Creating, Synthesizing, and Sharing: The Management of Knowledge in Public Health

Strategies to implement evidence-informed decision making at the organizational level: a rapid systematic review

BACKGROUND

Achievement of evidence-informed decision making (EIDM) requires the integration of evidence into all practice decisions by identifying and synthesizing evidence, then developing and executing plans to implement and evaluate changes to practice. This rapid systematic review synthesizes evidence for strategies for the implementation of EIDM across organizations, mapping facilitators and barriers to the COM-B (capability, opportunity, motivation, behaviour) model for behaviour change. The review was conducted to support leadership at organizations delivering public health services (health promotion, communicable disease prevention) to drive change toward evidence-informed public health.

METHODS

A systematic search was conducted in multiple databases and by reviewing publications of key authors. Articles that describe interventions to drive EIDM within teams, departments, or organizations were eligible for inclusion. For each included article, quality was assessed, and details of the intervention, setting, outcomes, facilitators and barriers were extracted. A convergent integrated approach was undertaken to analyze both quantitative and qualitative findings.

RESULTS

Thirty-seven articles are included. Studies were conducted in primary care, public health, social services, and occupational health settings. Strategies to implement EIDM included the establishment of Knowledge Broker-type roles, building the EIDM capacity of staff, and research or academic partnerships. Facilitators and barriers align with the COM-B model for behaviour change. Facilitators for capability include the development of staff knowledge and skill, establishing specialized roles, and knowledge sharing across the organization, though staff turnover and subsequent knowledge loss was a barrier to capability. For opportunity, facilitators include the development of processes or mechanisms to support new practices, forums for learning and skill development, and protected time, and barriers include competing priorities. Facilitators identified for motivation include supportive organizational culture, expectations for new practices to occur, recognition and positive reinforcement, and strong leadership support. Barriers include negative attitudes toward new practices, and lack of understanding and support from management.

CONCLUSION

This review provides a comprehensive analysis of facilitators and barriers for the implementation of EIDM in organizations for public health, mapped to the COM-B model for behaviour change. The existing literature for strategies to support EIDM in public health illustrates several facilitators and barriers linked to realizing EIDM. Knowledge of these factors will help senior leadership develop and implement EIDM strategies tailored to their organization, leading to increased likelihood of implementation success.

REVIEW REGISTRATION

PROSPERO CRD42022318994.

Nursing Leaders as Visionaries and Enablers of Action

OBJECTIVES

The engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future.

DATA SOURCES

Author experience, journal articles and organizational position papers were used.

CONCLUSION

To improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management.

IMPLICATIONS FOR NURSING PRACTICE

Nursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.

Nurse Leaders' Experiences of Professional Responsibility Toward Developing Nursing Competence in General Wards: A Qualitative Study

AIM

To explore nurse leaders' experiences of professional responsibility to facilitate nursing competence in general wards.

BACKGROUND

Nurse leaders are responsible for maintaining high levels of competence among nurses to improve patient safety.

METHODS

Qualitative analysis was conducted between February and April 2019, using semi-structured interview data from 12 nurse leaders in surgical and medical wards at three Norwegian hospitals.

RESULTS

Four main themes were identified: struggle to achieve nursing staff competence; focus on operational and budgetary requirements rather than professional development; demands to organize sick leaves and holiday periods; and challenges in facilitating professional development.

CONCLUSION

Nurse leaders felt that their responsibilities were overwhelming and challenging. They witnessed more support for current administrative tasks than for the implementation of professional development. Additionally, unclear work instructions from the employer provided few opportunities to facilitate professional development. Hospital management failed to ensure quality of care and patient safety in general wards by not supporting the strengthening of nurses' professional competence and preventing turnover.

IMPLICATIONS FOR NURSING MANAGEMENT

Management may integrate formal work instructions that clarify nurse leaders' responsibilities as professional developers, allowing nurse leaders to meet their obligation of maintaining adequate professional competence among nursing staff in general wards.

