia R Berian
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Juliana M Thomas
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Christina A Minami
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Paula R Farrell
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Kevin J O'Leary
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Mark V Williams
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Vivek N Prachand
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Amy L Halverson
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Karl Y Bilimoria
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Julie K Johnson
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
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Brandrud AS, Nyen B, Hjortdahl P, Sandvik L, Helljesen Haldorsen GS, Bergli M, Nelson EC, Bretthauer M. Domains associated with successful quality improvement in healthcare - a nationwide case study. BMC Health Serv Res 2017; 17:648. [PMID: 28903723 PMCID: PMC5597987 DOI: 10.1186/s12913-017-2454-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 07/17/2017] [Indexed: 12/02/2022] Open
Abstract
Background There is a distinct difference between what we know and what we do in healthcare: a gap that is impairing the quality of the care and increasing the costs. Quality improvement efforts have been made worldwide by learning collaboratives, based on recognized continual improvement theory with limited scientific evidence. The present study of 132 quality improvement projects in Norway explores the conditions for improvement from the perspectives of the frontline healthcare professionals, and evaluates the effectiveness of the continual improvement method. Methods An instrument with 25 questions was developed on prior focus group interviews with improvement project members who identified features that may promote or inhibit improvement. The questionnaire was sent to 189 improvement projects initiated by the Norwegian Medical Association, and responded by 70% (132) of the improvement teams. A sub study of their final reports by a validated instrument, made us able to identify the successful projects and compare their assessments with the assessments of the other projects. A factor analysis with Varimax rotation of the 25 questions identified five domains. A multivariate regression analysis was used to evaluate the association with successful quality improvements. Results Two of the five domains were associated with success: Measurement and Guidance (p = 0.011), and Professional environment (p = 0.015). The organizational leadership domain was not associated with successful quality improvements (p = 0.26). Conclusion Our findings suggest that quality improvement projects with good guidance and focus on measurement for improvement have increased likelihood of success. The variables in these two domains are aligned with improvement theory and confirm the effectiveness of the continual improvement method provided by the learning collaborative. High performing professional environments successfully engaged in patient-centered quality improvement if they had access to: (a) knowledge of best practice provided by professional subject matter experts, (b) knowledge of current practice provided by simple measurement methods, assisted by (c) improvement knowledge experts who provided useful guidance on measurement, and made the team able to organize the improvement efforts well in spite of the difficult resource situation (time and personnel). Our findings may be used by healthcare organizations to develop effective infrastructure to support improvement and to create the conditions for making quality and safety improvement a part of everyone’s job. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2454-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aleidis Skard Brandrud
- Quality Department, Vestre Viken Health Trust, Wergelandsgate 10, Postbox 800, 3004, Drammen, Norway.
| | - Bjørnar Nyen
- Municipality of Porsgrunn, Porstbox 128, N-3901, Porsgrunn, Norway
| | - Per Hjortdahl
- Department of Family Medicine, Faculty of Medicine, University of Oslo, PO Box 1130, Blindern, NO-0318, Oslo, Norway
| | - Leiv Sandvik
- Oslo Center for Biostatistics and Epidemiology, Research support Services, Oslo University Hospital, Sogn Arena, Klaus Torgaards vei 3, 0372, Oslo, Norway
| | | | - Maria Bergli
- Quality Department, Vestre Viken Health Trust, Wergelandsgate 10, Postbox 800, 3004, Drammen, Norway
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 30 Lafayette Street, Lebanon, NH, USA
| | - Michael Bretthauer
- Department of Health and Society, Faculty of Medicine, University of Oslo, PO Box 1130, Blindern, NO-0318, Oslo, Norway
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Silvester K, Harriman P, Downes T. Introducing quality improvement as an intrinsic part of healthcare. Future Hosp J 2016; 3:188-190. [PMID: 31098222 DOI: 10.7861/futurehosp.3-3-188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Healthcare systems worldwide face the challenge of recognising and improving safety, timeliness, quality and productivity. The authors describe how the COM-B model, developed by Michie et al in 2011 to explain and change criminal behaviour, is useful in identifying what skills and capabilities healthcare providers require to improve their systems. These skills include the intellectual capability to understand, design and improve healthcare processes; the opportunity to do this in their daily work; the motivation to do this - in particular recognising the reasons not to change; and finally unlearning the behaviours based on historical system beliefs that are now invalid. Individual self-awareness and organisational leadership are required to give staff the time and resources to reflect, experiment and learn.
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Affiliation(s)
- Kate Silvester
- Health Services Research Institute, Warwick Medical School, Warwick, UK
| | - Paul Harriman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tom Downes
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Ford JH, Robinson JM, Wise ME. Adaptation of the Grasha Riechman Student Learning Style Survey and Teaching Style Inventory to assess individual teaching and learning styles in a quality improvement collaborative. BMC MEDICAL EDUCATION 2016; 16:252. [PMID: 27681711 PMCID: PMC5041280 DOI: 10.1186/s12909-016-0772-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/20/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND NIATx200, a quality improvement collaborative, involved 201 substance abuse clinics. Each clinic was randomized to one of four implementation strategies: (a) interest circle calls, (b) learning sessions, (c) coach only or (d) a combination of all three. Each strategy was led by NIATx200 coaches who provided direct coaching or facilitated the interest circle and learning session interventions. METHODS Eligibility was limited to NIATx200 coaches (N = 18), and the executive sponsor/change leader of participating clinics (N = 389). Participants were invited to complete a modified Grasha Riechmann Student Learning Style Survey and Teaching Style Inventory. Principal components analysis determined participants' preferred learning and teaching styles. RESULTS Responses were received from 17 (94.4 %) of the coaches. Seventy-two individuals were excluded from the initial sample of change leaders and executive sponsors (N = 389). Responses were received from 80 persons (25.2 %) of the contactable individuals. Six learning profiles for the executive sponsors and change leaders were identified: Collaborative/Competitive (N = 28, 36.4 %); Collaborative/Participatory (N = 19, 24.7 %); Collaborative only (N = 17, 22.1 %); Collaborative/Dependent (N = 6, 7.8 %); Independent (N = 3, 5.2 %); and Avoidant/Dependent (N = 3, 3.9 %). NIATx200 coaches relied primarily on one of four coaching profiles: Facilitator (N = 7, 41.2 %), Facilitator/Delegator (N = 6, 35.3 %), Facilitator/Personal Model (N = 3, 17.6 %) and Delegator (N = 1, 5.9 %). Coaches also supported their primary coaching profiles with one of eight different secondary coaching profiles. CONCLUSIONS The study is one of the first to assess teaching and learning styles within a QIC. Results indicate that individual learners (change leaders and executive sponsors) and coaches utilize multiple approaches in the teaching and practice-based learning of quality improvement (QI) processes. Identification teaching profiles could be used to tailor the collaborative structure and content delivery. Efforts to accommodate learning styles would facilitate knowledge acquisition enhancing the effectiveness of a QI collaborative to improve organizational processes and outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00934141 Registered July 6, 2009. Retrospectively registered.
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Affiliation(s)
- James H. Ford
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726 USA
| | - James M. Robinson
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726 USA
| | - Meg E. Wise
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705 USA
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Lessard S, Bareil C, Lalonde L, Duhamel F, Hudon E, Goudreau J, Lévesque L. External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change. Implement Sci 2016; 11:97. [PMID: 27424171 PMCID: PMC4947272 DOI: 10.1186/s13012-016-0458-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
Background Facilitation is a powerful approach to support practice change. The purpose of this study is to better understand the facilitation roles exercised by both external facilitators and interprofessional facilitation teams to foster the implementation of change. Building on Dogherty et al.’s taxonomy of facilitation activities, this study uses an organizational development lens to identify and analyze facilitation roles. It includes a concise definition of what interprofessional facilitation teams actually do, thus expanding our limited knowledge of teams that act as change agents. We also investigate the facilitation dynamics between change actors. Methods We carried out a qualitative analysis of a 1-year process of practice change implementation. We studied four family medicine groups, in which we constituted interprofessional facilitation teams. Each team was supported by one external facilitator and included at least one family physician, one case manager nurse, and health professionals located on or off the family medicine group’s site (one pharmacist, plus at least one nutritionist, kinesiologist, or psychologist). We collected our data through focus group interviews with the four teams, individual interviews with the two external facilitators, and case audit documentation. We analyzed both predetermined (as per Dogherty et al., 2012) and emerging facilitation roles, as well as facilitation dynamics. Results A non-linear framework of facilitation roles emerged from our data, based on four fields of expertise: change management, project management, meeting management, and group/interpersonal dynamics. We identified 72 facilitation roles, grouped into two categories: “implementation-oriented” and “support-oriented.” Each category was subdivided into themes (n = 6; n = 5) for clearer understanding (e.g., legitimation of change/project, management of effective meetings). Finally, an examination of facilitation dynamics revealed eight relational ties occurring within and/or between groups of actors. Conclusions Facilitation is an approach used by appointed individuals, which teams can also foster, to build capacity and support practice change. Increased understanding of facilitation roles constitutes an asset in training practitioners such as organizational development experts, consultants, facilitators, and facilitation teams. It also helps decision makers become aware of the multiple roles and dynamics involved and the key competencies needed to recruit facilitators and members of interprofessional facilitation teams. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0458-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Céline Bareil
- HEC Montréal, Montreal, Canada. .,CETO (Center for Research in Organizational Transformation), Pôle Santé, HEC Montréal, Montreal, Canada.