The Impact of Relational and Organizational-Environmental Aspects in Hospital Blood Collection: Clinical and Health Indications and New Training Needs

This study deals with people who underwent a blood test and consequently suffered a fainting episode in the past. This phenomenon affects many people and if not adequately dealt with, it can lead to a perception of the blood test as a serious and traumatic event, which could limit its use as a preventive diagnostic tool. These experiences have been explored by research mainly on the basis of the physiological mechanisms involved in fainting, with a few studies considering the actual lived experience related to the blood test. This study explored how this experience is lived and managed, capturing aspects that could facilitate blood tests and the procedures associated with them, thus it focused on people with vasovagal syncope and was articulated through the semi-structured interview methodology. Among the significant results is the importance of the relational aspects implemented by health staff, the differing organisation of the blood test procedure, the need to make the hospital environment less aseptic and more humanistic, effective actions to counter the anxieties relating to the administration of the blood test and the importance of including the blood test with an inter-disciplinarity perspective.

Transformative agency and tensions in knowledge management-A qualitative interview study for nurse leaders

AIM

To describe Finnish nurse leaders' perceptions of and experiences with knowledge management.

BACKGROUND

Health science research has traditionally focused on knowledge transfer and research evidence instead of knowledge management, culture and organisational learning. Systematic reviews indicate a lack of awareness about nurse leaders' activities in knowledge management.

DESIGN

Qualitative interview study according to the consolidated criteria for reporting qualitative research (see Supporting Information Table S1).

METHODS

Data were collected at a Finnish public, social and healthcare organisation from 33 persons in 2015 and 2017 through 35 individual interviews and seven focus groups. Data were analysed by thematic analysis.

RESULTS

Nurse leaders' daily knowledge management activities included assurance of smooth work functions and decisions about sudden changes. When managing knowledge promotion, nurse leaders focused on the near future and served information providers, coaches and developers of operating culture. Anticipatory management of knowledge requirements emphasised nurse leaders' roles as assessors and visionaries. Tensions while managing knowledge were related to the following: changes in clients' service needs, insufficient structures and tools to support the assessment and joint development of competence, time and information management, the operating culture, and nurse leader support. Participants reported only few attempts to solve tensions and therefore little to no transformative agency.

CONCLUSION

Nurse leaders prioritised daily knowledge management over management of knowledge promotion and anticipatory management of knowledge requirements. Knowledge management in nursing is a complex task requiring a command of different kinds of agency and related leadership styles. The structures, processes and tools supporting knowledge management should be developed to ensure that activities are systematic.

RELEVANCE TO CLINICAL PRACTICE

A description of nurse leaders' perceptions of and experiences with knowledge management could improve recognition of nurse leaders' agencies for knowledge management, identification of related tensions and application of lessons learned from tensions. This description could also promote nurses' professional competence and supplement nurse leaders' training.

Benchmarking knowledge management practices in small and medium enterprises

Purpose

The purpose of this paper is to formulate the process of measuring and benchmarking the performance of knowledge management (KM) practices as a multicriteria group decision-making problem and present a new multicriteria group decision-making approach for effectively evaluating the performance of KM practices to meet the interests of various stakeholders in small and medium enterprises (SMEs).

Design/methodology/approach

A new multicriteria group decision-making approach is developed for evaluating the performance of KM practices of individual SMEs. Intuitionistic fuzzy numbers are used for representing the subjective assessments of decision makers in evaluating the relative importance of the evaluation criteria and the performance of individual KM practices with respect to specific evaluation criteria. A fuzzy multicriteria group decision-making algorithm is developed for measuring and benchmarking the performance of alternative KM practices.

Findings

The proposed multicriteria group decision-making approach is capable of effectively evaluating the performance of KM practices through adequately considering the presence of multiple decision makers, the multi-dimensional nature of the evaluation problem, and appropriately modeling the subjectiveness and imprecision of the evaluation process. The presentation of an example shows that the proposed fuzzy multicriteria group decision-making algorithm is simple to use and efficient in computation.

Research limitations/implications

The outcome of the multicriteria group decision-making approach is highly dependent on the inputs provided by the decision maker.

Practical implications

The novelty from this research lies in the utilization of a multicriteria group decision-making approach for evaluating the performance of KM practices in an organization. The outcome from the performance evaluation process allows the enterprise to adopt appropriate KM practices for achieving competitive advantages.

Social implications

The proposed multicriteria group decision-making approach has a significant social implication as it can be used as a decision-making tool for providing various decision makers in SMEs with useful and strategic information concerning the performance of KM practices in a given situation.

Originality/value

The originality of this paper lies in the development of the multicriteria group decision-making approach for effectively measuring and benchmarking the performance of KM practices of individual SMEs.