| | - Lyne Lalonde
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada.,CHUM Research Center (CRCHUM), Université de Montréal, Montreal, Canada.,Sanofi Aventis endowment chair in ambulatory pharmaceutical care, Université de Montréal, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Fabie Duhamel
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada.,Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Eveline Hudon
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Johanne Goudreau
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada.,Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Lise Lévesque
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada
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Burhouse A, Rowland M, Marie Niman H, Abraham D, Collins E, Matthews H, Denney J, Ryland H. Coaching for recovery: a quality improvement project in mental healthcare. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:u206576.w2641. [PMID: 26734387 PMCID: PMC4693036 DOI: 10.1136/bmjquality.u206576.w2641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/08/2015] [Indexed: 11/28/2022]
Abstract
Approximately one in four adults in the UK will experience a mental health difficulty at some point in their life. This figure is approximately 400 million people worldwide.[1] Depression alone is currently estimated to cost the UK 1.7% of GDP and is one of the largest causes of ill health in the world.[2] For conditions like psychosis, evidence tells us that people have poorer quality of life outcomes, are more likely to die early, become obese, smoke, be unemployed, and have long term physical conditions than average.[3] People's social situation is also likely to be more complex, with housing needs, social isolation, stigma, and poverty.[4] All of these factors can make it hard for a person with a long-term mental health condition, or those supporting them, to hold onto a sense of hope that positive change is possible or that "recovery" towards a life that holds optimum meaning to them is achievable. An innovative "pop up" Recovery College model was co-produced, delivered, and evaluated by a team of people with lived experience of mental health difficulties, known as peer trainers. The Recovery College offered courses containing the best evidence-based knowledge about recovery in mental health, self-care and self-management. Each learning session included theory, personal testament from peer trainers, and volunteers and demonstrations of practical self-care skills and techniques. The courses were open to people experiencing mental health difficulties, their families, friends, and professionals. After the college course finished each student was offered up to three individual coaching sessions to help support putting the lessons learnt from the college into practice. The project aimed to test whether this innovative educational and coaching model could offer hope, knowledge and practical skills in self-management to support resilience and recovery. The project was underpinned by quality improvement methodologies to develop, deliver, and refine the model.
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Godfrey MM, Oliver BJ. Accelerating the rate of improvement in cystic fibrosis care: contributions and insights of the learning and leadership collaborative. BMJ Qual Saf 2015; 23 Suppl 1:i23-i32. [PMID: 24608547 DOI: 10.1136/bmjqs-2014-002804] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The Learning and Leadership Collaborative (LLC) supports cystic fibrosis (CF) centres' responses to the variation in CF outcomes in the USA. Between 2002 and 2013, the Cystic Fibrosis Foundation (CFF) designed, tested and modified the LLC to guide front line staff efforts in these efforts. This paper describes the CFF LLC evolution and essential elements that have facilitated increased improvement capability of CF centres and improved CF outcomes. METHODS CF centre improvement teams across the USA have participated in 11 LLCs of 12 months' duration since 2002. Based on the Dartmouth Microsystem Improvement Curriculum, the original LLC included face to face meetings, an email listserv, conference calls and completion of between learning session task books. The LLCs evolved over time to include internet based learning, an electronic repository of improvement resources and examples, change ideas driven by evidence based clinical practice guidelines, benchmarking site visits, an applied QI measurement curriculum and team coaching. RESULTS Over 90% of the CF centres in the USA have participated in the LLCs and have increased their improvement capabilities. Ten essential elements were identified as contributors to the successful LLCs: LLC national leadership and coordination, local leadership, people with CF and families involvement, registry data transparency, standardised improvement curriculum with evidence based change ideas, internet resources with reminders, team coaching, regular progress reporting and tracking, benchmarking site visits and applied improvement measurement. CONCLUSIONS The LLCs have contributed to improved medical and process outcomes over the past 10 years. Ten essential elements of the LLCs may benefit improvement efforts in other chronic care populations and health systems.
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Affiliation(s)
- Marjorie M Godfrey
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, , New Hampshire, USA
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Nygårdh A, Ahlström G, Wann-Hansson C. Handling a challenging context: experiences of facilitating evidence-based elderly care. J Nurs Manag 2015; 24:201-10. [PMID: 25882164 DOI: 10.1111/jonm.12300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2015] [Indexed: 11/27/2022]
Abstract
AIM To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons. BACKGROUND Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care. METHOD Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis. FINDINGS A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance. CONCLUSION The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice. IMPLICATIONS FOR NURSING MANAGEMENT The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation.
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Affiliation(s)
- Annette Nygårdh
- Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christine Wann-Hansson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Jonasson LL, Carlsson G, Nyström M. Prerequisites for sustainable care improvement using the reflective team as a work model. Int J Qual Stud Health Well-being 2014; 9:23934. [PMID: 25361530 PMCID: PMC4216387 DOI: 10.3402/qhw.v9.23934] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2014] [Indexed: 11/14/2022] Open
Abstract
Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.
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Affiliation(s)
- Lise-Lotte Jonasson
- Academy of Care, Working Life and Social Welfare, University of Boras, Boras, Sweden;
| | - Gunilla Carlsson
- Academy of Care, Working Life and Social Welfare, University of Boras, Boras, Sweden
| | - Maria Nyström
- Academy of Care, Working Life and Social Welfare, University of Boras, Boras, Sweden
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Batterham RW, Buchbinder R, Beauchamp A, Dodson S, Elsworth GR, Osborne RH. The OPtimising HEalth LIterAcy (Ophelia) process: study protocol for using health literacy profiling and community engagement to create and implement health reform. BMC Public Health 2014; 14:694. [PMID: 25002024 PMCID: PMC4105165 DOI: 10.1186/1471-2458-14-694] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health literacy is a multi-dimensional concept comprising a range of cognitive, affective, social, and personal skills and attributes. This paper describes the research and development protocol for a large communities-based collaborative project in Victoria, Australia that aims to identify and respond to health literacy issues for people with chronic conditions. The project, called Ophelia (OPtimising HEalth LIterAcy) Victoria, is a partnership between two universities, eight service organisations and the Victorian Government. Based on the identified issues, it will develop and pilot health literacy interventions across eight disparate health services to inform the creation of a health literacy response framework to improve health outcomes and reduce health inequalities. METHODS/DESIGN The protocol draws on many inputs including the experience of the partners in previous co-creation and roll-out of large-scale health-promotion initiatives. Three key conceptual models/discourses inform the protocol: intervention mapping; quality improvement collaboratives, and realist synthesis. The protocol is outcomes-oriented and focuses on two key questions: 'What are the health literacy strengths and weaknesses of clients of participating sites?', and 'How do sites interpret and respond to these in order to achieve positive health and equity outcomes for their clients?'. The process has six steps in three main phases. The first phase is a needs assessment that uses the Health Literacy Questionnaire (HLQ), a multi-dimensional measure of health literacy, to identify common health literacy needs among clients. The second phase involves front-line staff and management within each service organisation in co-creating intervention plans to strategically respond to the identified local needs. The third phase will trial the interventions within each site to determine if the site can improve identified limitations to service access and/or health outcomes. DISCUSSION There have been few attempts to assist agencies to identify, and respond, in a planned way, to the varied health literacy needs of their clients. This project will assess the potential for targeted, locally-developed health literacy interventions to improve access, equity and outcomes.
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Affiliation(s)
| | | | | | | | | | - Richard H Osborne
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Melbourne, Victoria 3125, Australia.
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Peterson A, Hanberger L, Åkesson K, Bojestig M, Andersson Gäre B, Samuelsson U. Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden. PLoS One 2014; 9:e97875. [PMID: 24867418 PMCID: PMC4035257 DOI: 10.1371/journal.pone.0097875] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 04/24/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures. METHODS Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months. RESULTS All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p<0.001), compared with non-participating centres who improved their mean HbA1c with 1·7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities. CONCLUSIONS By involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late complications for children and adolescents with diabetes.
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Affiliation(s)
- Anette Peterson
- Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden
| | - Lena Hanberger
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Pediatric, County Hospital Ryhov, Jönköping, Sweden
- Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden
| | - Mats Bojestig
- Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden
| | - Boel Andersson Gäre
- Jönköping University, School of Health Science, the Jönköping Academy for Improvement of Health and Welfare and Jönköping County Council, Jönköping, Sweden
| | - Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden
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